STEP2: DM

Question 1

What is diabetes mellitus (DM)?

Answer 1

A group of metabolic diseases characterized by chronic hyperglycemia.

Hyperglycemia refers to abnormally high blood glucose levels.

Question 2

What causes Type 1 diabetes mellitus (T1DM)?

Answer 2

An autoimmune response that destroys insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency.

Question 3

When does Type 1 diabetes mellitus typically develop?

Answer 3

Often during childhood, with an acute onset.

Question 4

What characterizes Type 2 diabetes mellitus (T2DM)?

Answer 4

Insulin resistance and impaired insulin secretion due to pancreatic beta-cell dysfunction, resulting in relative insulin deficiency.

Question 5

What is the prevalence of Type 2 diabetes mellitus in the US?

Answer 5

Approximately 10.5% of the adult population.

Question 6

What are common symptoms of diabetes mellitus?

Answer 6

Polyuria, polydipsia, polyphagia, unexplained weight loss.

Question 7

What is the main goal of diabetes treatment?

Answer 7

Blood glucose control tailored to glycemic targets while avoiding hypoglycemia.

Question 8

What are some lifestyle modifications recommended for diabetes management?

Answer 8

Smoking cessation, exercise, nutritional support.

Question 9

What medications are commonly used in diabetes management?

Answer 9

Antihyperglycemics, statins, ACE inhibitors or angiotensin receptor blockers, and aspirin.

Question 10

What is the typical age of onset for Type 2 diabetes?

Answer 10

Typically over 40 years.

Question 11

What are the risk factors for developing Type 2 diabetes mellitus?

Answer 11

• Family history
• High-risk race or ethnicity
• Physical inactivity
• Obesity
• Hypertension
• Dyslipidemia

Question 12

What is the classification of diabetes mellitus according to the WHO and ADA?

Answer 12

Type 1 and Type 2 diabetes, gestational diabetes, and other specific types.

Question 13

What is the pathogenesis of Type 1 diabetes?

Answer 13

Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency.

Question 14

What is the difference in C-peptide levels between Type 1 and Type 2 diabetes?

Answer 14

Type 1: decreased or absent; Type 2: initially elevated, decreased in advanced stages.

Question 15

What is a common complication associated with Type 1 diabetes?

Answer 15

Diabetic ketoacidosis (DKA).

Question 16

What are the primary tests for diagnosing diabetes mellitus?

Answer 16

• Random blood glucose
• Fasting plasma glucose (FPG)
• Oral glucose tolerance test (OGTT)
• Hemoglobin A1C (HbA1c)

Question 17

What indicates a diagnosis of diabetes mellitus via random blood glucose?

Answer 17

A level ≥ 200 mg/dL in patients with symptoms of hyperglycemia.

Question 18

What is the typical presentation of Type 2 diabetes?

Answer 18

Gradual onset; often asymptomatic, with some presenting in a hyperglycemic crisis.

Question 19

What is the significance of HbA1c in diabetes management?

Answer 19

Reflects average blood glucose levels over the prior 8–12 weeks.

Question 20

What factors can falsely elevate HbA1c levels?

Answer 20

• Increased RBC lifespan
• Altered hemoglobin due to chronic kidney disease.

Question 21

What is MODY?

Answer 21

Maturity-onset diabetes of the young, a genetic form of diabetes characterized by β-cell dysfunction.

Question 22

What is the typical treatment approach for Type 1 diabetes?

Answer 22

Insulin therapy.

Question 23

What is the typical age of onset for Type 1 diabetes?

Answer 23

Typically occurs in childhood, often before 20 years.

Question 24

What is the relationship between obesity and Type 2 diabetes?

Answer 24

Obesity is strongly associated with the development of Type 2 diabetes.

Question 25

What are common microvascular complications of diabetes?

Answer 25

* Diabetic retinopathy * Diabetic nephropathy * Diabetic neuropathy

Question 26

What is the role of insulin in carbohydrate metabolism?

Answer 26

Insulin directly lowers blood glucose levels.

Question 27

What is a key difference in the genetic predisposition between Type 1 and Type 2 diabetes?

Answer 27

Type 1 has a positive HLA-DR4 and HLA-DR3 association; Type 2 has a strong familial predisposition without specific HLA association.

Question 28

What is the recommended screening for diabetes in adults?

Answer 28

All individuals ≥ 35 years and those < 35 with specific risk factors.

Question 29

What is aplastic anemia?

Answer 29

A condition where the body fails to produce enough blood cells.

Question 30

What can alter hemoglobin levels in chronic kidney disease?

Answer 30

Altered hemoglobin.

Question 31

What factors can result in a falsely low HbA1c?

Answer 31

Decreased RBC lifespan due to: * Acute blood loss * Hemoglobinopathies (e.g., sickle cell trait/disease, thalassemia) * G6PD-deficiency * Cirrhosis * Hemolytic anemia * Splenomegaly * Antiretroviral drugs.

Question 32

What conditions can lead to increased erythropoiesis?

Answer 32

Conditions such as: * EPO therapy * Reticulocytosis * Pregnancy (second and third trimesters) * Iron supplementation.

Question 33

What can cause altered hemoglobin levels?

Answer 33

High-dose vitamin C and E supplementation.

Question 34

What should be investigated if there is a significant discrepancy between HbA1c and glucose measurements?

Answer 34

The underlying cause, such as sickle cell trait.

Question 35

What is the FPG threshold for diagnosing diabetes mellitus?

Answer 35

≥ 126 mg/dL (≥ 7.0 mmol/L).

Question 36

What is the 2-hour glucose value after one-step OGTT for diagnosing diabetes mellitus?

Answer 36

≥ 200 mg/dL (≥ 11.1 mmol/L).

Question 37

What HbA1c level indicates diabetes mellitus?

Answer 37

≥ 6.5%.

Question 38

What is the range for impaired fasting glucose (prediabetes)?

Answer 38

100–125 mg/dL (5.6–6.9 mmol/L).

Question 39

What screening is recommended to detect microalbuminuria?

Answer 39

Spot urinary albumin-to-creatinine ratio.

Question 40

What does ↑ C-peptide levels indicate?

Answer 40

Insulin resistance and hyperinsulinemia, typically seen in T2DM.

Question 41

What do ↓ C-peptide levels indicate?

Answer 41

An absolute insulin deficiency, typically seen in T1DM.

Question 42

What is glucosuria?

Answer 42

Presence of glucose in urine, nonspecific for diabetes mellitus.

Question 43

What is microalbuminuria a sign of?

Answer 43

Early sign of diabetic nephropathy.

Question 44

What are Anti-GAD antibodies?

Answer 44

Antibodies against glutamic acid decarboxylase, indicating autoimmune diabetes.

Question 45

What are the general principles for managing diabetes?

Answer 45

Main goal: blood glucose control tailored to glycemic targets.

Question 46

What is the primary treatment for patients with T1DM?

Answer 46

Insulin therapy.

Question 47

What lifestyle modifications are recommended for diabetes care?

Answer 47

Modifications including: * Weight reduction * Balanced diet * Regular exercise * Smoking cessation.

Question 48

What glycemic target is suitable for most patients?

Answer 48

HbA1c < 7%.

Question 49

What is the preprandial capillary glucose target?

Answer 49

80–130 mg/dL (4.4–7.2 mmol/L).

Question 50

What is the peak postprandial capillary glucose target?

Answer 50

< 180 mg/dL (< 10.0 mmol/L).

Question 51

What should be assessed for episodes of hypoglycemia?

Answer 51

Assess at every follow-up visit.

Question 52

What is the dawn phenomenon?

Answer 52

A physiological increase of growth hormone in early morning causing increased blood glucose.

Question 53

What is the Somogyi effect?

Answer 53

A controversial hypothesis where nocturnal hypoglycemia leads to morning hyperglycemia.

Question 54

What is the initial approach to insulin treatment in T2DM?

Answer 54

Start with a basal insulin regimen with once-daily injections.

Question 55

What are the first-line therapy options for T2DM?

Answer 55

Metformin, unless contraindicated.

Question 56

What are some noninsulin diabetes medications?

Answer 56

Medications include: * Biguanides (Metformin) * Dipeptidyl peptidase-4 inhibitors * SGLT-2 inhibitors * GLP-1 receptor agonists * Sulfonylureas * Thiazolidinediones.

Question 57

What is the recommended screening for diabetic kidney disease?

Answer 57

Spot urine albumin to creatinine ratio (UACR) and serum glomerular filtration rate.

Question 58

When should screening for diabetic retinopathy begin?

Answer 58

At the time of diabetes diagnosis for Type 2 DM.

Question 59

What are acute complications of diabetes?

Answer 59

Complications include: * Hyperglycemic crisis * Hyperglycemic hyperosmolar state (HHS) * Diabetic ketoacidosis (DKA) * Life-threatening hypoglycemia.

Question 60

What are long-term complications associated with diabetes?

Answer 60

Complications include: * Macrovascular disease (atherosclerosis) * Microvascular disease (diabetic nephropathy, retinopathy, neuropathy).

Question 61

What is necrobiosis lipoidica?

Answer 61

An inflammatory granulomatous disorder of the skin associated with diabetes.

Question 62

What is the treatment for necrobiosis lipoidica?

Answer 62

Corticosteroids may be effective.

Question 63

What is diabetic cardiomyopathy?

Answer 63

A disorder of the myocardium seen in patients with diabetes.

Question 64

What is the significance of glycemic control in diabetes?

Answer 64

Strict glycemic control is crucial in preventing microvascular disease.

Question 65

What is the positive prayer sign?

Answer 65

Inability to approximate the palms due to flexion contractures.

Question 66

What is manifested as stiffness of the small joints of the hand?

Answer 66

Tight waxy skin, particularly on the dorsal surface of the fingers

Question 67

What does a positive prayer sign indicate?

Answer 67

Inability to approximate the palms due to flexion contractures of the PIP and MCP joints

Question 68

What does a positive tabletop test indicate?

Answer 68

Inability to flatten the palm against the surface of a table due to contractures in the metacarpophalangeal joints

Question 69

What is sialadenosis?

Answer 69

A condition characterized by swelling of the salivary glands

Question 70

What is a carbuncle?

Answer 70

A cluster of boils caused by bacterial infection

Question 71

What is one of the leading causes of death in the US?

Answer 71

Diabetes mellitus

Question 72

What are common complications from diabetes mellitus that can result in death?

Answer 72

* Myocardial infarction * End stage renal failure

Question 73

What are the leading causes of blindness related to diabetes?

Answer 73

Nontraumatic lower limb amputation, end stage renal failure, cardiovascular disease

Question 74

What does the prognosis of diabetes primarily depend on?

Answer 74

Glycemic control and treatment of comorbidities (e.g., hypertension, dyslipidemia)