week 5 HODI

A 24-year-old female presents to your clinic. She is seeing you for a routine visit in her 27th week of gestation. She reports no symptoms and has previously been well. An ultrasound of the baby shows normal growth and no congenital abnormalities. Which of the following should you do next?

A 24-year-old male comes to you for evaluation of hyperlipidemia. On your physical exam, you find thickening of his Achilles tendons bilaterally and scattered nodules on the tendons over the extensor surface of his hands. In which of the following genes would you most likely expect to find a mutation in this patient?

A 62-year-old man presents to your clinic with abdominal discomfort and nausea and vomiting. During the appointment he indicates to you that he has been stressed and has significantly increased the amount of alcohol he has been drinking. On exam, you note that his retinal blood vessels appear whitish. Which one of the following lab findings explain his symptoms and exam?

A 16-year-old girl comes to your clinic for management of type 1 diabetes. You are concerned that she may have a second autoimmune illness. Which of the following would you screen her for?

A 25-year-old male presents to your clinic for management of type 1 diabetes. He is already taking a long-acting insulin and you determine that he needs to be on a second type of insulin, which he will take before eating and to lower elevated glucose levels. Which of the following would be appropriate to prescribe to your patient?

A 57-year-old female with type 1 diabetes presents for a follow up visit. Her glucose levels have been very elevated but with occasional episodes of hypoglycemia. After clinic, she goes to the lab to get her blood drawn. Her A1C comes back at 13%. Her A1C value represents which of the following?

A 63-year-old male with type 2 diabetes on insulin presents to your clinic for management of his diabetes. In the waiting room, he becomes diaphoretic and tremulous. He has been fasting for the past 12 hours for a blood draw. He comes up to the front desk to ask for something, but his speech is slurred and the staff are unable to understand what he is asking for. He subsequently loses consciousness and has a seizure. What is the first step in managing his condition?

A 42-year-old woman with a BMI of 36 kg/m2 and a waist circumference of 39´is found to have a fasting glucose of 163 mg/dL on routine exam, which is confirmed with repeat testing. She is otherwise asymptomatic. She has multiple family members with diabetes who are managed with oral medications. Which of the following is contributing to her hyperglycemia?

A 54-year-old woman with type 2 diabetes is brought in to the emergency department by her family as she was found at home to be incoherent and confused. She lost her health insurance and stopped all of her medications 6 months prior. In the emergency room, she exhibits mental status changes and appears dehydrated. Her blood sugar at the time of admission was 897 mg/dL. Which one of the following lab findings confirms your suspected diagnosis of hyperosmolar hyperglycemic state?

A 23-year-old male with type 1 diabetes presents to you in urgent care. He uses an insulin pump and is concerned his infusion set has malfunctioned. His last glucose check that morning was 529 mg/dL. He endorses nausea/vomiting. On exam, his breath smells fruity, he has dry mucous membranes, and you can tent his skin easily. Which one of the following is likely to be contributing to the ongoing disease process?

In patients with diabetes who develop albuminuria, which of the following is the recommended drug treatment to decrease the rate of progression of kidney disease?

A 53-year-old male with type 1 diabetes presents to your clinic for the first time. He is often nauseated, quickly becomes full while eating, and occasionally even has to vomit. These symptoms have been happening daily for the past 3 months. He has a long past history of poor glucose control, but is no longer missing insulin injections and his last A1C was 6.8%. His symptoms are explained by which of the following diabetes-related complications?

A 67-year-old male presents for follow up of his type 2 diabetes and coronary artery disease. His blood pressure is 120/70 and his A1C is 6.7%. To reduce his risk of future cardiovascular events, you recommend which of the following medications?

insulin stimulates which of the following?

A 58-year old male fasts in preparation for a colonoscopy. He has no medical conditions and he does not take any medications. While he fasts, which of the following will help him avoid hypoglycemia?

A 62-year-old male with type 2 diabetes is taking metformin, sitagliptin, and glargine insulin. When he takes an injection of glargine insulin, the insulin facilitates peripheral uptake of glucose into adipose tissue by which of the following mechanisms?

You are seeing a 25-year-old female with new onset diabetes. You determined that she does not have type 1 or type 2 diabetes, but does have an uncommon form of diabetes, Mature Onset Diabetes of the Young (MODY), which is caused by a loss of function mutation of glucokinase. How will this mutation impact the function of this patient's response to rising circulating glucose levels?

A 44-year-old woman with no known medical problems comes to you for evaluation of hypoglycemia. She reports "spells" that occur on average twice daily, during which she reports feeling a shaky and sweating, and her symptoms resolve with eating. You admit her to the hospital for a 72-hour fast and her glucose drops to 31 mg/dL. Which of the following findings would be most suggestive of an insulinoma as the cause of her hypoglycemia?

You are considering prescribing metformin to your patient with type 2 diabetes to help lower his A1C. You review his medical chart for any possible contraindications. You should avoid prescribing metformin to patients with which one of the following conditions?

A 62 year-old male with type 2 diabetes is prescribed pioglitazone. Which of the following describes the mechanism of action for this drug?

A 44-year-old man presents to the Emergency Department with shakiness and palpitations. His weight is 280 lbs. and height is 5'8". He woke in the morning feeling unwell and has not eaten yet this morning. Upon examination, he is sweating and having difficulty speaking and concentrating during your conversation. Upon review of his medication list, you see he was recently started on a medication to treat diabetes. Which of the following is the most likely cause of his recent symptoms?

A 57-year-old female presents for evaluation of type 2 diabetes. She is already taking metformin. You prescribe her empagliflozin. As an astute physician, you want to warn her about potential side effects. Which of the following is a common side effect of empagliflozin?

The major structural protein of very low-density lipoprotein (VLDL) is which of the following?

Lorcaserin reduces appetite and results in weight loss by binding to which of the following receptors?

A 45 year old woman with a BMI of 32 kg/m2 has tried losing weight through several commercial weight loss programs that emphasize portion control and reducing calories. She is frustrated that her weight keeps coming back and she weighs the same months later as before going on a diet. Which of the following describes her body¶s response when she diets and prevents her from being able to keep her weight off?

A 59-year-old male is started on a medication and gains 20 lbs and is now obese. Initiation of which of the following medications could explain his weight gain?

You begin a 28-year-old female on phentermine for weight management. She is most likely to notice which of the following adverse effects?

Evolocumab is a medication that blocks the activity of PCSK9. The blockade of PCSK9 activity results in which of the following?

A 72-year-old male with type 2 diabetes is prescribed liraglutide. When he returns for his follow up visit, he is likely to report which of the following symptoms related to taking liraglutide?

A 42-year-old male presents with new onset type 2 diabetes. He walks on a treadmill in the basement for 30 minutes five days per week. His dietary recall is detailed below. He is taking metformin 500 mg twice daily. On exam: Ht = 6¶Wt = 237# BMI = 32.1. Labs: A1C = 6.7%, total cholesterol = 250 mg/dL, LDL = 177 mg/dL, HDL = 31 mg/dL, triglycerides = 210 mg/dL. Dietary recall: Breakfast = 2 scrambled eggs mixed with spinach and tomatoes and 2 oz shredded cheddar cheese, 2 chicken sausage links, 12 oz whole milk Lunch = chef salad (ham, 2 hard-boiled eggs, lettuce, tomato, cucumber, 3 oz shredded cheddar cheese), 4 tablespoons ranch salad dressing, 20 oz diet coke Dinner = 6 oz cooked beef brisket, spinach salad (3 cups raw spinach, tomatoes, yellow bell peppers, 3 oz shredded cheddar cheese), 4 tablespoons ranch salad dressing, 20 oz diet coke. Which one of the following lifestyle changes would you first address with this patient?