diabetes

Question 1

if an asymptomatic patient is being screened for diabetes what is the mosyt appropriate test?

Answer 1

fasting blood glucose levels

Question 2

what is the best test used for the monitoring of blood glucose ?

Answer 2

HBA1c

Question 3

what test is used for the screnin for gestational diabetes ?

Answer 3

glucose tolerance test

Question 4

what type of hypersensitivity reaction is associated with type 1 DM ?

Answer 4

type 4
t cell mediated

Question 5

what is seen on biopsy of T1Dm ?

Answer 5

ilets leuckoytic infiltation

Question 6

what is the treatment for T1Dm ?

Answer 6

insulin

Question 7

what is the most common initial presentation of T1DM ?

Answer 7

diabetic ketoacidosis
precipitated by infection
associated with skipping insulin therapy

Question 8

what is the presentation of DKA ?

Answer 8

dehydration
high glucose
hyperkalemia
fruity breath
abdominal pain and nausea

Question 9

what type of metabolic disturbance associated with T1DM ?

Answer 9

anion gap metabolic acidosis
kussmaul breathing

Question 10

what environmental triggers can be associated with T1DM ?

Answer 10

coxasckie virus B

Question 11

what are the levels of phosphate associated with DKA ?

Answer 11

risk of hypophosphatemia
which will cause osmotic diuresis

Question 12

what are the clinical consequences associated with hypophosphatemia ?

Answer 12

loss of ATP will lead to muscle weakness
eventually causing respiratory failure
and heart failure due to reduced cardiac contractility

Question 13

what are the common causes of death associated with DKA ?

Answer 13

arrythmia due to hyperkalemia
cerebral edema (common in children)

Question 14

what infections are associated with DKA ?

Answer 14

mucormycosis
fungal infection
caused by rhizopus and mucor

Question 15

what is the classic presentation of mucormycois ?

Answer 15

starts in the nose and sinuses
fever headache and eye pain

Question 16

what is the treatment for DKA ?

Answer 16

insulin and IV fluids

Question 17

what must be monitored in DKA ?

Answer 17

potassium levels must be monitored
careful monitoring of glucose

Question 18

what is the main pathology in T2Dm ?

Answer 18

insulin resistance

Question 19

what is the major risk factor associated with T2DM ?

Answer 19

obesity

Question 20

what are the different types of obesity are associated with T2DM ?

Answer 20

apple shape
pear shape
apple shape is worse

Question 21

what is the classic histology finding associated with T2DM ?

Answer 21

amyloid in pancreatic islets made by beta cells

Question 22

what is HHS ?

Answer 22

hyperglycemic hyperosmolar syndrome
life threatning complication of T2DM

Question 23

what is the difference between DKA and HHS ?

Answer 23

no ketones in HHS , so no acidosis
but very high serum osmolarity in HHS

Question 24

what are the symptoms of HHS ?

Answer 24

mental status changes
polyuria and polydydipsia

Question 25

what is the treatment of HHS ?

Answer 25

IV fluids and insulin

Question 26

what skin finding is associated with T2DM ?

Answer 26

acanthosis nigricans - present in skin folds

Question 27

what malignancy is associated with acanthosis nigricans ?

Answer 27

gastric adenocarcinoma

Question 28

what are they key mechanisms responsible for diabetic complications ?

Answer 28

sorbitol accumulation non enzymatic glycation

Question 29

what is no enzymatic glycation ?

Answer 29

when glucose sticks to important structures in the body creates a schiff bond turns into amadori products and eventually turns into Advanced Glycation End Products (AGEs)

Question 30

what do these AGE do ?

Answer 30

associated with atherosclerosis formation hence the coronary artery disease stroke TIA peripheral vascular disease leads to diabetic kidney disease

Question 31

what is the effect of diabetes in renal arterioles ?

Answer 31

hyaline atherosclerosis results from AGE affecting efferent and afferent

Question 32

what is the difference in effect if the afferent arteriole is affected vs the efferent arteriole ?

Answer 32

afferent arteriole : ischemia efferent arteriole : hyperfiltration

Question 33

when is efferent atherosclerosis seen ?

Answer 33

rare except in diabetes

Question 34

what is the best treatment for when albumin is found in urine in diabetics ?

Answer 34

use ACE inhibitors

Question 35

what effect does diabetes have on the glomerular basement membrane ?

Answer 35

causes thickening of the BM due to AGE

Question 36

what are the different types of glomerulosclerosis in association with diabetes ?

Answer 36

1- diffuse - deposition of proteins, collagen, may cause nephrotic syndrome 2- nodular glomerulosclerosis (more specific to diabetes)

Question 37

what is the hallmark of nodular sclerosis of the kidney in association with DM ?

Answer 37

kimmelstiel wilson nodule

Question 38

what are the pathologies associated with sorbitol accumulation ?

Answer 38

cataract neuropathy ( accumulation in schwann cells)

Question 39

what is the presentation of diabetic neuropathy ?

Answer 39

stocking and glove sensory loss loss of vibration sense, proprioception delayed gastric emptying - gastroparesis

Question 40

how does sorbitol cause diabetic retinopathy ?

Answer 40

pericyte degeneration