CDE Complications 3 — Questions and Answers
Question 1: A patient with long-standing type 1 diabetes has cotton wool spots on fundoscopic exam. What do these represent?
- Hard exudates from lipid deposition
- Microaneurysms
- Nerve fiber layer infarcts indicating ischemia (Correct answer)
- New blood vessel formation
Correct answer: Nerve fiber layer infarcts indicating ischemia
Cotton wool spots are nerve fiber layer infarcts caused by ischemia, indicating severe nonproliferative or preproliferative diabetic retinopathy.
Question 2: What is the primary driver of diabetic nephropathy progression from microalbuminuria to macroalbuminuria?
- Chronic hyperglycemia causing glomerular basement membrane thickening (Correct answer)
- Recurrent UTIs
- Contrast dye exposure
- Systemic lupus erythematosus
Correct answer: Chronic hyperglycemia causing glomerular basement membrane thickening
Chronic hyperglycemia leads to glomerular basement membrane thickening, mesangial expansion, and progressive proteinuria in diabetic nephropathy.
Question 3: Which statement about diabetic foot ulcers is correct?
- Neuropathic ulcers are most painful and located on the dorsum
- Ischemic ulcers are typically punched-out with callus on pressure points
- Neuropathic ulcers occur at pressure points and are often painless (Correct answer)
- Most diabetic foot ulcers are purely ischemic in origin
Correct answer: Neuropathic ulcers occur at pressure points and are often painless
Neuropathic ulcers occur at pressure points (metatarsal heads, heels) and are painless due to sensory nerve damage.
Question 4: A diabetic patient has an ABI (ankle-brachial index) of 0.55. How should this be interpreted?
- Normal peripheral perfusion
- Mild peripheral arterial disease
- Moderate to severe peripheral arterial disease (Correct answer)
- Incompressible vessels suggesting diabetes
Correct answer: Moderate to severe peripheral arterial disease
An ABI of 0.55 indicates moderate to severe peripheral arterial disease; values below 0.9 are abnormal and below 0.6 indicate severe disease.
Question 5: Which patient characteristic increases the risk of severe hypoglycemia unawareness in long-standing diabetes?
- Consistent carbohydrate intake
- Intact autonomic nervous system function
- Autonomic neuropathy reducing counter-regulatory symptoms (Correct answer)
- Frequent blood glucose monitoring
Correct answer: Autonomic neuropathy reducing counter-regulatory symptoms
Autonomic neuropathy blunts adrenergic warning symptoms of hypoglycemia (sweating, tremor, palpitations), causing hypoglycemia unawareness.
Question 6: What is the recommended screening interval for diabetic retinopathy in a patient with type 2 diabetes at diagnosis?
- No screening needed until 5 years after diagnosis
- Immediate dilated eye exam at time of diagnosis (Correct answer)
- Screen only when visual symptoms occur
- Every 5 years if initial exam is normal
Correct answer: Immediate dilated eye exam at time of diagnosis
ADA guidelines recommend a dilated eye exam at the time of type 2 diabetes diagnosis because retinopathy may already be present at diagnosis.
Question 7: Erectile dysfunction in men with diabetes is primarily caused by which mechanism?
- Elevated testosterone levels
- Autonomic and peripheral neuropathy plus vascular disease (Correct answer)
- Excessive insulin secretion
- Retinopathy affecting visual stimulation
Correct answer: Autonomic and peripheral neuropathy plus vascular disease
Erectile dysfunction in diabetes results from a combination of autonomic neuropathy, peripheral neuropathy, and vasculogenic disease affecting penile blood flow.
CDE Complications 3
A patient with long-standing type 1 diabetes has cotton wool spots on fundoscopic exam.
What do these represent?