BC ADM Complications Management 5 — Questions and Answers
Question 1: Which intervention is most effective at preventing amputation in a diabetic patient with a Wagner Grade 3 foot infection?
- Urgent surgical debridement, IV antibiotics, and vascular assessment (Correct answer)
- Oral antibiotics and offloading alone
- Hyperbaric oxygen therapy as primary treatment
- Topical antimicrobial dressings only
Correct answer: Urgent surgical debridement, IV antibiotics, and vascular assessment
Wagner Grade 3 involves deep abscess or osteomyelitis requiring urgent surgical debridement, broad-spectrum IV antibiotics, and limb perfusion assessment.
Question 2: A patient with diabetic CKD Stage 3b has hyperkalemia on an ACE inhibitor. Which newer agent can provide renoprotection while having a lower hyperkalemia risk than traditional MRAs?
- Finerenone (Correct answer)
- Spironolactone
- Eplerenone
- Triamterene
Correct answer: Finerenone
Finerenone's high selectivity and rapid tissue distribution reduce aldosterone-driven inflammation with a lower hyperkalemia risk than spironolactone or eplerenone.
Question 3: A T1DM patient reports nausea, early satiety, and postprandial hypoglycemia. Which diagnostic finding confirms the suspected complication?
- >10% gastric retention of radiolabeled meal at 4 hours on scintigraphy (Correct answer)
- Positive anti-gliadin antibodies
- pH <4 on esophageal manometry
- Elevated fasting gastrin level
Correct answer: >10% gastric retention of radiolabeled meal at 4 hours on scintigraphy
Greater than 10% retention at 4 hours on 4-hour solid-phase gastric emptying scintigraphy confirms gastroparesis causing erratic glucose absorption.
Question 4: Which statement accurately describes the relationship between HbA1c reduction and microvascular complication prevention based on the DCCT and UKPDS trials?
- Each 1% reduction in HbA1c reduces microvascular complication risk by approximately 25-35% (Correct answer)
- HbA1c must reach <6.5% to confer any microvascular benefit
- Benefit is only seen in T1DM, not T2DM
- Macrovascular benefits exceed microvascular benefits in both trials
Correct answer: Each 1% reduction in HbA1c reduces microvascular complication risk by approximately 25-35%
DCCT (T1DM) and UKPDS (T2DM) demonstrated that each 1% HbA1c reduction yields approximately 25-35% reduction in microvascular complication risk.
Question 5: A patient with diabetic macular edema and center involvement who is visually impaired should receive which primary treatment?
- Intravitreal anti-VEGF injections (Correct answer)
- Focal laser photocoagulation only
- Oral anti-VEGF medications
- Macular grid laser as first line
Correct answer: Intravitreal anti-VEGF injections
Anti-VEGF intravitreal injections are the standard of care for center-involved DME, showing superior visual outcomes compared to laser monotherapy.
Question 6: Which feature of diabetic neuropathy most clearly differentiates it from chronic inflammatory demyelinating polyneuropathy (CIDP)?
- Length-dependent distal-predominant pattern with axonal loss (Correct answer)
- Symmetric proximal weakness
- Elevated CSF protein with cytoalbuminous dissociation
- Response to IVIG treatment
Correct answer: Length-dependent distal-predominant pattern with axonal loss
Diabetic neuropathy follows a classic length-dependent, distal-to-proximal, axonal pattern, unlike CIDP which causes proximal weakness and demyelination.
Question 7: A patient with T2DM has recurrent urinary tract infections and urinary retention. Which autonomic complication is responsible?
- Neurogenic bladder (cystopathy) (Correct answer)
- Retrograde ejaculation
- Erectile dysfunction
- Sudomotor dysfunction
Correct answer: Neurogenic bladder (cystopathy)
Diabetic neurogenic bladder causes detrusor underactivity, incomplete emptying, and urinary retention which predisposes to recurrent UTIs.
BC ADM Complications Management 5
Which intervention is most effective at preventing amputation in a diabetic patient with a Wagner Grade 3 foot infection?