Ryan in-class questions

A. impaired fasting glucose

\*\*37 year old male with fasting blood glucose = 115 on 2 separation occasions.

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which of the following is the most appropriate classification?

A. impaired fasting glucose

B. impaired glucose intolerance

C. type 2 diabetes

D. type 1 diabetes

C. diabetes

\*\* 37 year old male with HbA1C= 6.9%

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which of the following is the most appropriate classification?

A. impaired fasting glucose

B. impaired glucose intolerance

C. diabetes

D. fasting blood glucose < 130

\*\* which of the following goals is appropriate for a 34 year old male with DM type 2 and no comorbidities?

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A. HbA1C < 6%

B. BP < 120/80

C. LDL < 70

D. fasting blood glucose < 130

A. A couple pieces of hard candy

\*\* your auntie has type 2 DM seemed a bit confused; she keeps asking you to turn on the fan (which is on)… using your brilliant detective skills, you deduce she has hypoglycemia.

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Which of the following is the most appropriate treatment?

A. A couple pieces of hard candy

B. Slice of chocolate cake

C. Diet soda

D. Lunch meat

E. Glucagon

C. check her blood glucose

\*\* your auntie has type 2 DM seemed a bit confused; she keeps asking you to turn on the fan (which is on)… using your brilliant detective skills, you deduce she has hypoglycemia. After 30 minutes after eating her candy, Auntie says she's ready for a nap.

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What should she do first?

A. have another snack or a small meal

B. take her insulin

C. check her blood glucose

A. Acute complications of diabetes

\*\* which is more dangerous?

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A. Acute complication of diabetes

B. Chronic complications of diabetes

D. order HbA1C

E. order another FBG

F. order OGTT

\*\* 42 year-old male with FBG = 125 today. What is the most appropriate plan? (select all that applies)

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A. diagnosed with impaired fasting glucose

B. diagnosed with diabetes

C. diagnosed with impaired glucose tolerance

D. order HbA1C

E. order another FBG

F. order OGTT

\`G. phone a friend

B. HHS

\*\* 63 year old patient brought to the ED by her daughter with altered mental status. Labs come back as follow:

Na: 132, K: 4.3, Cl: 91, HCO3: 24, BUN: 38, SCr:2.3, Glu: 565

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It is likely that this patient have:

A. DKA

B. HHS

A. DKA

\*\* 6 year-old with “flu” symptoms… Labs come back as follow:

Na: 132, Cl: 90, K: 4.3, HCO3: 14, BUN: 38, SCr:2.3, Glu: 565

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It is likely that this patient have:

A. DKA

B. HHS

C. Fluids

\*\* 6 year-old with “flu” symptoms… Labs come back as follow:

Na: 132, Cl: 90, K: 4.3, HCO3: 14, BUN: 38, SCr:2.3, Glu: 565

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Which of the following treatment option should be given to the patient first?

A. Insulin

B. Potassium

C. Fluids

C. reverse volume depletion

\*\* what is your first priority in DKA?

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A. decrease blood glucose

B. decrease K

C. reverse volume depletion

D. increase pH

A. immune mediated

\*\* which of the following characteristics is associated with type 1 DM?

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A. immune mediated

B. insulin resistance

C. obesity

D. high prevalence

false

\*\*true or false

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a pregnant women with prior GDM should be first screened for diabetes at 24-28 weeks of gestation

D. 6 year-old male with 2 siblings with type 1 DM

\*\*which of the following should NOT be screened for type 2 DM?

A. 56 year-old female with BMI of 26

B. 23 year-old hispanic male with BMI of 42

C. 10 year-old obese male with HTN and hyperlipidemia

D. 6 year-old male with 2 siblings with type 1 DM

A. Insulin resistance

\*\*which of the following are considered risk factor for type 2 DM?

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A. Insulin resistance

B. Insulin antibodies

C. FH of DM type 1

D. Scandinavian heritage

neonatal hypoglycemia

\*\*gestational diabetes is associated with which of the following?

A. maternal macrosomia

B. fetal microsomia

C. neonatal hyperglycemia

D. neonatal hypoglycemia

B. insulin resistance

C. obesity

D. high prevalence

\*\* which of the following characteristics is associated with type 2 DM? (select all that apply)

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A. immune mediated

B. insulin resistance

C. obesity

D. high prevalence

C. Deguldec

which of the following does NOT need to be used in conjunction with a meal?

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A. Lispro

B. Aspart

C. Deguldec

D. Glulisine

D. Duloxetine

A 52 year old male with BP 145/82 mmHg. Hx of smoke and MI has been diagnosed with DM2. What medications would be NOT appropriate to initiate for this patients?

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A. Lisinorpil

B. Carvedilol

C. Aspirin

D. Duloxetine

E. Metformin

B. Repaglinide

Which of the following anti diabetic medications require patients to take before each meal and if the patient were to skip a meal, the corresponding dose should be skipped?

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A. Glipizide

B. Repaglinide

C. Sitagliptin

D. Metformin

E. None of the above

B. 1 L of normal saline

A 65 year old patient with DM admitted to the ICU with DKA

pH 7.0, K 3.2, HCO3 13

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what’s first?

A. 25 meq potassium

B. 1 L of normal saline

C. 0.1 units/kg R insulin bolus followed by continuous infusion

D. 50 mol NaHCO3 with 10 mEq of K

E. None of the above

E. All of the above

Which of the following can cause hypoglycemia?

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A. injecting into abdomen scar tissue

B. injecting insulin before you go jogging

C. Alcohol

D. sulfonylureas

E. All of the above

post-pranial

in patients with type 2 diabetes loss ____ glucose control is usually the initial abnormality?

* weight gain
* hypoglycemia
* not affected for long-term use

what is the down side of using sulfonylureas long-term?

false

true or false

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a-glucosidase inhibitors have a larger effect on fasting glucose compared to their effect on post-prandial glucose

C. Fasting glucose control is lost soon after onset

what is NOT a contributing factor for why diagnosis for type 2 DM is often missed in first few years after onset?

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A. Presentation maybe asymtomatic

B. Hyperinsulinemia compensates for insulin resistance

C. Fasting glucose control is lost soon after onset

D. Oral glucose tolerance tests are not commonly performed

C. increase morning prandial insulin dose

If a patient fasting glucose before lunch is 210 mg/dL how would you adjust their insulin to prevent this from occurring?

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A. increase evening basal insulin dose

B. Decrease evening basal insulin dose

C. Increase morning prandial insulin dose

D. decrease morning prandial insulin dose

E. A and B

A patient with Type 1 DM has noticed that his blood glucose level has been running low before dinner. What insulin adjustment should be make?

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A. Decrease morning NPH dose

B. Decrease lunch bolus dose

C. Increase morning NPH dose

D. Increase his lunch bolus dose

E. A or B

F. C and D

A. Metformin 500 mg QD

An Md at your hospital asks for your advice on a patient with DM2 that comes in uncontrolled on MNT alone. The patient is obese, has HTN, and gastroparesis. What is the most appropriate therapy for this patient?

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A. Metformin 500 mg QD

B. Exenatide 5mcg BID

C. Liraglutide 0.6 mg QD

D. Pramlintide 60 mcg

B. palpitations

Which of the following is NOT of hypoglycemia?

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A. polyphagia

B. palpitations

C. blurred vision

D. polyuria

D. All of the above are symptoms of hyperglycemia

15 g

how many grams of carbs in a serving for mild hypoglycemia treatment?

HTN dosing for DM is given at bedtime

Choose the correct statement

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A. non-pregnant adults BP goal for HTN in DM is < 132/80

B. ACEi and ARBs are treatment of choice for pregnant women with HTN and DM

C. Thiazide should be add on if patient has not reached BP goal when on ACEi/ARB and with poor renal function

D. HTN dosing for DM is given at bedtime

C. at each visit

how often should you inspect your patient’s feet?

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A. yearly

B. quarterly

C. at each visit

D. never - I have a foot phobia

polydelerium

which of the following is NOT a sign/symptom of hyperglycemia?

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A. weight loss

B. polyphasic

C. polydipsia

D. polyuria

E. polydelerium

F. all of the above are signs and symptoms of hyperglycemia

hypertension

A child with newly diagnosed type 1 might be expected NOT to present with which of the following?

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A. loss of bladder control

B. infection

C. hypertension

D. lethargy

E. all of the above signs/symptoms are present with early DM1

infection

A child with newly diagnosed type 2 DM might be expected to NOT present with which of the following?

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A. loss of bladder control

B. infection

C. lethargy

D. HTN

E. weight gain

F. weight loss

false

true or false

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once a patient requires medication to control BO, lifestyle changes are irrelevant

lisinopril & HCTZ

A 45 year-old women with DM1 has asthma and newly diagnosed HTN (145/82), which of the following is appropriate initial treatment?

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A. ramipril

B. valsartan

C. lisinopril & HCTZ

D. amlodipine

temporarily looser glucose control

what is the most appropriate treatment for mild hypoglycemic unawareness?

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A. 2-3 pieces of hard candy

B. temporarily stricter glucose control

C. temporarily looser glucose control

D. discontinue hypoglycemic agents

A. metformin

C. insulin

SF if a 45 year old women who is referred to your clinic with newly diagnosed DM2 BP 140/72 mmHg, HR 68,RR 16, T 98.8, A1C 7.2%, Ht 168 cm, wt 83 kg. What would NOT be the initial treatment? (choose all that applies)

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A. metformin

B. MNT

C. insulin

D. exercise

E. education

6 units

patient BG goal is 100 mg/dL. His SMBG is 220 mg/dL and he plans to have 4 servings of carbs. Calculate his pre-prandial insulin dose