Complications Flashcards

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

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.

What is the primary driver of diabetic nephropathy progression from microalbuminuria to macroalbuminuria?

Answer: Chronic hyperglycemia causing glomerular basement membrane thickening

Chronic hyperglycemia leads to glomerular basement membrane thickening, mesangial expansion, and progressive proteinuria in diabetic nephropathy.

Which statement about diabetic foot ulcers is 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.

A diabetic patient has an ABI (ankle-brachial index) of 0.55. How should this be interpreted?

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.

Which patient characteristic increases the risk of severe hypoglycemia unawareness in long-standing diabetes?

Answer: Autonomic neuropathy reducing counter-regulatory symptoms

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

What is the recommended screening interval for diabetic retinopathy in a patient with type 2 diabetes at diagnosis?

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.

Erectile dysfunction in men with diabetes is primarily caused by which mechanism?

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.