Microvascular Complications

Question 1

diabetes id the leading cause of what three ailments?

Answer 1

blindness

dialysis

amputation of the lower limbs

Question 2

what are the types of neuropathy?

Answer 2

peripheral

autonomic

proximal

focal

Question 3

describe peripheral neuropathy?

Answer 3

pain/loss of feeling in feet, hands

Question 4

what are some complications of peripheral neuropathy?

Answer 4

charcot foot

painless trauma e.g stepping on nail without noticing

foot ulcers

Question 5

what is another name for charcot foot?

Answer 5

osteoarthropathy

Question 6

what is charcot foot?

Answer 6

disorgansied joint

loss of bone

multiple fractures

Question 7

what can be done in charcot foot?

Answer 7

in acue painful hot joint use biphosphonate drugs

orthotic shoes

Question 8

loss of blanace and coordination can occur in which neuropathy?

Answer 8

peripheral

Question 9

describe autonomic neuropathy?

Answer 9

chnages in bowel, bladder function, sexual response, sweating, HR, BP

Question 10

what effect does autonomic neuropathy have on the digestive system?

Answer 10

constipation/diarrhoea

gastroparesis (slow stomach emptying)- persistent nausea, vomiting, bloating

oesophagus nerve damage- can make swalowing difficult

Question 11

does gastroparesis affect blood glucose?

Answer 11

yes- blood glucose levels can fluctuate widely due to abnormal food digestion

Question 12

how do you treat gastroparesis?

Answer 12

improved glycaemic control

dietary- smaller portions

promotility drugs e.g metoclopramide

gastric pacemaker

botilnum toxin

Question 13

which neuropathy causes abnormalities in the sweat glands?

Answer 13

autonomic

Question 14

how are the sweat glands affected in autonomic neuropathy?

Answer 14

body cannot refulate its temperature so sweats at irregular time- profusely at night or while eating

Question 15

how would you treat gustatory sweating in autonomic neuropathy?

Answer 15

topical glycopyrrolate

clonidine

botulinum toxin

Question 16

describe proximal neuropathy?

Answer 16

pain in the thighs, hips, buttocks leading to weakness in the legs

Question 17

what is teh name given to the weakiening of the legs in proximal neuropahthy?

Answer 17

amyotrophy

Question 18

who is proximal neuropathy most common in?

Answer 18

elderly people with T2DM

Question 19

proximal neuropathy is commonly associated with what?

Answer 19

weight loss

Question 20

describe focal neuropathy?

Answer 20

sudden wekaness in one nerve or group of nerves casuign muscle weakness

Question 21

what are some examples of focal neuropathy?

Answer 21

carpal tunnel

ulnar mono neuropathy

foot drop

bells palsy

cranial nerve palsy

Question 22

focal neuropathy appears suddenly/gradually?

Answer 22

suddenly

Question 23

what are the treatment options fro painful neuropathy?

Answer 23

amitriptyline

duloxetine

gabapentin

topical capsaican cream

Question 24

what are some of the diagnostic tools used for neuropathy?

Answer 24

nerve conduction studies/ electromyography

heart rate variability

ultrasound

gastric emptying studies

Question 25

what is diabeteic nephropathy?

Answer 25

progressive kidney disease caused by damage to capillaries in the kidneys **glomeruli**

Question 26

diabetic nephropathhy is also known as?

Answer 26

kimmelsteil-Wilson syndrome nodular glomerulosclerosis

Question 27

what are the consequences of diabetic nephropathy?

Answer 27

development of hypertension decline in renal funcion accelerated vascular disease

Question 28

which ratio is used to screen for diabetic kidney disease?

Answer 28

urinary albumin creatinine ratio (ACR)

Question 29

what is the urine ACR in microalbuminuria for males and females?

Answer 29

males: 2.5-25 females: 3.5-35

Question 30

what are ther risk factors for nephropathy progression?

Answer 30

hypetension cholesterol smoking glycaemic control albuminuria

Question 31

what is the target for BP in pateints with diabetes?

Answer 31

130/70

Question 32

blood pressure should be maintained at \_/\_ in patients with diabetes?

Answer 32

\<130/80mmHg

Question 33

what eye pathologies do people with diabetes get?

Answer 33

retinopathy cataract glaucoma acute hyperglycaemia (visual blurring)

Question 34

what is a cataract?

Answer 34

clouding of the lens

Question 35

what is a glaucoma?

Answer 35

increase in fluid pessure in the eye leading to optic nerve damage

Question 36

which structure in the eye contains the most cones and allows us to see what is striaght in front of us?

Answer 36

macula

Question 37

what are the stages of retinopathy?

Answer 37

mild non-proliferative (backgorund) moderate non-proliferative severe non-proliferative proliferative

Question 38

what are hard exudates in the eye?

Answer 38

lipid breakdown products

Question 39

what are ischaemic areas in the eye called?

Answer 39

cotton wool spots

Question 40

what are haemorrages in the eye called?

Answer 40

dot/flame/blot

Question 41

what does IRMA stnad for?

Answer 41

Intra-retinal microvascular abnormalities

Question 42

retinopathy and maculopathy are graded together/seperately?

Answer 42

**seperately**

Question 43

mild background retinopathy encompasses what?

Answer 43

haemorrages and microaneurysms

Question 44

pre proliferative retinopathy encompasses what?

Answer 44

haemorrages, micro aneurysms, hard exudates

Question 45

severe non-proliferatve retinopathy encompasses what?

Answer 45

haemorrages, IRMA, venous bleeding

Question 46

what is the mainstay treatment for retinopathy?

Answer 46

**laser therapy** also vitrectomy, anti-VEGF injections

Question 47

what is a vitrectomy?

Answer 47

surgical removal of the vitreous gel layer of the eye

Question 48

how do anti- VEGF drugs work?

Answer 48

stopping vascular endothelial growth factor protein from working- prevents new blood vessel growth