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CDE Diabetes

Practice Exam: Retinopathy (Chapter 30)

Diabetic retinopathy remains the leading cause of new cases of blindness in adults of working age. The 2018 Clinical Practice Guidelines emphasize that with optimal glycemic and blood pressure control, coupled with regular screening and timely treatment, the vast majority of vision loss can be prevented.

This practice exam tests your ability to apply specific screening schedules, recognize the risk factors for progression, and identify the appropriate therapeutic interventions for sight-threatening disease.

Key Concepts Covered in This Exam:

  • Screening Protocols: Mastering the different screening initiation times for Type 1 diabetes (5 years after diagnosis) versus Type 2 diabetes (at diagnosis) and the frequency of follow-up.

  • Risk Reduction: Understanding the evidence behind “ABC” management (A1C, Blood pressure, Cholesterol) and the specific role of fenofibrate in slowing retinopathy progression.

  • Therapeutic Interventions: Identifying anti-VEGF (vascular endothelial growth factor) therapy as the first-line treatment for center-involved diabetic macular edema (DME), replacing standard laser therapy for many patients.

  • Pregnancy Considerations: Recognizing the rapid progression of retinopathy that can occur during pregnancy and the requirement for more frequent ophthalmological assessments.

  • Referral Pathways: Knowing when to refer patients to an optometrist or ophthalmologist and how to interpret screening results to determine follow-up intervals.

1. A 28-year-old patient was diagnosed with type 1 diabetes at age 12. When should screening for retinopathy have commenced according to guidelines?

2. A patient with type 2 diabetes and established mild retinopathy is currently on atorvastatin. Which additional lipid-lowering therapy could be considered to slow retinopathy progression?

3. A 45-year-old with type 1 diabetes for 18 years develops severe vitreous hemorrhage. According to the DRVS, what is the recommended approach?

4. A patient has centre-involving diabetic macular edema. Which treatment is considered first-line therapy?

5. A patient with type 2 diabetes has had two annual eye exams showing no retinopathy. What is the recommended rescreening interval?

6. According to landmark trials (DCCT and UKPDS), for how long do the beneficial effects of intensive glycemic control persist after completion of the trials?

7. A patient with diabetes and atrial fibrillation requires anticoagulation but is concerned about eye complications. Based on the evidence, what can you advise about ASA use and diabetic retinopathy?

8. A patient with type 1 diabetes and a history of poor glycemic control (A1C 10.5%) wants to achieve tight glucose control rapidly. What should you counsel regarding retinopathy?

9. A normotensive patient with type 2 diabetes asks whether they should take an ACE inhibitor specifically to prevent retinopathy. Based on current evidence, what is the most appropriate response?

10. Regarding the use of bevacizumab for diabetic retinopathy in Canada, which statement is correct?

11. A patient with moderate visual loss from diabetic retinopathy feels discouraged about their quality of life. What referral is recommended?

12. Which of the following best describes proliferative diabetic retinopathy?

13. A meta-analysis comparing RAAS inhibitors for diabetic retinopathy (21 RCTs, 13,823 participants) reached what conclusion regarding ACE inhibitors versus ARBs?

14. A patient is being considered for intravitreal steroid therapy for diabetic macular edema. Which adverse effects are associated with intraocular steroid treatment?

15. A 9-year-old child was diagnosed with type 1 diabetes at age 6. The parents ask about retinopathy screening. Based on the evidence, which statement is most accurate?

16. Diabetic retinopathy is the most common cause of incident blindness (legal) in which population?

17. A patient with diabetic retinopathy requires ophthalmic surgery. They are currently taking warfarin for a mechanical heart valve. Based on the evidence, should warfarin be stopped?

18. A 35-year-old woman with type 1 diabetes for 12 years and mild nonproliferative retinopathy is planning pregnancy. Her A1C is 8.2%. Based on understanding of risk factors, which statement best describes the retinopathy risk during pregnancy?

19. A 42-year-old patient with type 2 diabetes has been on simvastatin for cardiovascular protection. They have established mild retinopathy. Based on the FIELD and ACCORD Eye studies, if fenofibrate is added, approximately how many patients would need to be treated to prevent one retinopathy progression event over 4 years?

20. Which of the following is NOT a recognized risk factor for the development or progression of diabetic retinopathy?

21. What technology has encouraged the terminology “centre-involving” diabetic macular edema (DME)?

22. What is considered the gold standard screening method for diabetic retinopathy?

23. A 55-year-old patient is newly diagnosed with type 2 diabetes. When should retinopathy screening be initiated?

24. Visual loss from diabetic retinopathy is associated with which of the following?

25. What is the prevalence rate of proliferative retinopathy in people with type 1 diabetes?

26. Which cytokine plays a pivotal role in the development of diabetic macular edema?

27. Which anti-VEGF agent demonstrated superiority in participants with worse baseline visual acuity in the head-to-head Protocol T study?

28. According to the Eye Diseases Prevalence Research Group, what is the crude prevalence rate of retinopathy in the adult diabetic population?