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Painful diabetic neuropathy — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CarePainful diabetic neuropathyUSMLE Step 3

A woman with type 1 diabetes plans pregnancy. Her retinopathy is mild and stable, and glycemic control is being intensified before conception. Which eye-surveillance plan is appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Examine before conception and in the first trimester; follow by severity

The best answer is “Examine before conception and in the first trimester; follow by severity”. Pregnancy can accelerate diabetic retinopathy, particularly when glycemia improves rapidly. A patient with preexisting diabetes should have a dilated comprehensive eye examination before conception and again in the first trimester, followed during pregnancy and postpartum at intervals determined by the degree of retinopathy.

Reference: ADA Standards of Care in Diabetes—2026: Retinopathy, Neuropathy, and Foot Care: https://diabetesjournals.org/care/article/49/Supplement_1/S261/163919/12-Retinopathy-Neuropathy-and-Foot-Care-Standards