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Diabetic neuropathy — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareDiabetic neuropathyUSMLE Step 3

A 63-year-old man with long-standing type 2 diabetes reports burning foot pain worse at night. Exam shows reduced vibration and monofilament sensation in both feet. Ankle reflexes are decreased. Which of the following is the most likely diagnosis?

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Correct answer: D — Distal symmetric polyneuropathy

Length-dependent sensory loss and burning pain in both feet are typical of diabetic distal symmetric polyneuropathy.

Reference: American Diabetes Association Standards of Care in Diabetes—2026