Microvascular Complications

Question 1

chronic complication categories

Answer 1

macrovascular
microvascular
cognitive dysfunction/dementia
erectile dysfunction
psychiatric e.g. depression

Question 2

mechanism of action of complications

Answer 2

unknown

potentially AGE-RAGE, hypoxia, oxidative stress, inflammation and mitochondrial dysfunction

Question 3

what should annual screening of diabetics include?

Answer 3

retinal screening
foot risk assessment
creatine:albumin ratio

Question 4

why are certain areas of the body at risk?

Answer 4

poyol pathway

Question 5

four types of neuropathy

Answer 5

1. peripheral neuropathy
2. proximal neuropathy (diabetic amyotrophy)
3. autonomic neuropathy
4. focal neuropathy

Question 6

define peripheral neuropathy

Answer 6

pain/loss of feeling in hands and feet in symmetrical distribution

Question 7

presentation of peripheral neuropathy

Answer 7

numbness/tingling/burning
sharp pain
loss of balance and coordination

Question 8

consequences of peripheral neuropathy

Answer 8

painless trauma
foot ulcers
clawing of toes
Charcot foot

Question 9

sweating is impaired in peripheral neuropathy which leads to?

Answer 9

this is due to damage to autonomic nerves leading to dry and cracked feet

Question 10

what must peripheral neuropathy be distinguished from?

Answer 10

peripheral vascular disease

Question 11

charcot arthropathy on XR

Answer 11

bag of bones appearance (fractures/deformity in foot)

Question 12

treatment of charcot foot

Answer 12

treat infection

non-weight bearing

Question 13

how is pain in peripheral neuropathy managed?

Answer 13

antidepressants
anti-epileptics
topical capsaicin cream

Question 14

presentation of proximal neuropathy (diabetic amyotrophy)

Answer 14

pain in hips, thighs, buttocks or legs usually on one side of the body
proximal weakness
marked weight loss

Question 15

define autonomic neuropathy

Answer 15

affects nerves regulating HR, BP (postural hypotension), gastric motility, respiratory function, urination, sexual function and vision

Question 16

diagnosis of autonomic neuropathy

Answer 16

loss of R-R variability with respiration

Question 17

what is common in autonomic neuropathy

Answer 17

gastroparesis with slowed stomach emptying

anhidrosis and hyperhidrosis (sweat glands

Question 18

define focal neuropathy

Answer 18

sudden weakness in one nerve or a group of nerve causing muscle weakness or pain e.g. carpal tunnel, ulnar mononeuropathy, foot drops, Bell’s palsy and cranial nerve palsy

Question 19

define nephropathy

Answer 19

progressive kidney disease with damage to capillaries in kidney glomeruli

Question 20

diagnosis of nephropathy

Answer 20

proteinuria
diffuse scarring of glomeruli- decline in renal function
albumin-creatinine ratio

Question 21

albumin-creatinine ratio

Answer 21

NORMAL= less than 2.5 males and 3.5 in women
microalbuminuria (high risk)= less than 30 (ACR) or 50(PCR)
proteinuria (overt nephropathy)= above 30 ACR or above 50 PCR

Question 22

classification of nephropathy

Answer 22

incipient or overt

Question 23

proteinuria diagnosis

Answer 23

must have 2/3 samples positive

can be false positives

Question 24

what should patients with microalbuminuria or proteinuria be managed with?

Answer 24

ACEI as there is constriction of efferent arterioles in nephron which increases pressure in glomerulus leading to increased protein leads whereas ACEI/ARBs reduce this constriction

Question 25

eye pathologies in diabetics

Answer 25

macular oedema
cataracts
glaucoma risk increased
blurred vision
maculopathy

Question 26

retinopathy presentation

Answer 26

haemorrhages
cotton wool spots (ischaemia)
hard exduates (lipids)
IRMA

Question 27

management of diabetic retinopathy

Answer 27

laser

vitrectomy