WBR1144

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Endocrine, SubCategory::Endocrine
Prompt	[[Prompt::A 43 year old man, is complaining of increased frequency of urination, increased thirst, weakness and fatigue. He is exercising regularly and trying to reduce weight. He denies difficulties in the vision, and tingling and numbness in hands and feet. His BMI is 27.2, however his appearance is otherwise normal. The fasting blood glucose was 121mg/dl and Hb A1c: 7.1 Glucose tolerance test results are, 1 hr blood glucose level is 186mg/dl and 2 hr blood glucose is 154mg/dl. What is the most likely diagnosis?]]
Answer A	AnswerA::Diabetes mellitus
Answer A Explanation	[[AnswerAExp::Correct! An increased frequency of urination, and thirst, weakness, fatigue are common manifestations of diabetes mellitus. The patient also has increased BMI, which puts him at the risk of developing diabetes mellitus. The American Endocrine Society recommends, HbA1C 6.5% or higher as the primary criterion for the diagnosis of diabetes mellitus. Therefore, the most likely diagnosis is diabetes mellitus.]]
Answer B	AnswerB::Diabetes insipidus
Answer B Explanation	[[AnswerBExp::Incorrect! Excessive urination and also extreme thirst (especially for cold water and sometimes ice or ice water) are typical for diabetes insipidus. The symptoms of excessive urination and extreme thirst are similar to what is seen in untreated diabetes mellitus, with the distinction that there is no impairment in the glucose levels and change in HbA1C.]]
Answer C	AnswerC::Impaired glucose tolerance
Answer C Explanation	AnswerCExp::Incorrect! Although glucose tolerance test is suggestive of impaired glucose tolerance, HbA1C is 7.1, the American Endocrine Society recommends, HbA1C 6.5% or higher as the primary criterion for the diagnosis of diabetes mellitus.
Answer D	AnswerD::Insulinoma
Answer D Explanation	[[AnswerDExp::Incorrect! Insulinoma is an insuline producing tumor of the pancreas. Excess insuline results in hypoglycemia and not hyperglycemia. Patients with insulinoma usually develop neuroglycopenic symptoms. These include recurrent headache, lethargy, diplopia, and blurred vision, particularly with exercise or fasting. Severe hypoglycemia may result in seizures, coma, and permanent neurological damage. Symptoms resulting from the catecholaminergic response to hypoglycemia (i.e. tremulousness, palpitations, tachycardia, sweating, hunger, anxiety, nausea) are not as common. Sudden weight gain is sometimes seen.]]
Answer E	AnswerE::Growth hormone excess
Answer E Explanation	[[AnswerEExp::Incorrect! Growth harmone excess thickens the bones of the jaw, fingers and toes. Resulting heaviness of the jaw and increased size of digits is referred to as acromegaly. Accompanying problems can include sweating, pressure on nerves (e.g. carpal tunnel syndrome), muscle weakness, excess sex hormone-binding globulin (SHBG), insulin resistance or even a rare form of diabetes mellitus, and reduced sexual function. The patient does not have features of growth hormone excess.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::The American Endocrine Society recommends, HbA1C 6.5% or higher as the primary criterion for the diagnosis of diabetes mellitus. Educational Objective: References: https://www.aace.com/files/position-statements/a1cpositionstatement.pdf]]
Approved	Approved::No
Keyword	WBRKeyword::Diabetes mellitus, WBRKeyword::Diabetes mellitus type 2
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