CDE Complications 5 — Questions and Answers
Question 1: A diabetic patient undergoes a below-knee amputation. What is the most common precipitating factor leading to lower-extremity amputation in diabetes?
- Trauma from motor vehicle accident
- Infected foot ulcer with osteomyelitis (Correct answer)
- Spontaneous bone fracture
- Deep vein thrombosis
Correct answer: Infected foot ulcer with osteomyelitis
The most common pathway to lower-extremity amputation in diabetes is an infected foot ulcer complicated by osteomyelitis or gangrene.
Question 2: Which test is recommended to assess for microalbuminuria in diabetes screening?
- 24-hour urine protein only
- Spot urine albumin-to-creatinine ratio (UACR) (Correct answer)
- Serum creatinine only
- Urinalysis dipstick only
Correct answer: Spot urine albumin-to-creatinine ratio (UACR)
The spot urine albumin-to-creatinine ratio (UACR) is the preferred screening test for early diabetic kidney disease due to convenience and accuracy.
Question 3: What defines the transition from microalbuminuria to macroalbuminuria in diabetic nephropathy?
- UACR > 30 mg/g
- UACR > 300 mg/g on two of three samples (Correct answer)
- Serum creatinine > 2.0 mg/dL
- eGFR < 60 mL/min
Correct answer: UACR > 300 mg/g on two of three samples
Macroalbuminuria (overt nephropathy) is defined as UACR >300 mg/g (or >300 mg albumin/24 hours) confirmed on two of three samples.
Question 4: A patient with diabetes reports sudden onset of double vision and ptosis of one eye with the pupil spared. What is the most likely diagnosis?
- Posterior communicating artery aneurysm
- Diabetic cranial mononeuropathy (CN III palsy) (Correct answer)
- Multiple sclerosis
- Myasthenia gravis
Correct answer: Diabetic cranial mononeuropathy (CN III palsy)
Diabetic cranial nerve III palsy causes sudden diplopia and ptosis with pupil sparing, distinguishing it from an aneurysmal CN III palsy.
Question 5: Which intervention has the strongest evidence for preventing progression from microalbuminuria to macroalbuminuria in type 1 diabetes?
- Strict dietary protein restriction to 0.4 g/kg/day
- Intensive glycemic control and blood pressure management with ACE inhibitors (Correct answer)
- High-dose vitamin E supplementation
- Avoidance of all contrast imaging
Correct answer: Intensive glycemic control and blood pressure management with ACE inhibitors
Intensive glucose control combined with blood pressure management using ACE inhibitors or ARBs is the most evidence-based intervention to slow nephropathy progression.
Question 6: A patient with type 2 diabetes presents with painless jaundice and clay-colored stools. Which diabetes-related complication should be considered?
- Diabetic gastroparesis
- Nonalcoholic fatty liver disease progressing to cirrhosis (Correct answer)
- Hyperosmolar hyperglycemic state
- Diabetic ketoacidosis
Correct answer: Nonalcoholic fatty liver disease progressing to cirrhosis
Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in type 2 diabetes and can progress to cirrhosis, presenting with jaundice and biliary obstruction.
Question 7: A 65-year-old with type 2 diabetes has been identified as high-risk for foot ulceration. Which intervention is the MOST important component of preventive foot care?
- Daily soaking of feet in warm water
- Wearing open-toed sandals to reduce pressure
- Daily foot inspection and appropriate therapeutic footwear (Correct answer)
- Applying petroleum jelly between the toes
Correct answer: Daily foot inspection and appropriate therapeutic footwear
Daily self-inspection for skin breakdown and properly fitted therapeutic footwear are the cornerstone of preventive diabetic foot care.
CDE Complications 5
A diabetic patient undergoes a below-knee amputation.
What is the most common precipitating factor leading to lower-extremity amputation in diabetes?