CDE Complications 3

Question 1

A patient with long-standing type 1 diabetes has cotton wool spots on fundoscopic exam. What do these represent?

Accepted Answer

Nerve fiber layer infarcts indicating ischemia

Answer

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?

Accepted Answer

Chronic hyperglycemia causing glomerular basement membrane thickening

Answer

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?

Accepted Answer

Neuropathic ulcers occur at pressure points and are often painless

Answer

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?

Accepted Answer

Moderate to severe peripheral arterial disease

Answer

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?

Accepted Answer

Autonomic neuropathy reducing counter-regulatory symptoms

Answer

Autonomic neuropathy blunts adrenergic warning symptoms of hypoglycemia (sweating, tremor, palpitations), causing hypoglycemia unawareness.

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