A 32-year-old woman comes to the office for a regular follow-up. She was diagnosed with type 2 diabetes mellitus 4 years ago. Her last blood test showed a fasting blood glucose level of 6.6 mmol/L (118.9 mg/dL) and HbA1c of 5.1%. No other significant past medical history. Current medications are metformin and a daily multivitamin. No significant family history. The physician wants to take her blood pressure measurements, but the patient states that she measures it every day in the morning and in the evening and even shows him a blood pressure diary with all the measurements being within normal limits. Which of the following statements is correct?
AThe physician has to measure the patient’s blood pressure because it is a standard of care for any person with diabetes mellitus who presents for a check-up.
BAssessment of blood pressure only needs to be done at the initial visit; it is not necessary to measure blood pressure in this patient at any follow-up appointments.
CThe physician should not measure the blood pressure in this patient and should simply make a note in a record showing the results from the patient’s diary.
DThe physician should not measure the blood pressure in this patient because she does not have hypertension or risk factors for hypertension.
EThe physician should not measure the blood pressure in this patient because the local standards of care in the physician's office differ from the national standards of care so measurements of this patient's blood pressure cannot be compared to diabetes care guidelines.
A 28-year-old soldier is brought back to a military treatment facility 45 minutes after sustaining injuries in a building fire from a mortar attack. He was trapped inside the building for around 20 minutes. On arrival, he is confused and appears uncomfortable. He has a Glasgow Coma Score of 13. His pulse is 113/min, respirations are 18/min, and blood pressure is 108/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows multiple second-degree burns over the chest and bilateral upper extremities and third-degree burns over the face. There are black sediments seen within the nose and mouth. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management?
AInsertion of nasogastric tube and enteral nutrition
BIntravenous antibiotic therapy
CIntubation and mechanical ventilation
DImmediate bronchoscopy
EIntravenous corticosteroid therapy
One hour after being admitted to the hospital for sharp, acute chest pain and diaphoresis, a 55-year-old woman with type 2 diabetes mellitus loses consciousness in the emergency department. There are no palpable pulses. Chest compressions are started. The patient has a history of breast cancer that was surgically treated 4 years ago. Prior to admission, the patient was on a long bus ride to visit her sister. Her medications include tamoxifen, atorvastatin, metoprolol, metformin, and insulin. Serum troponin levels are elevated. The cardiac rhythm is shown. Which of the following is the most appropriate next step in management?
ADefibrillation
BCoronary angiography
CIntravenous dextrose therapy
DIntravenous epinephrine therapy
EIntravenous glucagon therapy
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