pt presents with uncontrolled diabetes. All information to d | Figure 1

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pt presents with uncontrolled diabetes. All information to date on pt presented. Pt on 4 #Metformin daily for past 3 mos. pt reports resolving #Diarrhea to one normal stool daily. Adverse reaction to #Metformin? #Metformin not controlling #Diabetes-mellitus? #TSH is 4.13? Result of uncontrolled #Diabetes-mellitus?

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  1. A 40 yrs old female: Diagnosed with diabetes in a rural health center, took herbal medications for 2 months, presently fasting and pp are 430 and 447 mg/dl, respectively. She insists on taking oral medications only. What do I start her on?

  2. A 50-year-old obese woman: Diagnosed with type 2 diabetes during a visit with her primary care physician, found to have an HbA1c level of 8.7% on routine screening blood tests. Despite dietary changes and treatment with metformin, her HbA1c remains above target at 7.7%. Options for second medication include:
    A. Add glipizide
    B. Add insulin degludec
    C. Add nateglinide
    D. Add pioglitazone
    E. No change in treatment
    Source: The Brigham Intensive Review of Internal Medicine Question and Answer Companion.

  3. A 52-year-old man: Presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. Common findings included bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed, and the patient was referred to the emergency department.

  4. A 28-year-old woman: Presented with a 3-day history of intense pruritus over the lower back. No recent travel or exposure to new environments. She cares for dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

  5. A 4-month-old male infant: Presented with skin lesions localized to the chin for the past 3 days. Multiple small pustules with surrounding inflammatory signs on the chin and a few scattered papules on the chest were observed.

  6. Patient in late teens: Presented after a collapse with no chest pain and no previous cardiac history. Are there any features in this ECG that would warrant further work-up, or is this just a pediatric ECG?