Diabetes Mellitus - Endocrine - Medbullets Step 2/3
(M2.EC.4754) A 63-year-old male presents to the emergency department complaining of worsening nausea. He reports that the nausea began several months ago and is accompanied by occasional bloating and heartburn. He reports that he frequently feels full even after eating only a little at each meal, and occasionally he will vomit if he eats too much. The vomit is non-bloody and contains bits of undigested food. A review of systems is notable for occasional headaches, tingling in his distal extremities, and constipation. His medical history is significant for Parkinsons disease diagnosed 3 years ago, hypertension diagnosed 8 years ago, and type II diabetes mellitus diagnosed 10 years ago. The patient reports that he was given prescriptions for both his blood pressure and diabetes medications, but he has not taken either for months because one of them was causing erectile dysfunction. He reports he regularly takes his levodopa. An endoscopy is performed, which rules out cancer. In addition to restarting medications for his hypertension and diabetes, what of the following is most appropriate treatment for the patients symptoms? Review Topic Continue reading >>
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Explanations For The 2018-2019 Official Step 2 Ck Practice Questions
Explanations for the 2018-2019 Official Step 2 CK Practice Questions The NBME recently released an updated May 2018 official USMLE Step 2 CK Sample Test Questions , but these are actually completely unchanged over the past two years since the June 2016 update, which was itself almost unchanged from the 2015 set. Since its been a couple years, Ive included the explanations below (which are, again, unchanged). You might see the comments on the old post for possible additional questions you may have. The multimedia question explanations are also at the bottom of this page. Last year, helpful reader Jarrett made a list converting the question order from the online FRED version to the pdf numbers. I didnt go through in detail to see if the online version order has changed, but the multimedia questions were in the same spots except that the block 3 question had shifted by one, so they may have done a little something. E Intermittent polyarthritis with positive ANA (sensitive but not specific) and anti-DNA (very specific) means lupus. You dont even need the non-painful mouth ulcers. C Anesthesia to the anterolateral thigh is the distribution of the lateral femoral cutaneous nerve. LFCneuropathy canbe caused bycompression near the inguinal ligament (say, from a hematoma). Note that its the compression of the nerve that causes decreased sensation, not the hematoma itself. H Recurrent infections withabscesses should raise the suspicion of chronic granulomatous disease. Suppurative arthritis does even more, if youre likely to remember that. The real diagnosis is made from the Step 1 style question. Nitroblue tetrazolium is the test used to diagnose CGD, which is a defect in NADPH oxidase (the oxidative burst that kills Staph aureus). D Unstable and hypotensive patients after blun Continue reading >>
Usmle Step 2: Which Screening For A Patient With 29 Bmi?
If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 2 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series. This month’s stumper A 48-year-old man comes to the physician for a routine health maintenance examination. He has had no chest pain, shortness of breath or palpitations. His medical history is unremarkable and he takes no medications. He does not smoke cigarettes, drink alcohol or use illicit drugs. He weighs 203 pounds and he is 5 feet 8 inches tall. Body mass index is 29. His blood pressure is 145/82 mm Hg and his pulse is 92/minute. Examination shows no other abnormalities. Serum electrolyte levels, complete blood count and cholesterol levels are within normal limits. Which of the following screening tests is most appropriate in this patient? A. Measurement of C-reactive protein. B. Measurement of erythrocyte sedimentation rate. C. Measurement of fasting plasma glucose. D. Measurement of homocysteine. E. Measurement of lipoprotein (a). The correct answer is C. Kaplan Medical explains why The American Diabetes Association (ADA) recommends screening for diabetes or prediabetes in all adults who have a BMI greater than 25. According to the ADA, all adults older than 45 should be screened for diabetes. The U.S. Preventive Services Task Force concluded that there is insufficient evidence to perform routine screening in healthy adults; however, screening for diabetes in patients with hypertension is recommended to assess cardiovascular risk. This patient does have hypertension and thus warrants screening for diabetes, even by conservative standards. Why the other Continue reading >>
Free Diabetes Mellitus Board Review Questions Of The Week
diabetes mellitus sample questions can be accessed via this weeks Quick Quiz , and via free trials of our specialty specific comprehensive review courses with CME . Every week Med-Challenger, the leader in online medical education, provides FREE board review questions and the opportunity to earn free CME credits via our insanely popular free, online CME Quick Quiz . Its an easy way to get board review Q&A, earn CME credits, and see how your knowledge ranks with peers. All you need is a free Med-Challenger account. Its 100% risk-free to sign up . No purchase necessary to play or try our products. A 71-year-old man with type 2 diabetes mellitus presents to you for a follow-up visit. He has chronic obstructive pulmonary disease for which he requires supplemental oxygen. The medications he takes for T2DM include insulin glargine and insulin lispro. His most recent glycated hemoglobin (HbA1C) level is 9.6%. What is the next appropriate course of action? Advise the patient to follow-up with you in 3 months and reassess HbA1C at that time. Adjust his current insulin dosages for an HbA1C goal 8.5%. Due to his comorbid conditions, HbA1C is at goal and no interventions are needed at this time. Adjust his current insulin dosages for an HbA1C goal 8.5%. This patient has multiple end-stage chronic medical conditions in addition to T2DM. Given his age and comorbidities, his goal for HbA1C goal should be 8.5% or less. Special consideration is needed for older patients (age 65 years) when adjusting medications for a particular HbA1C goal. HbA1C levels at 8.5% are equivalent to an estimated average blood glucose level of 200 mg/dL. This level, unfortunately, increases the patients risk for developing glycosuria, dehydration, hyperglycemic hyperosmolar syndrome, and poor wound healing. Continue reading >>
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Diabetic Nephropathy Question
Poll: A 25-year-old man has had type 1 diabetes mellitus for 5 years. His physician is concerned about the Be advised that this is a public poll: other users can see the choice(s) you selected. A 25-year-old man has had type 1 diabetes mellitus for 5 years. His physician is concerned about the possibility of permanent renal damage. Which of the following is the best early indicator for diabetic nephropathy? A. Permanent renal damage can develop in as little as 5 years after diabetes mellitus. Diabetic nephropathy complicates about one third of cases of type 2 diabetes mellitus, and a smaller proportion of type 2 cases. One of the problems is that diabetic nephropathy tends to be asymptomatic until end-stage disease develops, so there has been considerable interest in identifying early markers for significant renal disease. The spilling of albumin into the urine and, more specifically, the spilling of very small levels of albumin ("microalbuminuria") are the best markers to date for significant diabetic nephropathy. Hypertension (choice B) often coexists with, and apparently favors the development of, microalbuminuria, but is not a specific marker for renal damage. Rising blood urea nitrogen (choice C) and rising creatinine (choice D) occur a little later, when there is already a very significant decrease in glomerular filtration rate. Urinary tract infection (choice E) can permanently damage the kidneys but does not always do so. By mspropst in forum Ross University School of Medicine By IMG SURVIVOR in forum Microbiology And Immunology By digitaldoc2002 in forum USMLE Step 1 Forum By pharmacology in forum Pharmacology Forum Continue reading >>
Rx_of_diabetes [tusom | Pharmwiki]
List the first-line agent(s) for controlling hypertension and dyslipidemia associated with diabetes. Describe the treatment of choice for ketoacidosis in a patient with Type 1 diabetes Recognize the clinical features of Maturity Onset Diabetes mellitus of the Young (MODY) (discussed in a separate MOD Self Study on Diabetes). For this Learning Exercise, Focus on Drug Classes vs Individual Drugs the list of antidiabetic drugs is growing steadily, making it very challenging to remember them all the main emphasis in this learning exercise will be on recognizing the common traits of each drug category vs those of individual drugs be able to compare and contrast the traits of sulfonylureas vs meglitinides (as two types of insulin secretagogues) as compared to getting bogged down with trying to remember the mostly subtle differences between different drugs within each drug class during assessment exercises, you won't be asked to recognize glyburide, glipizide & glimepiride as names for different sulfonylureas; that level of detail can be dealt with later on in your clinical training. drug trade names are provided only for completeness, and they are not included on exam questions (as is true for questions on the USMLE Step 1 exam); only characteristics of drug classes will be assessed because prandial and basal insulins are used differently, you will need to recognize the various prandial & basal insulins (according to ADA Clinical Practice guidelines 2017) Aim to achieve normal or near normal glycemia with an A1C goal of <7 percent. More stringent goals (ie, a normal A1C, <6.5 percent) without hypoglycemia can be considered in individual patients. Less stringent treatment goals (ie, <8 percent) may be appropriate for patients with a history of severe hypoglycemia, patients wi Continue reading >>
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Is The Patient At Risk For Diabetes? It’s A $100 Billion Question
A recent study of U.S. spending on more than 150 medical conditions found diabetes to be the top expense, far and away. Diabetes is preventable, and prediabetes is reversible, so there is a tremendous opportunity to cut costs by improving care. According to data on awareness of the risk of diabetes, one problem might be how little patients and physicians are talking with each other about this costly, dreadful disease. The overwhelming majority of people with prediabetes are unaware of it. The JAMA study featured an analysis of data from more than 180 sources and found an estimated $101.4 billion in spending on diabetes in 2013—15 percent more than the next costliest condition, ischemic heart disease. But that heavy toll on patients and payers could be avoided. All the chronic diseases in the list of the 20 costliest conditions “have an underlying health burden nearly exclusively attributable to modifiable risk factors,” the JAMA study’s authors noted. “For example, diabetes was 100 percent attributed to behavioral or metabolic risk factors that included diet, obesity, high fasting plasma glucose, tobacco use and low physical activity.” A conversation waiting to happen While some 29 million Americans have diabetes, another 86 million have prediabetes, including half of those 65 and older, according to the Centers for Disease Control and Prevention (CDC). But nine in 10 who have prediabetes don’t know it, suggesting there is a great opportunity for physicians and health systems to identify patients at risk for diabetes and help them get evidence-based prevention. Since time in the exam room is so limited, the AMA and the CDC have developed a toolkit, Prevent Diabetes STAT, that features step-by-step instructions to help health care teams screen patients for Continue reading >>
Diabetic Medication
1. 2. What Oral Antidiabetic stimulates beta cells to secrete more insulin and increase receptor sites in the tissue? 3. 4. 5. What Oral Diabetic Medication has the following side effects:Diarrhea, Stomach upset, and Lactic acidosis? 6. 7. Which of the following medications are a first generation Sulfonylureas? There is more than one!!! 8. Which of the following medications are a first generation Sulfonylureas? There is more than one!!! 9. 10. 11. What Combination of drugs are used to make Gucovance? Also include classification of drugs? 12. What Combination of drugs are used to make Gucovance? Also include classification of drugs? 13. 14. 15. What decreases the rate of liver glucose production, augments glucose uptake by tissues and lowers lipids? 16. What decreases the rate of liver glucose production, augments glucose uptake by tissues and lowers lipids? 17. What following Oral Anti-diabetics list the side effects of hypoglycemia? (Classification listed)There could be more than one. 18. What following Oral Anti-diabetics list the side effects of hypoglycemia? (Classification listed)There could be more than one. 19. 20. 21. 22. 23. 24. 25. Alpha-Glucosidase should ONLY BE GIVEN WITH MEALS, choose the generic names of the drugs that belong to this category. 26. Alpha-Glucosidase should ONLY BE GIVEN WITH MEALS, choose the generic names of the drugs that belong to this category. 27. 28. 29. 30. 31. 32. 33. What should not be used if liver or kidney dysfunction is present, works for 10 to 24 hours, and has a HIGHER hypoglycemic potency? 34. Continue reading >>
Diabetes Mellitus
Diabetes mellitus (DM) describes a group a metabolic diseases that are characterized by chronic hyperglycemia (elevated blood glucose levels). The two most common forms are type 1 and type 2 diabetes mellitus. Type 1 is the result of an autoimmune response that triggers the destruction of insulin-producing β cells in the pancreas and results in an absolute insulin deficiency. Type 2, which is much more common, has a strong genetic component as well as a significant association with obesity and sedentary lifestyles. Type 2 diabetes is characterized by insulin resistance (insufficient response of peripheral cells to insulin) and pancreatic β cell dysfunction (impaired insulin secretion), resulting in relative insulin deficiency. This form of diabetes usually remains clinically inapparent for many years. However, abnormal metabolism (prediabetic state or impaired glucose intolerance), which is associated with chronic hyperglycemia, causes microvascular and macrovascular changes that eventually result in cardiovascular, renal, retinal, and neurological complications. In addition, type 2 diabetic patients often present with other conditions (e.g. hypertension, dyslipidemia, obesity) that increase the risk of cardiovascular disease (e.g., myocardial infarction). Renal insufficiency is primarily responsible for the reduced life expectancy of patients with DM. Due to the chronic, progressive nature of type 1 and type 2 diabetes mellitus, a comprehensive treatment approach is necessary. The primary treatment goals for type 2 diabetes are the normalization of glucose metabolism and the management of risk factors (e.g., arterial hypertension). In theory, weight normalization, physical activity, and a balanced diet should be sufficient to prevent the manifestation of diabetes in Continue reading >>
Diabetes Practice Questions
1. The risk factors for type 1 diabetes include all of the following except: a. Diet b. Genetic c. Autoimmune d. Environmental 2. Type 2 diabetes accounts for approximately what percentage of all cases of diabetes in adults? a. 55%-60% b. 35%-40% c. 90-95% d. 25-30% 3. Risk factors for type 2 diabetes include all of the following except: a. Advanced age b. Obesity c. Smoking d. Physical inactivity 4. What percentage of women with gestational diabetes is diagnosed with type 2 diabetes following pregnancy? a. 25%-30% b. 5%-10% c. <5% d. 20%-25% 5. Untreated diabetes may result in all of the following except: a. Blindness b. Cardiovascular disease c. Kidney disease d. Tinnitus 6. Prediabetes is associated with all of the following except: a. Increased risk of developing type 2 diabetes b. Impaired glucose tolerance c. Increased risk of heart disease and stroke d. Increased risk of developing type 1 diabetes 7. Diabetics are at increased risk of heart disease if they also: a. Smoke b. Have high HDL cholesterol levels c. Take aspirin d. Consume a high-fiber diet 8. Blood sugar is well controlled when Hemoglobin A1C is: a. Below 7% b. Between 12%-15% c. Less than 180 mg/dL d. Between 90 and 130 mg/dL 9. Excessive thirst and volume of very dilute urine may be symptoms of: a. Urinary tract infection b. Diabetes insipidus c. Viral gastroenteritis d. Hypoglycemia 10. Among female children and adolescents, the first sign of type 1 diabetes may be: a. Rapid weight gain b. Constipation c. Genital candidiasis d. Insomnia 11. Untreated hyperglycemia may lead to all of the following complications except: a. Hyperosmolar syndrome b Vitiligo c. Diabetic ketoacidosis d. Coma 12. Hyperinsulinemia may be caused by all of the following except: a. An insulinoma b. Nesidioblastosis c. Insulin Continue reading >>
Questions & Answers
Are autoantibodies useful in differentiating type 1 and type 2 diabetes mellitus (DM)? [Guideline] Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010 Jan. 33 Suppl 1:S62-9. [Medline] . [Full Text] . [Guideline] American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care. 2012 Jan. 35 Suppl 1:S11-63. [Medline] . U.S. Preventive Services Task Force. Screening for Type 2 Diabetes Mellitus in Adults. Available at . Keller DM. New EASD/ADA Position Paper Shifts Diabetes Treatment Goals. Medscape Medical News. Available at . Accessed: October 15, 2012. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012 Jun. 55(6):1577-96. [Medline] . Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012 Jun. 35(6):1364-79. [Medline] . [Full Text] . Tucker ME. New diabetes guidelines ease systolic blood pressure target. December 20, 2012. Medscape Medical News. Available at . Accessed: January 8, 2013. [Guideline] American Diabetes Association Professional Practice Committee. American Diabetes Association clinical practice recommendations: 2013. Diabetes Care. January 2013. 36 (suppl 1):S1-S110. [Full Text] . Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003 Jan. 26 Suppl 1:S5-20. [Medline] . Centers Continue reading >>
Genentech: Quiz: Diabetic Retinopathy
1. TRUE OR FALSE: DIABETIC RETINOPATHY IS THE LEADING CAUSE OF BLINDNESS AMONG ADULTS AGED 20-74. 2 Diabetic retinopathy is the most common cause of vision loss in people with diabetes and the leading cause of blindness among adults aged 20 to 74. 2. TRUE OR FALSE: POORLY CONTROLLED DIABETES CAN DAMAGE BLOOD VESSELS IN THE RETINA AND CAN EVENTUALLY LEAD TO VISION LOSS.3 The longer a person has diabetes, especially if blood sugar is poorly controlled, the higher the risk for developing diabetic retinopathy. Diabetic retinopathy occurs when blood vessels in the retina become damaged. This can cause vision loss or distortion when the abnormal vessels leak blood or fluid into the eye. 3. WHO IS AT RISK FOR DIABETIC RETINOPATHY? 3 People with both type 1 and type 2 diabetes All people with diabetes both type 1 and type 2 are at risk for diabetic retinopathy. 4. HOW MANY PEOPLE ARE LIVING WITH DIABETIC RETINOPATHY IN THE U.S.?4,5 Diabetic retinopathy affects nearly 7.7 million Americans and that number is expected to grow to 16 million people by 2050. 5. TRUE OR FALSE: PEOPLE NOTICE IMMEDIATELY WHEN THEY DEVELOP DIABETIC RETINOPATHY.3 Symptoms of diabetic retinopathy may not appear until the condition has progressed, which may lead to vision loss. Diabetic retinopathy is often without noticeable symptoms in its early stages. 6. WHAT ARE THE SYMPTOMS OF DIABETIC RETINOPATHY?6 Patches of vision loss, such as small black dots or lines Symptoms of diabetic retinopathy may include blurred vision, loss of color contrast, or patches of vision loss, which may appear as small black dots or lines "floating" across the front of the eye. 7. HOW MANY PEOPLE IN THE U.S. HAVE DIABETIC MACULAR EDEMA (DME), A COMPLICATION OF DIABETIC RETINOPATHY THAT CAUSES SWELLING OF THE MACULA, THE CENTRA Continue reading >>
Diabetes Mellitus Questions
1. A patient has Diabetes Mellitus Type 2. Which of the following will help reduce blood sugar. a. Weight loss & Exercise c. Sedentary lifestyle b. Eat higher carbohydrates d. All of the above. a. Type 2 Diabetes c. Type 1 Diabetes 3. The hormone that keeps blood sugar within normal limits: a. Glucagon c. Islets of Langerhan 4. If a patient is suffering from Type 2 DM, which is true: 5. A person is feeling cold and clammy. Which is true? a. He has hypoglycemia c. both A and B b. He has hyperglycemia d. None of the above 6. Which is the typical treatment for Type 1 DM? a. Oral meds c. Insulin Injection b. Healthy diet d. Diet soft drinks 10. When a person is having hot flushes, headache, or drowsiness, which is true? 11. Which type of DM is 10% of the cases of all DM? 12. When the body has a problem using natural insulin, which is true? a. He has Type 1 Diabetes b. He has type 2 diabetes 13. When the body has no natural insulin at all, which is true? a. He has Type 1 Diabetes b. He has type 2 diabetes 14. When a person with DM is always thirsty (polydipsia), which type does he have? 15. People who are obese typically have which type of DM? 16. When a person is easily tired or fatigued, he is suffering from? 17. When a person has excessive urine (polyuria), which is true? a. He has type 1 DM b. He has type 2 DM 18. A person complains of dizziness and shakiness. Which is true? a. He is feeling hypoglycemic b. He is feeling hyperglycemic 19. When a person is said to have a diabetic coma, which is true? a. He is hypoglycemic b. He is hyperglycemic 20. When a person has a rapid pulse or rapid and shallow respirations, he is suffering from? 22. Which complication is NOT typically found in a diabetic person? a. Renal disease c. Cardiovascular problem and vision problems 24. Wh Continue reading >>
Diabetes Mellitus, Type 2, Pediatric
Type 2 diabetesmellitus is a metabolic disorder characterized by peripheral insulin resistance and a failure of beta cells to compensate, leading to hyperglycemia. While once considered an adult pathology, it is increasing in prevalence in children. Risk factors for children are similar to those in adults: ethnicity, family history, obesity, and sedentary lifestyle. However, presentation and management differ from adults with the disorder. Children with diabetes (of any kind) are at an increased risk of many complications of the disease. Early recognition, screening, and treatment of children with type 2 diabetesmellitusare important for prevention of long-term complications from the disease. Hyperglycemia results when there is a relative lack of insulin compared to glucose in the blood. In type 2 diabetesmellitus, insulin resistance first leads to increased insulin production by the beta cells of the pancreas. When the beta cells are unable to produce enough insulin to maintain euglycemia, hyperglycemia results. Hyperglycemia has damaging effects to multiple organs, including kidneys, eyes, heart, and nerves. Further, hyperglycemia puts children at risk for other electrolyte disturbances. Comparatively, type 1diabetesmellitusis characterized by autoimmune destruction of beta cells in the pancreas leading to alack of insulin production. Type 1 diabetes remains the most prevalent form of diabetes in children. However,type 2 diabetesmellitusis estimated to occur in one in three (20% to 33%) of new diagnoses of diabetes in children today. The rate oftype 2 diabetesmellitusin children continues to rise even as the obesity rates have plateaued in these age groups. Risk factors include high-risk ethnicity(African American, Hispanic, Native Americans, Pacific Islanders, Asian Continue reading >>
Free Usmle / Comlex Practice Questions | Doctors In Training
Click on the Question image to view the full size version. Answer:The best answer is option A. This childs presentation of palpable purpura, arthritis and arthralgias, abdominal pain and renal disease (hematuria) is classic for IgA vasculitis, an immune-mediated vasculitis caused by deposition of IgA immune complexes in multiple tissues, also known as Henoch-Schnlein purpura. It is primarily a disease of children, and often follows a recent upper respiratory infection, especially group A streptococcal infection. It is usually a benign, self-limited disease that does not require any treatment beyond supportive care. Mixed cryoglobulinemia syndrome (B) is a type of immune vasculitis due to polyclonal IgG and IgM antibodies that causes a triad of purpura, arthralgia, and weakness due to peripheral neuropathy (Meltzers triad). Hepatic dysfunction is also quite common, and 20-30% of patients develop glomerulonephritis. Mixed cryoglobulinemia is most commonly seen in patients with hepatitis C infection. Post-streptococcal glomerulonephritis (C) is caused by recent group A strep infection, and typically occurs in children. In addition to hematuria (which often causes cola-colored or tea-colored urine), symptomatic individuals will often have edema and hypertension. It does not cause arthralgias, abdominal pain, or purpura. Rheumatic fever (D) is another complication of group A strep infection, usually occurring in children. It causes arthritis as well as a rash called erythema marginatum, a well-defined ring-like erythematous rash that begins on the trunk and gradually spreads outward before resolving spontaneously. Other prominent features of rheumatic fever include pancarditis, chorea, and painless subcutaneous nodules. Scarlet fever (E) is a diffuse erythematous rash that Continue reading >>
