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Prep4USMLE Forum » USMLE Step 1 Forum » Pathology Forum

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jean robert
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05/23/08 - 07:56 AM

A 58 yr old XY has DM. Disease has been poorly controlled for many years.As a consequence, he has had nonenzymatic glycosylation of free amino acid groups of proteins.This process is best illustrated by finding which of the following pathologic abnormalities?

a) Peripheral neuropathy

b) Amyloid replacement of islets

c) Formation of retinal microaneurysms

d) Accelerated atherogenesis

e) Cataracts

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Tiff
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05/23/08 - 09:35 AM

A - peripheral neuropathy

Kalyann
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05/23/08 - 11:39 AM

d) Accelerated atherogenesis

The BM becomes leaky due to gly of its proteins

new_n_lost
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05/23/08 - 01:50 PM

d) Accelerated atherogenesis << would best describe NAG pathology.

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doctor123
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05/23/08 - 09:32 PM

I am sorry I cant understand why one need to go so much deep into the vessels at molecular level to find out RBS is Uncontrolled..

Should be Cataract/ though one suspects and go for RBS /HbA1C checkup when someone c/o Peripheral Neuropathy.

Plz some lights here

DR.123

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Kalyann
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05/24/08 - 09:22 AM

Its a mechanism one needs to know that DM and HTN cause hyaline arteriosclerosis thru glycosylation of BM proteins making them leaky in DM and thru hydrostatic pressure of blood driving pl prs into BM .

Its not used for diagnosis of DM.

This point is for knowing why the complication ( accelerated atherogenesis ) occurs in DM and what we can do to avoid it.

hitesh
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05/24/08 - 10:18 AM

d) Accelerated atherogenesis

Dr123, the question is not about when to suspect or how to diagnose T2DM. It just tests if you know the mechanisms of diabetic complications. e.g. cataracts are formed because of formation of sorbitol from glucose (by aldose reductase) , and its deposition in the lens.

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doctor123
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05/24/08 - 11:37 AM

got it

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jean robert
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05/24/08 - 12:08 PM

Kalyann wrote:
d) Accelerated atherogenesis

The BM becomes leaky due to gly of its proteins

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jean robert
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05/24/08 - 12:12 PM

#10

EXPLANATION

Nonenzymatic glycosylation of collagen accelerates atherosclerosis bcoz it leads to the formation of irreversible advanced glycosylation end products, which accumulate over some period. Such changes in collagen in arterial walls aid in trapping LDLs and thus accelerate lipid deposition.

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jean robert
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05/24/08 - 12:15 PM

#11

The neuropathy, retinal microaneurysms ,cataracts common to DM result from Sorbitol accumulation and subsequent osmotic cell injury.

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