Diabetes Mellitus Q 89

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Which of the following chronic complications is associated with diabetes?

  

    A. Dizziness, dyspnea on exertion, and coronary artery disease

    B. Retinopathy, neuropathy, and coronary artery disease

    C. Leg ulcers, cerebral ischemic events, and pulmonary infarcts

    D. Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias

    

    

Correct Answer: B. Retinopathy, neuropathy, and coronary artery disease

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These are all chronic complications of diabetes. Regardless of the specific type of diabetes, complications involve microvascular, macrovascular, and neuropathic issues. Microvascular and macrovascular complications vary according to the degree and the duration of poorly controlled diabetes and include nephropathy, retinopathy, neuropathy, and ASCVD events, especially if it is associated with other comorbidities like dyslipidemia and hypertension.

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Option A: Dizziness, dyspnea on exertion, and coronary artery disease are symptoms of aortic valve stenosis. The acquired aortic stenosis manifests with exertional dyspnea, syncope, angina, and, ultimately, heart failure. Angina results from the combination of the need for increased oxygen in hypertrophied myocardium and reduction of oxygen delivery secondary to the excessive compression of coronary vessels.

Option C: Leg ulcers, cerebral ischemic events, and pulmonary infarcts are complications of sickle cell anemia. Approximately 2.5% of patients with SCA above 10 years of age have leg ulcers. Chronic hemolysis leads to pulmonary vascular changes classified under WHO group 1 in up to 10% of all SCA patients. PAH in SCA can also occur due to left heart dysfunction (Group II), chronic lung disease from SCA (Group III), chronic thromboembolism (Group IV), or extrathoracic causes (Group V).

Option D: Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias are symptoms of hyperparathyroidism. Physical examination findings are usually noncontributory. Examination may reveal muscle weakness and depression. A palpable neck mass is not usually expected with hyperparathyroidism, although in rare cases, it may indicate parathyroid cancer.

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