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NBME Q

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10 Posts

structure
Forum Junior

Topics: 26
Posts: 28

08/15/06 - 08:06 PM

A 57 yr old man with a 10 yr history of type 2 diabetes mellitus comes to the physician fora routine exam. His last office visit was 6 months ago He feels well. Current medications include enalapril and glyburide. He is 168 cm tall and weigh 84kg BMI is 30 kg/m2. His pulse is 60 / min. and blood pressure is 100/70 mm Hg. Funduscopic exam shows soft and hard exudates. Lab studies show:

Hemoglobin A1 12%
Serum
Urea nitrogen(BUN) 23mg/dL
Creatinine 1.4 mg/dL
Urine protein 1+

Which of the following is the most appropriate additional pharmacotherapy?

A. Atenolol
B Captopril
C Hydrochlorothiazide
D Metformin
E Verapamil

go with A

usmle262005
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Topics: 7
Posts: 18

08/15/06 - 09:29 PM

d metformin

study_ing
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Topics: 180
Posts: 2,511

08/15/06 - 09:55 PM

d

since pulse is 60 and bp 100/70, i dont htink atenolol is nencessary. he needs metformin more

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frank100
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Topics: 48
Posts: 586

08/15/06 - 10:40 PM

(d), same reasons

achilles
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Topics: 88
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08/16/06 - 07:22 AM

metformin. and it will also help him lose weight as opposed to the other group of oral hypoglycemics which cause a slight increase in weight.

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shumaila
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Topics: 58
Posts: 347

08/16/06 - 11:31 AM

D too

usmlecracker
Forum Elite

Topics: 37
Posts: 136

08/16/06 - 02:21 PM

put him on captopril..to reduce his renal failure and proteinuria..
i knnow ...sr .cr is only 1.6...it is contraindicated if .2.5..please correct if any change

Perhaps
Forum Elite

Topics: 61
Posts: 162

08/16/06 - 02:33 PM

usmlecracker wrote:
put him on captopril..to reduce his renal failure and proteinuria..
i knnow ...sr .cr is only 1.6...it is contraindicated if .2.5..please correct if any change

I chose the same captopril when taking the test, but now after reading again the question, the pt is already on enalapril. Otherwise ACEi would be the one I guess.

AAAAA
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Topics: 156
Posts: 1,991

08/16/06 - 03:05 PM

structure wrote:
A 57 yr old man with a 10 yr history of type 2 diabetes mellitus comes to the physician fora routine exam. His last office visit was 6 months ago He feels well. Current medications include enalapril and glyburide. He is 168 cm tall and weigh 84kg BMI is 30 kg/m2. His pulse is 60 / min. and blood pressure is 100/70 mm Hg. Funduscopic exam shows soft and hard exudates. Lab studies show:

Hemoglobin A1 12%
Serum
Urea nitrogen(BUN) 23mg/dL
Creatinine 1.4 mg/dL
Urine protein 1+

Which of the following is the most appropriate additional pharmacotherapy?

A. Atenolol
B Captopril
C Hydrochlorothiazide
D Metformin
E Verapamil

go with A

D

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juanma0
Forum Senior

Topics: 10
Posts: 146

08/17/06 - 08:55 PM

#10

this patient already has great HTN control, but horrible glycemic control. Needs metformin (only one that can do this). Also benefits other areas already discussed. Hmmm, watch out for this Q. It is poorly written because metformin is only answer that is completely different. USMLE would not make such simple mistake in Q format.

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