NMS Q&A Family Medicine

Diabetes Mellitus 197normal saline for the first 90 minutes), after a 20-unitbolus of regular human insulin, and slow infusion ofregular insulin at 10 units/hour until the blood sugarhas fallen to 250 mg/dL. After slowing the progressof remission, adding 5% dextrose in half-normalsaline (0.45% NaCl) intravenously, you find that sheemerges from acidosis and is ready for dischargehome after 36 hours. Her premorbid weight was120 lb (54.4 kg) at a height of 5 ft, 4 in. (1.63 m). Whichof the following insulin daily dosages would be themost reasonable for an initial regimen?(A) 120 units daily(B) 60 to 120 units daily(C) 27 to 54 units daily(D) 25 units daily(E) 15 units daily12 In evaluating a patient regarding his renal status, younow estimate the progress of disease by noting theresults of the 24-hour urine collection just received.Which of the following findings in the 24-hour urinespecimen should command the most attention inevaluating this patient’s renal status?(A) 10 mg albumin/dL(B) 20 mcg/minute in an overnight specimen(C) 500 mg protein/dL(D) Positive urine culture(E) 3.5 g of protein/24-hour urine output13 A 35-year-old woman, gravida 3, para 2, is in her 25thweek of pregnancy. Although her weight is normalfor her period of gestation, her mother has type2 diabetes, as does an older sister who is overweight.She undergoes the 1 hour, 50-g glucose tolerancetest and the blood sugar at 1 hour is 155 mg/dL(8.6 mmol/L). You decide to place her on a limited CHOdiet to prevent the complications in diabetic progenysuch as macrosomia and neonatal hypoglycemia.Which of the following ranges is considered theminimum necessary to prevent such complications?(A) 105 mg/dL(B) 190 mg/dL (10.5 mmol/L)(C) 165 mg/dL (9.2 mmol/L)(D) 145 mg/dL (8 mmol/L)(E) 73 mg/dL (4 mmol/L)14 A pregnant patient is treated with diet therapy alonefor 3 weeks. You now check her home blood sugarrecordings to assess the degree of success on this regimen,prepared to start insulin if control of the diabetesis not satisfactory. At which of the followingfasting and 2-hour PP limits would you pose as theminimum requirement to start insulin therapy?(A) 75 mg/dL fasting, 95 mg/dL at 2 hours(B) 105 mg/dL fasting, 120 mg/dL at 2 hours(C) 120 mg/dL fasting, 150 mg/dL at 2 hours(D) 150 mg/dL fasting, 160 mg/dL at 2 hours(E) 100 mg/dL fasting, 105 mg/dL at 2 hours15 Diabetologists consider three stages of glucose toleranceor intolerance. Which of the following fastingblood sugar (FBS) levels fits the definition of impairedglucose regulation (vs. normal or diabetes mellitus)?(A) 90 mg/dL FBS(B) 100 mg/dL 2 hours PP(C) 100 to 125 mg/dL fasting(D) 150 to 200 mg/dL 2 hours PP(E) 200 mg/dL PP16 A 16-year-old girl who is known to be a type 1 diabetichas gone through a period of rebellious denialand stopped taking her insulin 7 days ago. Now she isfeeling very thirsty and frightened. She wishes toresume her diabetes management. She is alert. Whichof the following laboratory findings would indicatethat it is safe to manage her case outside thehospital?(A) Serum bicarbonate level of 10 to 15 mEq/L(B) Arterial pH of 7.25 to 7.30(C) High level of beta-hydroxybutyrate; alertpatient(D) Blood sugar of 250 mg/dL(E) Urine ketones positive; alert patient17 A 36-year-old male insulin-dependent diabetic of15 years complains of blurred vision in his left eye.You discover that he did not keep his ophthalmologist’sappointments over the past 3 years. The eyechart shows his near visual acuity to be 20/50 OS and20/20 OD; his far visual acuity is 20/40 OS and 20/25OD. One year ago, his visual acuity was 20/25 OU farand 20/20 OU near. Random blood sugar was 130 byfinger-stick performed by the office nurse as thepatient entered today. A hemoglobin A1C leveldrawn last week was 8.5%. Which of the followingpathophysiologic mechanisms is the cause of thiscondition?(A) Retinal surface proliferative changes impedelight transmission to the retina.(B) Microaneurysms interfere with retinal function.(C) Dot hemorrhages interfere with retinalfunction.(D) Cotton-wool exudates interfere with retinalfunction.(E) Changes in average blood sugar affect refractiondensity of the aqueous fluid.