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