DIABETES MELLITUS PART 2

Question 1

sudden onset
polyuria
25% present with DKA
weight loss
 blurred vision
paresthesias

Answer 1

type I DM

Question 2

gradual onset of hyperglycemia
metabolic signs often realized in retrospect
GU signs: balanitis, candidly vulvovaginitis

Answer 2

type 2 DM

Question 3

what percent of dosing should be basal insulin?

Answer 3

40-50%

Question 4

NPH, Detemir, Glargine are examples of what kind of insulin?

what about Degludec?

Answer 4

basal insulin, intermediate to long acting preparation

basal insulin, very long acting

Question 5

this is the preferred initial agent in asymptomatic patients without catabolism

if A1C is greater 7.5-8% then medication should be considered?

side effects: GI, Vit B12 deficiency, reduced lactate uptake by liver

Answer 5

metformin

Question 6

what conditions should you worry about lactic acidosis with the use of metformin?

renal failure
liver failure
excess alcohol intake
all the above

Answer 6

all the above

Question 7

the goal Hgb A1C for most patients being for treated diabetes is?

<6
<6.5
<7
<7.5
<8

Answer 7

goal Hgb A1C <7.0%

FBG 80-130 mg/dL
PP glucose (90-120 min) <180 mg/dL

Question 8

of the parameters listed, which is least important in the CV health of an elderly patient?

cholesterol
blood pressure
fasting blood sugar

Answer 8

blood sugar

Question 9

when considering secondary medication following metformin in a diabetic patient with continued elevation of Hgb A1C level and established CV disease, which agent is preferred?

GLP-1 RA
Glyburide
SGLT-2 inhibitor
insulin

Answer 9

GLP-1 RA

reduces incidence of:
nonfatal MI
nonfatal stroke
death from CV causes

and

slow the rate of decline in GFR and worsening of albuminuria

Question 10

when considering secondary medication following metformin in a diabetic patient with continued elevation of Hgb A1C level and heart failure, which agent is preferred?

GLP-1RA
Glyburide
SGLT-2 inhibitor
insulin

Answer 10

SGLT-2 inhibitor

empagliflozin and canagliflozin lower CV death (MI, stroke)

dapagliflozin lowers risk of HF or CV death

if HF or CKD, SGLT2 inhibitors slow the rate of decline of GFR

Question 11

common side effect of SGLT-2 inhibitors is?

thrombocytopenia
GU yeast infections
Rash
anaphylaxis

Answer 11

GU yeast infections

Question 12

when considering secondary medication following metformin in a diabetic patient with fasting BG?250 mg/dL, Hgb A1C level >9.0% and ketonuria, which agent is preferred?

GLP-1RA
glyburide
SGLT-2 inhibitor
insulin

Answer 12

insulin

Question 13

which meds for diabetes can causes weight gain?

insulin and sulfonylureas
GLP-1 RAs and DPP-4 inhibitors
SGLT-2 inhibitors
metformin

Answer 13

insulin and sulfonylureas

Question 14

of the medications listed below, which is considered first line for tx for HFrEF?

empagliflozin
sacubitril/valsartan
lisinopril
epleronone

Answer 14

sacubitril/valsartan

Question 15

what SGLT-2 inhibitor has been added to the list of recommended agents in HFrEF?

Answer 15

empagliflozin

Question 16

previously, no medications were shown to have an outcome improvement in HFpEF. What meds have now been shown to have an outcome improvement?

lisinopril
sacubitril/valsartan
empagliflozin
epleronone

Answer 16

sacubitril/valsartan

Question 17

when monitoring heart rhythm with implantable or surface devices, what percentage or patients have >5 minutes of asymptomatic atrial fibrillation?

<10%
35%
50%
70%

Answer 17

35%

Question 18

what is worse of the oxygen supply demand mismatch of the heart?

tachycardia
hypertension

Answer 18

tachycardia

Question 19

what is the normal contribution of atrial contraction to total ventricular filling of blood?

10-15%
20-25%
45-50%
100%

Answer 19

20-25%

Question 20

what area of the heart is a clot likely to form during episodes of blood stagnation due to atrial fibrillation and leads to a stroke?

right atrium
right ventricle
left atrium
left ventricle

Answer 20

left atrium

Question 21

the most frequent manifestation of embolization in patients with atrial fibrillation is?

renal infarct
coronary artery embolus
acute ischemic stroke
mesenteric ischemia

Answer 21

acute ischemic stroke

Question 22

of the tests listed, which test should be ordered in a patient with a new diagnosis of atrial fibrillation:

procalcitonin
TSH, FT4
cortisol level
epinephrine level

Answer 22

TSH, FT4

Question 23

A 68 y/p patient with a history of HTN presents to the ED with new onset of palpitations and AF (rate 120) on ECG. His is otherwise asymptomatic and stable. What would be a reasonable first intervention for this patient?

metoprolol
amiodorone
electrical cardioversion

Answer 23

metoprolol