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Created page with "{{WBRQuestion |QuestionAuthor={{MM}} |ExamType=USMLE Step 3 |MainCategory=Primary Care Office |SubCategory=Endocrine |MainCategory=Primary Care Office |SubCategory=Endocrine |..."
 
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|ExamType=USMLE Step 3
|ExamType=USMLE Step 3
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|MainCategory=Primary Care Office
|SubCategory=Endocrine
|SubCategory=Endocrine, Endocrine
|Prompt=A 45 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago.  She has been following a diet and exercise to control her hyperglycemic state without medication, but so far it has no effect on her blood glucose level.  Her recent laboratory test results are shown below:
|Prompt=A 45 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago.  She has been following a diet and exercise to control her hyperglycemic state without medication, but so far it has no effect on her blood glucose level.  Her recent laboratory test results are shown below:
*Hemoglobin 13 mg/dL
*Hemoglobin 13 mg/dL
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|Explanation=[[Metformin]] is contraindicated in those with [[renal dysfunction]] because it can accumulate and cause [[metabolic acidosis]].  It should not be used among [[chronic kidney disease]](CKD) patients with eGFR <30 mL/min because of an increased risk of [[lactic acidosis]].  The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI)  guidelines recommended that metformin may be used among patients with an estimated GFR >45 mL/min.  
|Explanation=[[Metformin]] is contraindicated in those with [[renal dysfunction]] because it can accumulate and cause [[metabolic acidosis]].  It should not be used among [[chronic kidney disease]](CKD) patients with eGFR <30 mL/min because of an increased risk of [[lactic acidosis]].  The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI)  guidelines recommended that metformin may be used among patients with an estimated GFR >45 mL/min.  
The oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting sulfonylureas (eg, glipizide) and repaglinide.
The oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting sulfonylureas (eg, glipizide) and repaglinide.
|AnswerA=Metformin
|AnswerA=Metformin
|AnswerAExp=Incorrect
|AnswerAExp=Incorrect
[[Metformin]] is contraindicated in those with renal dysfunction.
[[Metformin]] is contraindicated in those with renal dysfunction.
|AnswerB=Sulfonylureas
|AnswerB=Sulfonylureas
|AnswerBExp=Correct
|AnswerBExp=Correct
[[Sulfonylureas]] are the oral hypoglycemic drug of choice in patients with renal dysfunction.
[[Sulfonylureas]] are the oral hypoglycemic drug of choice in patients with renal dysfunction.
|AnswerC=Glitazones
|AnswerC=Glitazones
|AnswerCExp=Incorrect
|AnswerCExp=Incorrect
Short acting [[sulfonylureas]] are the oral hypoglycemic drug of choice in patients with [[renal dysfunction]].
Short acting [[sulfonylureas]] are the oral hypoglycemic drug of choice in patients with [[renal dysfunction]].
|AnswerD=Insulin
|AnswerD=Insulin
|AnswerDExp=Incorrect
|AnswerDExp=Incorrect
If oral hypoglycemic drugs fail (or stop helping), [[insulin]] therapy may be necessary, usually in addition to oral medication therapy, to maintain normal glucose levels.
If oral hypoglycemic drugs fail (or stop helping), [[insulin]] therapy may be necessary, usually in addition to oral medication therapy, to maintain normal glucose levels.
|AnswerE=Alpha glucosidase inhibitors
|AnswerE=Alpha glucosidase inhibitors
|AnswerEExp=Incorrect
|AnswerEExp=Incorrect
Short acting sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.
Short acting sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.
 
|EducationalObjectives=[[Metformin]] is contraindicated in those with [[renal dysfunction]], the oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting [[sulfonylureas]] (eg, glipizide) and repaglinide.
|EducationalObjectives=Metformin is contraindicated in those with renal dysfunction, the oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting sulfonylureas (eg, glipizide) and repaglinide.  
|References=The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.
|References=The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.
|RightAnswer=B
|RightAnswer=B

Revision as of 22:09, 16 March 2014

 
Author [[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type ExamType::USMLE Step 3
Main Category MainCategory::Primary Care Office
Sub Category SubCategory::Endocrine, SubCategory::Endocrine
Prompt [[Prompt::A 45 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago. She has been following a diet and exercise to control her hyperglycemic state without medication, but so far it has no effect on her blood glucose level. Her recent laboratory test results are shown below:
  • Hemoglobin 13 mg/dL
  • Total blood cholesterol of 270mg/dL
  • LDL of 190mg/dL
  • HDL of 28 mg/dL
  • Glucose 190 mg/dL
  • HgbA1C 9.8%
  • BUN 35
  • Creatinine 3.4
  • eGFR <30 mL/min
  • ALT 15 IU/L
  • AST 10 IU/L

You decided to start a medical therapy to control her hyperglycemia. Which of the following is the best initial medical therapy for her condition?]]

Answer A AnswerA::Metformin
Answer A Explanation [[AnswerAExp::Incorrect

Metformin is contraindicated in those with renal dysfunction.]]

Answer B AnswerB::Sulfonylureas
Answer B Explanation [[AnswerBExp::Correct

Sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.]]

Answer C AnswerC::Glitazones
Answer C Explanation [[AnswerCExp::Incorrect

Short acting sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.]]

Answer D AnswerD::Insulin
Answer D Explanation [[AnswerDExp::Incorrect

If oral hypoglycemic drugs fail (or stop helping), insulin therapy may be necessary, usually in addition to oral medication therapy, to maintain normal glucose levels.]]

Answer E AnswerE::Alpha glucosidase inhibitors
Answer E Explanation [[AnswerEExp::Incorrect

Short acting sulfonylureas are the oral hypoglycemic drug of choice in patients with renal dysfunction.]]

Right Answer RightAnswer::B
Explanation [[Explanation::Metformin is contraindicated in those with renal dysfunction because it can accumulate and cause metabolic acidosis. It should not be used among chronic kidney disease(CKD) patients with eGFR <30 mL/min because of an increased risk of lactic acidosis. The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommended that metformin may be used among patients with an estimated GFR >45 mL/min.

The oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting sulfonylureas (eg, glipizide) and repaglinide.
Educational Objective: Metformin is contraindicated in those with renal dysfunction, the oral agents that are thought to be relatively safe in patients with non-dialysis CKD include short-acting sulfonylureas (eg, glipizide) and repaglinide.
References: The 2012 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines.]]

Approved Approved::No
Keyword [[WBRKeyword::Diabetes mellitus type 2]]
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