CDE Complications 2 — Questions and Answers
Question 1: A patient with type 2 diabetes reports numbness and tingling in both feet that worsens at night. Which complication is most likely?
- Peripheral arterial disease
- Distal symmetric polyneuropathy (Correct answer)
- Charcot neuroarthropathy
- Restless leg syndrome
Correct answer: Distal symmetric polyneuropathy
Distal symmetric polyneuropathy is the most common form of diabetic neuropathy, causing bilateral numbness and tingling that typically worsens at night.
Question 2: Which finding on a monofilament foot exam indicates loss of protective sensation?
- Feeling the 10-g monofilament at all tested sites
- Unable to feel the 10-g monofilament at one or more sites (Correct answer)
- Reduced vibration sense only
- Absent patellar reflex only
Correct answer: Unable to feel the 10-g monofilament at one or more sites
Inability to feel the 10-g Semmes-Weinstein monofilament at one or more plantar sites indicates loss of protective sensation and high ulcer risk.
Question 3: A diabetic patient develops a painless, swollen, deformed ankle joint. X-ray shows fragmented bone and joint disorganization. What condition is this?
- Septic arthritis
- Gout
- Charcot neuroarthropathy (Correct answer)
- Osteomyelitis
Correct answer: Charcot neuroarthropathy
Charcot neuroarthropathy (Charcot foot) presents as a painless, hot, swollen joint with bony destruction due to loss of protective sensation.
Question 4: Which HbA1c target is associated with the greatest reduction in microvascular complications in type 1 diabetes, per the DCCT trial?
- Less than 9%
- Less than 8%
- Less than 7% (Correct answer)
- Less than 6%
Correct answer: Less than 7%
The DCCT trial demonstrated that intensive therapy targeting HbA1c below 7% reduced microvascular complications by approximately 50–76%.
Question 5: Autonomic neuropathy affecting the cardiovascular system in diabetes can manifest as which finding?
- Hypertensive crisis after standing
- Resting tachycardia and orthostatic hypotension (Correct answer)
- Bradycardia with hypertension
- Paroxysmal atrial fibrillation only
Correct answer: Resting tachycardia and orthostatic hypotension
Cardiovascular autonomic neuropathy typically presents as resting tachycardia, reduced heart rate variability, and orthostatic hypotension.
Question 6: A patient with diabetes has gastroparesis. Which glucose management challenge does this create?
- Consistently elevated fasting glucose
- Unpredictable glucose excursions due to delayed gastric emptying (Correct answer)
- Persistent hypoglycemia only at night
- Rapid postprandial glucose spikes followed by stable levels
Correct answer: Unpredictable glucose excursions due to delayed gastric emptying
Gastroparesis causes delayed and erratic gastric emptying, making glucose absorption unpredictable and insulin timing difficult.
Question 7: Which class of antihypertensive is preferred for patients with diabetes and microalbuminuria to slow progression of diabetic kidney disease?
- Beta-blockers
- Calcium channel blockers
- ACE inhibitors or ARBs (Correct answer)
- Thiazide diuretics
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs reduce intraglomerular pressure and have proven renoprotective effects in patients with diabetic nephropathy and microalbuminuria.
CDE Complications 2
A patient with type 2 diabetes reports numbness and tingling in both feet that worsens at night.
Which complication is most likely?