BC ADM Complications Management 3 — Questions and Answers
Question 1: A diabetic patient develops a foot ulcer with exposed tendon but no bone involvement. What is the Wagner classification grade?
- Grade 3
- Grade 2 (Correct answer)
- Grade 1
- Grade 4
Correct answer: Grade 2
Wagner Grade 2 involves a deep ulcer penetrating to tendon, capsule, or bone without osteomyelitis or abscess.
Question 2: Which cardiac condition is most strongly associated with diabetic autonomic neuropathy that increases mortality risk?
- Prolonged QT interval (Correct answer)
- Atrial fibrillation
- Right bundle branch block
- Ventricular hypertrophy
Correct answer: Prolonged QT interval
Prolonged QT interval from cardiac autonomic neuropathy predisposes to fatal ventricular arrhythmias and sudden cardiac death.
Question 3: When screening for diabetic retinopathy in a patient newly diagnosed with T2DM, how soon should the first dilated eye exam occur?
- At the time of diagnosis (Correct answer)
- After 5 years
- After 3 years
- Only when symptomatic
Correct answer: At the time of diagnosis
T2DM patients should have a dilated fundus exam at diagnosis because retinopathy may already be present due to prolonged undetected hyperglycemia.
Question 4: A patient with T1DM develops microalbuminuria. ACE inhibitor therapy is initiated. What is the primary mechanism of renoprotection?
- Reduction in efferent arteriolar tone lowering intraglomerular pressure (Correct answer)
- Direct anti-inflammatory effect on glomerular basement membrane
- Reduction in afferent arteriolar tone
- Increased sodium excretion reducing renal workload
Correct answer: Reduction in efferent arteriolar tone lowering intraglomerular pressure
ACE inhibitors preferentially dilate the efferent arteriole, reducing intraglomerular hypertension which drives glomerular injury.
Question 5: Which clinical feature best distinguishes peripheral arterial disease from diabetic peripheral neuropathy in a patient with foot pain?
- Pain relieved by dependent positioning (hanging leg down) (Correct answer)
- Burning quality of pain worse at night
- Loss of vibration sense
- Absent ankle reflexes
Correct answer: Pain relieved by dependent positioning (hanging leg down)
Ischemic rest pain from PAD is relieved by dependency as gravity improves perfusion, unlike neuropathic pain which is positional-independent.
Question 6: NPDR progresses to PDR when which hallmark finding appears on fundoscopy?
- Neovascularization of the disc or elsewhere (Correct answer)
- Hard exudates at the macula
- Dot and blot hemorrhages
- Cotton wool spots
Correct answer: Neovascularization of the disc or elsewhere
New vessel formation (neovascularization) marks the transition to proliferative diabetic retinopathy and risk of vitreous hemorrhage.
Question 7: A patient with CKD Stage 4 and diabetes requires pain management for neuropathy. Which agent requires the most caution due to renal accumulation of active metabolites?
- Gabapentin (Correct answer)
- Duloxetine
- Amitriptyline
- Tapentadol
Correct answer: Gabapentin
Gabapentin and pregabalin are renally cleared and accumulate in CKD, requiring significant dose reduction to avoid sedation and toxicity.
BC ADM Complications Management 3
A diabetic patient develops a foot ulcer with exposed tendon but no bone involvement.
What is the Wagner classification grade?