CDE Pathophysiology 4

Question 1

Advanced glycation end products (AGEs) contribute to diabetic complications primarily by:

Accepted Answer

Cross-linking proteins and activating RAGE receptors to cause inflammation

Answer

AGEs accumulate on long-lived proteins causing cross-linking that stiffens vessels and tissues, and activate RAGE receptors triggering inflammatory cascades that damage endothelium and other structures.

Question 2

The polyol pathway contributes to diabetic complications through which primary mechanism?

Accepted Answer

Sorbitol accumulation and osmotic stress combined with NADPH depletion

Answer

Excess glucose is converted to sorbitol by aldose reductase (consuming NADPH), then to fructose (generating NADH), causing osmotic damage and depleting antioxidant capacity via reduced glutathione regeneration.

Question 3

Diabetic nephropathy progresses from microalbuminuria to overt proteinuria primarily because of:

Accepted Answer

Intraglomerular hypertension causing progressive podocyte injury and loss

Answer

Intraglomerular hypertension driven by efferent arteriolar constriction causes mechanical stress on podocytes, leading to their detachment and foot process effacement, allowing increasing protein filtration.

Question 4

In diabetic peripheral neuropathy, which nerve fiber type is typically affected earliest?

Accepted Answer

Small unmyelinated C fibers and thinly myelinated A-delta fibers

Answer

Small unmyelinated C fibers (pain, temperature) and A-delta fibers are most vulnerable to the metabolic insults of hyperglycemia, explaining why burning pain and temperature loss typically precede vibration loss.

Question 5

Nonproliferative diabetic retinopathy progresses to the proliferative stage primarily driven by:

Accepted Answer

Retinal ischemia triggering VEGF-mediated neovascularization

Answer

Pericyte loss and capillary occlusion cause retinal ischemia, which upregulates VEGF secretion; this drives growth of fragile new blood vessels that can bleed and cause traction retinal detachment.

Certified Diabetes Educator Test Practice Test

Certified Diabetes Educator Test Practice Test

CDE Pathophysiology 4