2021 Diabetes KSA Flashcards
67-year-old male sees you 6 months after he was hospitalized with a non–ST-elevation myocardial infarction. He also has a history of hypertension and type 2 diabetes. His current medications are rosuvastatin (Crestor), 40 mg daily; benazepril (Lotensin), 20 mg daily; metoprolol, 25 mg twice daily; aspirin, 81 mg daily; and clopidogrel (Plavix), 75 mg daily. His fasting lipid profile reveals a total cholesterol level of 198 mg/dL, an LDL-cholesterol level of 70 mg/dL, an HDL-cholesterol level of 40 mg/dL, and a serum triglyceride level of 375 mg/dL.
Adding which one of the following agents is recommended by the American Diabetes Association to further reduce his cardiovascular risk?
Extended-release niacin, 1000 mg at bedtime
Ezetimibe (Zetia), 10 mg daily
Fenofibrate (Tricor), 145 mg daily
Fish oil capsules, 4 g twice daily
Icosapent ethyl (Vascepa), 4 g daily
A 63-year-old male with a 10-year history of type 2 diabetes and hypertension sees you for the first time. On examination he is found to have mild nonproliferative diabetic retinopathy with a few microaneurysms seen on ophthalmic examination. His current medications are simvastatin (Zocor), 40 mg daily; hydrochlorothiazide, 25 mg daily; lisinopril (Prinivil, Zestril), 10 mg daily; extended-release metformin (Glucophage XR), 1000 mg daily; extended-release glipizide (Glucotrol XL), 10 mg daily; and aspirin, 81 mg daily.
Laboratory Findings
Serum sodium…………140 mEq/L (N 135–145)
Serum potassium…………4.3 mEq/L (N 3.5–5.0)
Serum chloride…………105 mEq/L (N 100–108)
CO2…………26 mEq/L (N 24–30)
Serum creatinine…………1.2 mg/dL (N 0.6–1.5)
BUN…………22 mg/dL (N 8–25)
LDL-cholesterol…………98 mg/dL
HDL-cholesterol…………39 mg/dL
Triglycerides…………245 mg/dL
Hemoglobin A1c…………7.7%
The addition of which one of the following lipid-lowering agents has shown potential benefit for reducing the rate of progression of diabetic retinopathy in patients such as this?
A Ezetimibe (Zetia)
Fenofibrate (Tricor)
Fish oil
Gemfibrozil (Lopid)
Niacin
A 58-year-old male with type 2 diabetes has a blood pressure of 147/92 mm Hg. You start him on benazepril (Lotensin) and order a baseline serum creatinine level, which is 1.7 mg/dL (N 0.7–1.3). Two weeks later his blood pressure is 128/80 mm Hg, and his serum creatinine level is 2.1 mg/dL. His creatinine level is unchanged 1 week later.
Which one of the following would be most appropriate at this point?
A Continue benazepril at the same dosage
Reduce the benazepril dosage
Discontinue benazepril
Evaluate the patient for bilateral renal artery stenosis
Have the patient increase his sodium intake
A 66-year-old female sees you for a routine follow-up visit. Her past medical history is notable for type 2 diabetes and hypertension. Her current medications include extended-release metformin (Glucophage XR), 1000 mg daily; lisinopril (Prinivil, Zestril), 40 mg daily; and aspirin, 81 mg daily. A physical examination is unremarkable except for a BMI of 28 kg/m2, a blood pressure of 132/80 mm Hg, and a grade 2/6 midsystolic ejection murmur.
The patient’s hemoglobin A1c is 6.7%, her serum creatinine level is 1.5 mg/dL (N 0.6–1.1), and her estimated glomerular filtration rate is 51 mL/min/1.73 m2. An echocardiogram reveals moderate aortic sclerosis and concentric left ventricular hypertrophy with a left ventricular ejection fraction of 60%–65%.
Based on current American Diabetes Association Guidelines, which one of the following would be most appropriate?
Add glipizide (Glucotrol)
B Add linagliptin (Tradjenta)
Add liraglutide (Victoza)
Add pioglitazone (Actos)
Discontinue metformin
A 72-year-old female with a history of hypertension, stage 4 chronic kidney disease, heart failure, and recurrent urinary tract infections is found to have type 2 diabetes. A trial of dietary therapy is unsuccessful. Her laboratory evaluation is notable for a random glucose level of 240 mg/dL, a hemoglobin A1c of 8.2%, macroalbuminuria, and a serum creatinine level of 3.4 mg/dL.
Which one of the following diabetes agents would be most appropriate?
A Exenatide (Byetta)
Glyburide
Metformin (Glucophage)
Pioglitazone (Actos)
Repaglinide (Prandin)
Diabetes
Knowledge Self-Assessment
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Instructions:
Welcome to the Diabetes KSA! As you work through the 60 questions provided, please read each one carefully and select the single best answer. After you have selected your answer, you may click the “Next Question” button located above the item on the right side in order to proceed to the next unanswered question. If you wish to go back to review previously displayed questions, just click on the “previous question” button above the item on the left side.
To navigate to different tools, references, or to return to your physician portfolio, use the buttons on the left side of the page. Occasionally, physicians prefer to download the questions, and work through the KSA offline. If you want to do this, you can click the “Offline Questions and Answer Sheet” button, located on the left side of the page.
Once you have answered all 60 questions, you will have the opportunity to see which questions you got correct or incorrect, read the critiques and see the references. You can also access comments made by physicians who have taken the KSA previously, as well as add your own comments as desired.
To receive a satisfactory score for this KSA, you will need to answer 80% of all questions correctly. If you do not receive a satisfactory score on your first attempt, you may submit new answers for any questions you got incorrect.
Question: 20 of 60
A 56-year-old male is brought to the emergency department by ambulance with confusion and disorientation. His medical history includes type 2 diabetes and glaucoma.
Laboratory Findings
Arterial pH…………7.25 (N 7.35–7.45)
Blood glucose…………240 mg/dL
Serum sodium…………129 mEq/L (N 136–145)
Serum potassium…………3.1 mEq/L (N 3.5–4.5)
Serum chloride…………95 mEq/L (N 98–107)
Serum HCO3…………7 mEq/L (N 22–29)
Which one of the following is the most likely cause of his high anion gap metabolic acidosis?
Alcoholic ketoacidosis A
Use of acetazolamide
Proximal tubular acidosis
Severe diarrhea
Renal tubular acidosis
A 63-year-old male with a 10-year history of type 2 diabetes presents with a 3- to 4-day history of severe painful swelling of his scrotum and the adjacent skin, accompanied by fever and a foul-smelling discharge. An examination reveals a grossly edematous and tender scrotum that has necrotic-appearing patches of skin with palpable crepitations.
Which one of the following diabetes medications has been linked to this type of scrotal infection?
Canagliflozin (Invokana) A
Exenatide (Byetta)
Glipizide (Glucotrol)
Pioglitazone (Actos)
Sitagliptin (Januvia)
An obese 52-year-old male has a 4-month history of early satiety, nausea, and bloating with occasional vomiting. His past medical history is notable for a 10-year history of type 2 diabetes with moderate nonproliferative retinopathy and diabetic nephropathy with albuminuria. He reports that over the past year he has experienced tingling in both feet as well as erectile dysfunction. His current medications include extended-release metformin (Glucophage XR), 1000 mg daily, and atorvastatin (Lipitor), 10 mg daily. On examination his blood pressure is 150/100 mm Hg supine and 120/80 mm Hg upright. He has reduced sensation to pinprick and vibration in his feet. His hemoglobin A1c is 8.9%. Upper gastrointestinal endoscopy is notable only for some food residue despite the preceding overnight fast.
Which one of the following diabetes medications should be AVOIDED in this patient?
Basal insulin glargine (Lantus)
Dapagliflozin (Farxiga)
Exenatide (Bydureon, Byetta) A
Extended-release glipizide (Glucotrol XL)
Pioglitazone (Actos)
An overweight 50-year-old female with newly diagnosed type 2 diabetes asks you about dietary measures she might use to control her blood glucose. Which one of the following would be accurate advice regarding carbohydrate intake and diabetes?
The glycemic index has consistently been shown to be of value in managing diabetes A
Carbohydrate sources high in protein are effective for treating hypoglycemia
Low-fat diets are more effective for achieving weight loss than low-carbohydrate diets (<130 g daily)
Reducing overall carbohydrate intake for individuals with diabetes has the most evidence for improving glycemia
Carbohydrates have more calories per gram than alcohol
An obese 60-year-old male with a 10-year history of type 2 diabetes and hypertension sees you for a routine follow-up visit. His current medications include extended-release metformin (Glucophage XR), 1500 mg daily; valsartan (Diovan), 320 mg daily; atorvastatin (Lipitor), 40 mg daily; and aspirin, 81 mg daily. He reports having one glass of wine on the weekend only. This past week he underwent a workup for vague right-sided upper abdominal pain. Ultrasonography of the right upper quadrant revealed mild hepatic steatosis and laboratory testing revealed normal aminotransferases. His FIB-4 score is 1.03.
Which one of the following statements is true?
He has a 15% risk for developing cirrhosis
His normal AST and ALT levels rule out nonalcoholic steatohepatitis (NASH) A
The diagnosis of NASH can only be made with a liver biopsy
Vitamin E and pioglitazone (Actos) are FDA approved for the treatment of NASH
Statin therapy should be avoided in patients with NASH
A 45-year-old male with a 10-year history of type 2 diabetes is diagnosed with hypertension. He does not smoke and his current medications include extended-release metformin (Glucophage XR), 1500 mg daily; sitagliptin (Januvia), 100 mg daily; simvastatin (Zocor), 40 mg daily; and aspirin, 81 mg daily. His average blood pressure at a visit last week and today is 154/94 mm Hg. His urine albumin level is 30 µg/mg creatinine. His total cholesterol level is 200 mg/dL, his LDL-cholesterol level is 90 mg/dL, and his HDL-cholesterol level is 52 mg/dL. His 10-year American Heart Association cardiovascular risk score is 10.5%.
Which one of the following is true regarding treatment recommendations for this patient?
Current American Diabetes Association (ADA) guidelines recommend treatment to a systolic blood pressure goal of <130 mm Hg and a diastolic blood pressure goal of <80 mm Hg
JNC 8 guidelines recommend treatment to a systolic blood pressure goal of <150 mm Hg and a diastolic blood pressure goal of <90 mm Hg
The SPRINT trial (Systolic Blood Pressure Intervention Trial) supports targeting a systolic blood pressure goal of <120 mm Hg
A ADA guidelines recommend initiating therapy with either an ACE inhibitor or an angiotensin receptor blocker
A 62-year-old female has a 5-year history of type 2 diabetes and a 2-year history of poorly controlled hypertension. Her current medications are olmesartan medoxomil (Benicar), 40 mg daily; amlodipine (Norvasc), 10 mg daily; chlorthalidone, 25 mg daily; extended-release metformin (Glucophage XR), 850 mg twice daily; and liraglutide (Victoza), 1.2 mg subcutaneously daily. A physical examination is notable for a blood pressure of 150/94 mm Hg.
Laboratory Findings
Serum sodium…………140 mEq/L (N 135–145)
Serum potassium…………3.9 mEq/L (N 3.5–5.0)
Serum chloride…………108 mEq/L (N 100–108)
CO2…………26 mEq/L (N 24–30)
Serum creatinine…………1.4 mg/dL (N 0.6–1.5)
BUN…………29 mg/dL (N 8–25)
Hemoglobin A1c…………6.7%
The American Diabetes Association recommends which one of the following to improve control of this patient’s blood pressure?
Aliskiren (Tekturna)
Doxazosin (Cardura)
Enalapril (Vasotec)
A Metoprolol
Spironolactone (Aldactone)
A 62-year-old female has a 5-year history of type 2 diabetes and a 2-year history of poorly controlled hypertension. Her current medications are olmesartan medoxomil (Benicar), 40 mg daily; amlodipine (Norvasc), 10 mg daily; chlorthalidone, 25 mg daily; extended-release metformin (Glucophage XR), 850 mg twice daily; and liraglutide (Victoza), 1.2 mg subcutaneously daily. A physical examination is notable for a blood pressure of 150/94 mm Hg.
Laboratory Findings
Serum sodium…………140 mEq/L (N 135–145)
Serum potassium…………3.9 mEq/L (N 3.5–5.0)
Serum chloride…………108 mEq/L (N 100–108)
CO2…………26 mEq/L (N 24–30)
Serum creatinine…………1.4 mg/dL (N 0.6–1.5)
BUN…………29 mg/dL (N 8–25)
Hemoglobin A1c…………6.7%
The American Diabetes Association recommends which one of the following to improve control of this patient’s blood pressure?
Aliskiren (Tekturna)
Doxazosin (Cardura)
Enalapril (Vasotec)
A Metoprolol
Spironolactone (Aldactone)
A mildly obese 56-year-old female sees you for follow-up of type 2 diabetes which was diagnosed earlier in the year. She is taking metformin (Glucophage XR), 2000 mg daily. Her most recent hemoglobin A1c was 7.9% and she expresses an interest in starting linagliptin (Tradjenta), a DPP-4 inhibitor that her brother takes.
Which one of the following statements about DPP-4 inhibitors is true?
They are more effective than metformin for lowering hemoglobin A1c
They reduce insulin resistance
They augment glucagon secretion
They are associated with weight loss
A They will not increase her risk for hypoglycemia
An obese 47-year-old female with a 5-year history of impaired fasting glucose sees you for a routine follow-up visit. Her condition has been managed with lifestyle intervention and metformin (Glucophage), 1000 mg twice daily. She is upset that she has gained 5 kg (11 lb) during the past year even though she has continued her previous exercise routine and has not changed her diet. Her hemoglobin A1c is now 7.2%. A friend of hers has experienced success with semaglutide (Ozempic), a GLP-1 receptor agonist, and the patient asks if this would be an option for her. Laboratory testing at this visit includes a normal TSH level.
Which one of the following is NOT a mechanism of action of GLP-1 receptor agonists?
Enhancing insulin secretion
Suppressing of glucagon secretion
A Enhancing insulin sensitivity of muscle
Slowing of gastric motility
Increasing satiety
