pat05
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A 54 yo female comes into your office with complaints of malaise, fatigue, and chest pain with exertion. After taking a detailed history, you find out that she has Type I Diabetes Mellitus. You decide to get some labs. Laboratory studies show HbA1C at 12%, plasma glucose at 223 mg/dl, increased BUN, and macroalbuminuria. On fundoscopic examination, you notice retinopathy. What else is likely to be in this patient?
a. Hypothyroidism
b. Hypoparathyroidism
c. Decreased plasma creatinine
d. Normocytic anemia
e. Increased plasma calcitriol
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| pat05
Forum Newbie
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i would guess it's d. Normocytic anemia.
if it were hypothyroidism wouldn't her glucose be higher? since they tend to gain weight? -bad logic, oh well.
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| doc179
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D I think
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| silver
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a. Hypothyroidism
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| pat05
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why?
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| silver
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Type 1 DM has autoimmune pathogenesis, and it's observed in these type 1 diabetics, that once they have manifested type 1DM, the other autoimmune processes also become dysfunctional-->therefore hypothyroidism, specifically Hashimoto.
furthermore, type 1 DM has HLA-DR3 association and Hashimoto's also has HLA-DR3.
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| new_n_lost
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its Hypothyroidism
Auto-immunity i.e Hashimoto's, Graves's disease and Addison's all having HLA - Dr 3
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| new_n_lost
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there is no indication that this pt has gone into CRF and the question hasnt suggested that so unless the Question gives a hint of CRF the D Normocyctic anemia is not possible.
My 2 cents.
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| Luckyall
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i d also go with hypoTH ism..whas the answer , pat05 ???
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| pat05
Forum Newbie
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i don't know... thought you'd know.
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| RayBerg
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silver wrote:
Type 1 DM has autoimmune pathogenesis, and it's observed in these type 1 diabetics, that once they have manifested type 1DM, the other autoimmune processes also become dysfunctional-->therefore hypothyroidism, specifically Hashimoto.
furthermore, type 1 DM has HLA-DR3 association and Hashimoto's also has HLA-DR3.
Good catch Silver! Very impressive. I picked D myself..but that's because I didn't think about the HLA-DR3 relationship.
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| doc179
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yeah...thanx silver, could not think in that way. 
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| new_n_lost
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Ok Guys after Being kinda reminded by one of My very good friend and a Fellow Moderator of the 2 rules of MLE :-
1) DONT ASSUME LOOK FOR THE INFO WHICH IS PRESENT NOT WHT U THINK SHUD BE THERE
2) If 2 Options SEEM to be CORRECT then THEY BOTH R WRONG AND U HAVE TOTALLY MISSED THE POINT OF THE QUESTION.
According to her Choices A and B r correct if we follow the Auto Immune Theory i.e Poly Glandular Syndromes Such as PGS 1 ( which Incorporates DM1 with Hypo PTHism) and PGS 3A ( which Incorporates DM1 with Hypo THism)
2ndly the age doesnt fit the Criteria of the Auto Immune cos since its DM1 she will have them long before this picture.
Lastly the Increased Macroalbuminuria and Inc BUN with Chest Pain which is due to Hyperkalemia all indicate towards ESRD ( End Stage Renal Disease) thus making the Choice D as the best answer.
Damn i totally missed that. Overthought and didnt focus on the question and forgot the 2 rules. I posted them here so that all can benefit and Remember.
Edited by new_n_lost on 06/07/07 - 07:41 PM. Reason: Happy Now !!!!!!
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| Aashi
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new_n_lost wrote:
Ok Guys after Being kinda reminded by one of My very good friend and a Fellow Moderator of the 2 rules of MLE :-
1) DONT ASSUME LOOK FOR THE INFO WHICH IS PRESENT NOT WHT U THINK SHUD BE THERE
2) If 2 Options SEEM to be CORRECT then THEY BOTH R WRONG AND U HAVE TOTALLY MISSED THE POINT OF THE QUESTION.
According to her Choices A and B r correct if we follow the Auto Immune Theory i.e Poly Glandular Syndromes Such as PGS 1 ( which Incorporates DM1 with Hypo PTHism) and PGS 3A ( which Incorporates DM1 with Hypo THism)
2ndly the age doesnt fit the Criteria of the Auto Immune cos since its DM1 she will have them long before this picture.
Lastly the Increased Macroalbuminuria and Inc BUN with Chest Pain which is due to Hyperkalemia all indicate towards ERDS ( End Stage Renal Disease) thus making the Choice D as the best answer.
Damn i totally missed that. Overthought and didnt focus on the question and forgot the 2 rules. I posted them here so that all can benefit and Remember.
  cant be happier NNL
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| silver
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well then!
important lessons learned!! thanks nnl
true...macroalbuminuria and retinopathy are indicative of ESRD...i overlooked this and focused more on the autoimmune aspect.
need to read every word carefully!!!!!!!
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| pat05
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great rules to live by
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| kingusmle
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whats the answer guys??is it not d??I think its d....
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| silver
Forum Guru
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kingusmle wrote:
whats the answer guys??is it not d??I think its d.... yes it's D
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| kingusmle
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pat05 where is this qs from?
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| pat05
Forum Newbie
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valuemd.com forum. it was never answered by the poster.
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| doc179
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nice rules, thanx for them NNL and to that friend of yours as well.
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| drduck
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i have a doubt....
MACROalbuminuria.....with H/O DM......dont u think its signing progressive renal failure......and early onset of ESRD????
also look at the symptoms.....i mean malaise, fatigue.....both pointing towards moderate anaemia.
also, the chest pain....it is a high output condition and.....many patients of anaemia come with only with this sole symptom....
nowhere Q tells us or shows any evidence of hypothyroidism......
most important.....hypothyroidism will not be diagnosed so late in life.....
other things like retinopathy and HbA1C...values shows its is quite possible to have a nephropathy with early onset of ESRD.
so, i feel answer must be ANAEMIA....
anyone there to help me out??????
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| new_n_lost
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lol Dude go thru last 7-8 posts u will find the answer
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| drduck
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OH GOD.....i am really sorry,
i didnt go thru the post completely......actually everyone in the begining posted hypothyroidism as answer....
i just cudnt accept....
so that means answer is D.....is that final.....
plz for the last time post the correct answer...
and thanks NNL....
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| ssrpk
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wow, nnl has dissected the question beautifully ..... thanks a lot.
and yes drduck answer is D
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