50 y/o obese woman with a history of gestational diabetes an | Figure 1

Case Study: 50 y/o Obese Woman with Type 2 Diabetes

A 50-year-old obese woman with a history of gestational diabetes and a family history of diabetes and coronary artery disease was diagnosed with type 2 diabetes during a visit with her primary care physician, at which time she was found to have an HbA1c level of 8.7% on routine screening blood tests. Despite implementing dietary changes under the supervision of a dietitian, engaging in moderate exercise several times weekly, and complying with treatment with metformin 1000 mg twice daily, her HbA1c remains above target at 7.7%. You wish to add a second medication to intensify her treatment, but she is resistant due to concern for hypoglycemia. You learn that her brother-in-law died after a motor vehicle accident thought to be caused by insulin-induced hypoglycemia.

Which of the following would be the best option for this patient, given the above considerations?

  1. Add glipizide
  2. Add insulin degludec
  3. Add nateglinide
  4. Add pioglitazone
  5. No change in treatment

Question from The Brigham Intensive Review of Internal Medicine Question and Answer Companion, 2nd edition, by Ajay K. Singh. ISBN: 9780323480437. Copyright ©2020 Elsevier, Inc.

Case Study: Female Patient, 50 y/o, Diabetic for Over 20 Years

female 47 years old after a course of treatment with cortisone accidentally she found her fasting diabetes 222 mg/dl A1C 7.4 without any symptoms what should she do ? can her blood glucose level return normal ?

Case Study: Diabetic Lady with Vitiligo

This Diabetic lady has vitiligo (facial), subclinical hypothyroid and is maintained on twice daily aspart insulin and once Co-formulation Aspart / Degludeg. Her HbA1c is 7 now but she has this typical rash over her knuckles for many years and responded to topical steroids only to come back on stopping. Her ANF is negative. Need idea about this rash? The condition name?

The 52-Year-Old Man Case Study

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. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-Year-Old Woman with Pruritus

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight 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.

Pediatric Case Study: 4-Month-Old Male Infant

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Case Study: Teenage Patient with Collapse

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?