NMS Q&A Family Medicine

196 NMS Q&A Family Medicine(E) Hyperosmolar state precipitated by inadequateblood sugar control5 Which of the following statements about the HHS istrue?(A) It carries a mortality rate considerably lowerthan that of DKA.(B) It is known for a significant anion gap.(C) The major precipitants are medicationnoncompliance, ethanol, and cocaine use.(D) The presence of gastroparesis effectively rulesout hyperosmolar state in favor of ketoacidosisand diabetes type 1.(E) The most rapidly effective therapy is insulin.6 Which of the following families of oral agents applicableto diabetes type 2 can facilitate weight loss?(A) Sulfonylurea agents, such as glyburide(B) Biguanides, metformin(C) Non-sulfonylurea secretagogues such asrepaglinide(D) Thiazolidinediones (“glitazones”), for example,pioglitazone(E) Alpha-glucosidase inhibitors, such as acarbose7 A 47-year-old 257-lb (116.4-kg) man whose height is5 ft, 7 in. (1.7 m) has been followed for type 2 diabetesfor the past 2 years. His treatment has consisted ofescalating institutions and additions of, first, 10 to20 mg of glyburide; 500 to 2 g of metformin daily; and4 mg of pioglitazone daily. During that time, his weighthas increased from an initial level of 215 lb (97.4 kg)2 years ago to the present weight given here. His latesthemoglobin A1C level was 8.5%. He now complainsof burning pains in his legs and feet and asks whythat would be so and what should be done about it.For you to address the base cause, which of the followingis the most clearly relevant information?(A) The pains are caused by noncompliance by thepatient.(B) The pains are caused by ischemic peripheralvascular disease.(C) The pains are a side effect of the metformin.(D) The pains are caused by long-standinghyperglycemia.(E) The pains are caused by lumbar radiculopathy.8 In performing a routine periodic history and physicalexamination on a 56-year-old Mexican woman whoweighs 175 lb (79.3 kg), you included a glycohemoglobin(HbA1C) study to supplement a complete bloodcell count, comprehensive metabolic panel, and fastinglipids. Her fasting glucose level was 115 mg/dL,and a 2-hour postprandial (PP) blood sugar level was160 mg/dL. BUN and creatinine levels are normal.The complete blood cell count shows a hemoglobinlevel of 8 g/L and a hematocrit measure of 31. TheHbA1C level was 5.9% (normal is 6%). Which ofthe following factors could not explain a lower thanexpected HbA1C?(A) Thallassemia(B) Recent blood loss(C) Patient’s diabetes is not severe enough to createa sustained level of hyperglycemia.(D) A hemoglobin variant that co-elutes withhemoglobin A(E) Hereditary spherocytosis9 Which of the following list of factors is includedby both the World Health Organization and theAdult Treatment Panel III in defining metabolicsyndrome X?(A) Waist circumference, serum triglyceride level,high-density lipoprotein cholesterol (HDL-C)level, blood pressure, and fasting glucose level(B) Triglyceride level 150 mg/dL, HDL-C level 40 mg/dL, and blood pressure of 130/85(C) Triglyceride level 150 mg/dL, HDL-C level 35 mg/dL, waist-to-hip ratio 0.9, and bloodpressure 140/90(D) Central obesity, type 2 diabetes mellitus, andhypertension(E) Dyslipidemia and diabetes mellitus10 A 45-year-old type 2 diabetic male patient weighing240 lb (109 kg) at a height of 5 ft, 10 in. (1.77 m) hasnot lost weight as mandated by his physician. Recentlya coworker underwent leg amputation as a result ofuncontrolled diabetes. Now the patient is newlymotivated to lose weight and wishes to review thecorrect diet for control of his diabetes. Which of thefollowing is the correct diet for control of his diabetes,assuming he has stable weight?(A) An intake of 3,000 cal as 412 g of carbohydrate(CHO), 113 g of protein, and 113 g of fat(B) An intake of 2,000 cal as 250 g of CHO, 75 g ofprotein, and 75 g of fat(C) An intake of 1,700 cal as 233 g of CHO, 64 g ofprotein, and 64 g of fat(D) An intake of 1,200 cal as 164 g of CHO, 45 g ofprotein, and 45 g of fat(E) An intake of 800 cal as 100 g of CHO, 40 g ofprotein, and 30 g of fat11 A 16-year-old girl, who weighs normally 140 lb at aheight of 5 ft, 8 in., is brought to you with complaintsof weight loss, increasing fatigue, thirst, and polyuriaaccelerating over the past 3 weeks. Her blood sugar is450 mg/dL and serum bicarbonate level is 19 mmol.You hospitalize her and start fluid therapy (1 L of