A 56-year-old man comes to the office for follow up.

He has type 2 diabetes

mellitus of 15 years duration, hypertension, and hyperlipidemia. His
diabetes mellitus is currently managed with metformin and glimepiride.
Hemoglobin A1c level is 8.5%. Switching to insulin therapy to attain better
glycemic control is discussed with the patient. Achieving a goal hemoglobin
A1c of 6.5% with use of insulin is most likely to reduce the risk of
?which of the following complications over the next 5 years

A. All-cause mortality
B. Hypoglycemia
C. Myocardial infarction
D. Retinopathy
E. Stroke
A 63-year-old man comes to the urgent care center with a 2-week history of an ulcer on his
right foot. He has no associated pain, fever, chills, or
skin rash. The patient was diagnosed with hypertension 5 years ago but did not follow up
with a physician, and he has had no surgeries or
hospitalizations. He takes ibuprofen for occasional back pain. The patient has a 30-pack
year smoking history but quit 2 years ago . He drinks 1
or 2 beers daily and does not eat red meat or processed foods. The patient considers
.himself to be in good health and walks several miles a day
Temperature is 36. 7 C (98.1 F), blood pressure is 156/98 mm Hg, and pulse is 88/min. BMI
is 32 kg/m2. On examination, the feet are warm and
dry. A nontender ulcer with a thick surrounding callus is present on the sole of the foot just
below the head of the first metatarsal bone. Which of
?the following will most likely diagnose the underlying cause of this patient's foot ulcer
A. Alcohol screening questionnaire 0
B. Ankle-brachia! index 0
C. Culture from the ulcer bed 0
D. Duplex venous ultrasound 0
E. Hemoglobin A1c assay 0
F Hepatitis C testing 0
G. TSH level 0
0 Which of the following recognized causes of DKA is
most common?

0 Missed or disrupted insulin treatments

0 Previously unknown/newly diagnosed diabetes
0 Underlying concomitant infection
0 Stress
0 Which of the following is not considered a routine test used in the investigation
of DKA?

0 Glucose tests every 1-2 hours until stable, then every 4-6 hours

0 Prothrombin time initially and then repeated 4-6 hours later

0 Serum electrolyte determinations every 1-2 hours until stable, then every 4-6
hours

0 Initial arterial blood gas measurements, followed by bicarbonate measurement

as necessary
0 A 52-year-old obese woman has long-standing type 2 diabetes mellitus
inadequately controlled on metformin and pioglitazone. Insulin glargine
(15 units subcutaneously at bedtime) has recently been started because
of a hemoglobin A1C level of 8.4. Over the weekend, she develops
nausea, vomiting, and diarrhea after exposure to family members with a
similar illness. Afraid of hypoglycemia, the patient omits the insulin for 3
nights. Over the
next 24 hours, she develops lethargy and is brought to the emergency
room. On examination, she is afebrile and unresponsive to verbal
command.
Blood pressure is 84/52.
Skin turgor is poor and mucous membranes dry.
Neurological examination is nonfocal; she does not have neck rigidity.
Laboratory results are as follows:

Na: 126 mEq/L

K: 4.0 mEq/L
Cl: 95 mEq/L
HCO3: 22 mEq/L
Glucose: 1100 mg/dL
BUN: 84 mg/dL
Creatinine: 3.0 mg/dL
0 
0 Which of the following is the most likely cause of this
patient’s coma?

• A Diabetic ketoacidosis
• B Hyperosmolar hyperglycemic state
• C Syndrome of inappropriate ADH secretion
• D Drug-induced hyponatremia
• E Bacterial meningitis