L3: Macrovascular Complications of DM

Question 1

People with diabetes have a significantly ……. of macrovascular complication than that of the non diabetic population

Answer 1

greater risk

Question 2

Diabetes is a …….. in the development of atherosclerosis

Answer 2

risk factor

Question 3

Macrovascular complications of DM (Table)

Answer 3

Question 4

Overlap of Atherosclerotic Disease

Answer 4

Patients with one manifestation often have coexisted disease in other vascular beds

Question 5

Macrovascular complications of DM

Answer 5

Question 6

Diabetic Risk Factors of macrovascular complications

Answer 6

Question 7

Introduction to atherosclerosis

Answer 7

Question 8

nature of atherometous lesions in DM

Answer 8

Athermanous lesion tend to be more sever, extensive and run more aggressive in diabetes than non-diabetic people

Question 9

Pathogenesis of atherosclerosis in DM

(Very Important)

Answer 9

Question 10

Myocardial infarction is …… times more among diabetic people

Answer 10

three to five

Question 11

Women with diabetes …… their premenopausal protection from coronary artery disease.

Answer 11

lose

Question 12

Angina in patients with DM

Answer 12

• Painless angina and myocardial infarction may be due to neuropathic damage to the autonomic nerves serving the myocardium.
• Atypical presentation of angina and myocardial infarction (malaise, sweating, dyspnea and syncope which may be confused with hypoglycemia).

Question 13

Long term mortality from MI are increased in diabetes may be due to increased risk of HF in diabetes

Answer 13

..

Question 14

Management of MI is similar to non-diabetic population with more caution with usage of thrombolytic therapy because of the risk of intraocular hemorrhage in the patient with retinopathy

Answer 14

..

Question 15

Cardiomyopathy in Diabetic Patients

Answer 15

Question 16

Hypertension in Diabetic Patients

Answer 16

Question 17

Investigastions in patients with CHD & DM

Answer 17

Question 18

TTT in patients with CHD & DM

Answer 18

Question 19

What is the first line TTT in patients with CHD & DM?

Answer 19

ACE inhibitors

Question 20

SE of thiazides & Beta-Blockers in TTT of DM & HTN

Answer 20

• Thiazide should be used at low dose to avoid worsening of glycemic control and aggravation of dyslipidemia
• Beta-Blockers can aggravate hyperglycemia, dyslipidemia and impotence.

Question 21

Prevelance of PAD

Answer 21

Diabetic Patients have a 2-5 fold increase in the rates of PAD

Question 22

Age of occurence of PAD

Answer 22

PAD in people with DM > 40y is found to be 20 %

Question 23

Male/Feamale ratio of PAD

Answer 23

Loss of female protection with equal Male to female ratio

Question 24

Clinical Presentation of PAD

Answer 24

Question 25

Symptoms of PAD

Answer 25

Question 26

Typical vs Atypical Symptoms in Patients with Symptomatic PAD

Answer 26

Question 27

Signs of PAD

Answer 27

1. Absence of pedal pulse ( 8%dorsalis pedis 2% posterior tibialis) 2. Cold extremities 3. Pale or bluish colour of the skin 4. thin ,shiny skin with scanty hair **(dystrophic toenail)**

Question 28

Common Sites of Claudication

Answer 28

Question 29

Investigastions in PAD

Answer 29

1. Doppler US 2. Angiography 3. Ankle Brachial Index (ABI) : normal value 0.98-1.31

Question 30

Describe ABI

Answer 30

Question 31

Levels of ABI

Answer 31

Question 32

Impairment of the collaterals

Answer 32

- Diabetic patients have a diminished ability to establish collateral circulation , especially around the knee

Question 33

Medial Calcinosis

Answer 33

- False High Ankle Brachial Index - Adverse effect on both angioplasty and surgical bypass.

Question 34

Dx of PAD

Answer 34

Question 35

Cerebral Stroke & DM

Answer 35

- Stroke is twice higher in diabetic population than non-diabetics - Mortality and disability from stroke are also worse in the diabetic person compared to non- diabetic people **(May because of elevation of blood glucose level following stroke)**