BC ADM Complications Management 2 — Questions and Answers
Question 1: A patient with T2DM presents with an eGFR of 28 mL/min/1.73m². Which medication should be discontinued to prevent lactic acidosis?
- Metformin (Correct answer)
- Glipizide
- Sitagliptin
- Pioglitazone
Correct answer: Metformin
Metformin is contraindicated when eGFR falls below 30 mL/min/1.73m² due to the risk of lactic acidosis from drug accumulation.
Question 2: Which finding on monofilament testing indicates loss of protective sensation in the diabetic foot?
- Inability to feel the 10-g Semmes-Weinstein monofilament (Correct answer)
- Pain on filament application
- Hyperreflexia at the ankle
- Positive Babinski sign
Correct answer: Inability to feel the 10-g Semmes-Weinstein monofilament
Inability to detect the 10-g monofilament at plantar sites indicates loss of protective sensation and high ulcer risk.
Question 3: A patient with proliferative diabetic retinopathy is started on which first-line intravitreal treatment to reduce neovascularization?
- Anti-VEGF agents (Correct answer)
- Intravitreal corticosteroids
- Panretinal photocoagulation alone
- Vitrectomy
Correct answer: Anti-VEGF agents
Anti-VEGF agents (e.g., ranibizumab, aflibercept) are first-line for proliferative diabetic retinopathy and diabetic macular edema.
Question 4: Which autonomic neuropathy manifestation most directly increases the risk of silent myocardial infarction in diabetic patients?
- Cardiac autonomic neuropathy causing reduced pain perception (Correct answer)
- Gastroparesis delaying medication absorption
- Orthostatic hypotension
- Neurogenic bladder
Correct answer: Cardiac autonomic neuropathy causing reduced pain perception
Cardiac autonomic neuropathy impairs pain signaling, allowing myocardial infarctions to occur without typical chest pain.
Question 5: A patient with diabetic nephropathy has a urine albumin-to-creatinine ratio of 450 mg/g. Which drug class is indicated to slow progression?
- SGLT2 inhibitors (Correct answer)
- Sulfonylureas
- Alpha-glucosidase inhibitors
- DPP-4 inhibitors
Correct answer: SGLT2 inhibitors
SGLT2 inhibitors (e.g., canagliflozin, dapagliflozin) have proven renoprotective effects independent of glucose lowering in CKD with albuminuria.
Question 6: Which stage of Charcot neuroarthropathy is characterized by active bone destruction, warmth, and erythema without deformity?
- Eichenholtz Stage 1 (Development) (Correct answer)
- Eichenholtz Stage 2 (Coalescence)
- Eichenholtz Stage 3 (Reconstruction)
- Wagner Grade 2
Correct answer: Eichenholtz Stage 1 (Development)
Eichenholtz Stage 1 (Development) features acute inflammation, bone fragmentation, and joint dislocation without established deformity.
Question 7: In a patient with diabetic peripheral neuropathy experiencing burning pain, which first-line pharmacological agent is recommended by ADA guidelines?
- Duloxetine (Correct answer)
- Opioids
- Pregabalin as monotherapy first
- Capsaicin cream only
Correct answer: Duloxetine
Duloxetine (SNRI) is an ADA-recommended first-line agent for painful diabetic peripheral neuropathy with good evidence for efficacy.
BC ADM Complications Management 2
A patient with T2DM presents with an eGFR of 28 mL/min/1.73m².
Which medication should be discontinued to prevent lactic acidosis?