Clinical management scenarios for diabetes control, thyroid nodule workup, and adrenal incidentalomas as tested on USMLE Step 2 CK.
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- First-line pharmacologic therapy for type 2 diabetes
- Metformin
- General HbA1c goal for most nonpregnant adults with diabetes
- Less than 7%
- Primary mechanism of action of metformin
- Decreases hepatic gluconeogenesis
- Metformin is contraindicated at what level of renal function
- eGFR below 30 mL/min/1.73m2
- Preferred add-on agent to metformin in a type 2 diabetic with established atherosclerotic cardiovascular disease
- A GLP-1 receptor agonist or SGLT2 inhibitor
- Mechanism of action of SGLT2 inhibitors
- Block glucose reabsorption in the renal proximal tubule
- Serious adverse effect of SGLT2 inhibitors involving ketoacidosis with normal glucose
- Euglycemic diabetic ketoacidosis
- Recommended annual screening test for diabetic nephropathy
- Urine albumin-to-creatinine ratio
- Recommended annual screening exam for diabetic retinopathy
- Dilated fundoscopic eye exam
- Earliest laboratory marker of diabetic nephropathy
- Microalbuminuria
- First step in managing diabetic ketoacidosis
- Aggressive IV isotonic fluid resuscitation
- A fasting plasma glucose of ____ mg/dL or higher on two occasions is diagnostic of diabetes.
- 126
- First test to order when a thyroid nodule is discovered
- Serum TSH
- Next step when a thyroid nodule is found and TSH is low
- Radioactive iodine uptake scan
- Malignancy risk of a hot (hyperfunctioning) thyroid nodule on RAIU scan
- Rarely malignant