TABLE IV-114 Risk Factors for Active Tuberculosis Among Persons Who Have Been Infected With Tubercle Bacilli 29 page

D. Translocation of the cytoplasmic nuclear receptor into the nucleus with constitutive activation of
GnRH.

X-4. The mineralocorticoid receptor in the renal tubule is responsible for the sodium retention and potassium wasting that is seen in mineralocorticoid excess states such as aldosterone-secreting tumors. However, states of glucocorticoid excess (e.g., Cushing’s syndrome) can also present with sodium retention and hypokalemia. What characteristic of the mineralocorticoid-glucocorticoid pathways explains this finding?

A. Higher affinity of the mineralocorticoid receptor for glucocorticoids

B. Oversaturation of the glucocorticoid degradation pathway in states of glucocorticoid excess

C. Similar, but distinct, DNA-binding sites producing the same metabolic effect

D. Upregulation of the mineralocorticoid-binding protein in states of glucocorticoid excess

X-5. All of the following hormones are produced by the anterior pituitary EXCEPT:

A. Adrenocorticotropic hormone

B. Growth hormone

C. Oxytocin

D. Prolactin

E. Thyroid-stimulating hormone

X-6. A 22-year-old woman who is otherwise healthy undergoes an uneventful vaginal delivery of a full-term infant. One day postpartum she complains of visual changes and severe headache. Two hours after these complaints, she is found unresponsive and profoundly hypotensive. She is intubated and placed on mechanical ventilation. Her blood pressure is 68/28 mmHg, heart rate is regular at 148 beats/min, and oxygen saturation is 95% on FiO₂ 0.40. Physical exam is unremarkable. Her laboratories are notable

for glucose of 49 mg/dL and normal hematocrit and white blood cell count. Which of the following is most likely to reverse her hypotension?

A. Activated drotrecogin alfa

B. Hydrocortisone

C. Piperacillin/tazobactam

D. T₄

E. Transfusion of packed red blood cells

X-7. A 45-year-old man reports to his primary care physician that his wife has noted coarsening of his facial features over several years. In addition, he reports low libido and decreased energy. Physical examination shows frontal bossing and enlarged hands. An MRI confirms that he has a pituitary mass. Which of the following screening tests should be ordered to diagnose the cause of the mass?

A. 24-hour urinary free cortisol

B. ACTH assay

C. Growth hormone level

D. Serum IGF-1 level

E. Serum prolactin level

X-8. All of the following are potential causes of hyperprolactinemia EXCEPT:

A. Cirrhosis

B. Hirsutism

C. Nipple stimulation

D. Opiate abuse

E. Rathke’s cyst

X-9. A 28-year-old woman presents to her primary care physician’s office with 1 year of amenorrhea.

She reports mild galactorrhea and headaches. Although she is sexually active, a urine pregnancy test is negative. Serum prolactin level is elevated and she is subsequently diagnosed with a microscopic prolactinoma. Which of the following represents the primary goal of bromocriptine therapy for her condition?

A. Control of hyperprolactinemia

B. Reduction in tumor size

C. Resolution of galactorrhea

D. Restoration of menses and fertility

E. All of the above

X-10. A 58-year-old man undergoes severe head trauma and develops pituitary insufficiency. After recovery, he is placed on thyroid hormone, testosterone, glucocorticoids, and vasopressin. On a routine visit he questions his primary care physician regarding potential growth hormone deficiency. All of the following are potential signs or symptoms of growth hormone deficiency EXCEPT:

A. Abnormal lipid profile

B. Atherosclerosis

C. Increased bone mineral density

D. Increased waist:hip ratio

E. Left ventricular dysfunction

X-11. A 75-year-old man presents with development of abdominal obesity, proximal myopathy, and skin hyperpigmentation. His laboratory evaluation shows a hypokalemic metabolic alkalosis. Cushing’s syndrome is suspected. Which of the following statements regarding this syndrome is true?

A. Basal ACTH level is likely to be low.

B. Circulating corticotropin-releasing hormone is likely to be elevated.

C. Pituitary MRI will visualize all ACTH-secreting tumors.

D. Referral for urgent performance of inferior petrosal venous sampling is indicated.

E. Serum potassium level below 3.3 mmol/L is suggestive of ectopic ACTH production.

X-12. A 23-year-old college student is followed in the student health center for medical management of panhypopituitarism after resection of craniopharyngioma as a child. She reports moderate compliance with her medications but feels generally well. A TSH is checked and is below the limits of detection of the assay. Which of the following is the next most appropriate action?

A. Decrease levothyroxine dose to half of current dose.

B. Do nothing.

C. Order free T₄ level.

D. Order MRI of her brain.

E. Order thyroid uptake scan.

X-13. A 23-year-old woman presents to the clinic complaining of months of weight gain, fatigue, amenorrhea, and worsening acne. She cannot precisely identify when her symptoms began, but she reports that without a change in her diet she has noted a 12.3-kg weight gain over the past 6 months. She

has been amenorrheic for several months. On examination she is noted to have truncal obesity with bilateral purplish striae across both flanks. Cushing’s syndrome is suspected. Which of the following tests should be used to make the diagnosis?

A. 24-hour urine free cortisol

B. Basal adrenocorticotropic hormone (ACTH)

C. Corticotropin-releasing hormone (CRH) level at 8 a.m.

D. Inferior petrosal venous sampling

E. Overnight 1-mg dexamethasone suppression test

X-14. A patient visited a local emergency room 1 week ago with a headache. She received a head MRI, which did not reveal a cause for her symptoms, but the final report states, “An empty sella is noted. Advise clinical correlation.” The patient was discharged from the emergency department with instructions to follow up with her primary care physician as soon as possible. Her headache has resolved, and the patient has no complaints; however, she comes to your office 1 day later very concerned about this unexpected MRI finding. What should be the next step in her management?

A. Diagnose her with subclinical panhypopituitarism, and initiate low-dose hormone replacement.

B. Reassure her and follow laboratory results closely.

C. Reassure her and repeat MRI in 6 months.

D. This may represent early endocrine malignancy—whole-body positron emission tomography/CT
is indicated.

E. This MRI finding likely represents the presence of a benign adenoma—refer to neurosurgery for
resection.

X-15. A 31-year-old woman is admitted to the hospital after an appendectomy for acute appendicitis. The surgery is uncomplicated, but postoperatively she is noted to make copious urine (6 L/d) and complain of severe thirst. On the third postoperative day, her BUN and creatinine are noted to be elevated. On further questioning, she reports a long history of extreme thirst, urinary frequency, and occasional episodes of enuresis that she was too embarrassed to bring to the attention of a health care practitioner. Aside from oral contraceptives, she takes no medications and reports no past medical history. Which of the following is the most appropriate first step to confirm her diagnosis?

A. 24-hour urine volume and osmolarity measurement

B. Fasting morning plasma osmolarity

C. Fluid deprivation test

D. MRI of the brain

E. Plasma ADH level

X-16. A 63-year-old man is admitted to the hospital to begin induction chemotherapy for acute myelomonocytic leukemia (AML-M4). He is afebrile and has been feeling well other than fatigue and bruising. His physical examination is notable for normal vital signs and no focal findings other than three 1- × 2-cm subcutaneous nodules that had previously been demonstrated to be cutaneous spread of AML-M4. On the night of admission, the patient’s wife calls for assistance because her husband’s mental status is altered. He is confused and somnolent. You notice that there are four urinals filled with urine by his bed. His wife reports that for the last 6 hours he has been urinating frequently and has been

drinking water constantly. However, over the last hour, despite urinating frequently, he has not been able to drink water due to somnolence. Laboratory studies are notable for an absolute neutrophil count of 400, a platelet count of 35,000, and a serum sodium of 155. Which of the following therapies should be administered immediately?

A. All-trans retinoic acid (ATRA)

B. Desmopressin

C. Hydrochlorothiazide

D. Hydrocortisone

E. Lithium

X-17. Which of the following is the most common cause of preventable mental deficiency in the world?

A. Beriberi disease

B. Cretinism

C. Folate deficiency

D. Scurvy

E. Vitamin A deficiency

X-18. Which of the following proteins is the primary source of bound T₄ in the plasma?

A. Albumin

B. Gamma globulins

C. Transthyretin

D. Thyroid peroxidase

E. Thyroxine-binding globulin

X-19. All of the following are associated with increased levels of total T₄ in the plasma with a normal free T₄ EXCEPT:

A. Cirrhosis

B. Pregnancy

C. Sick-euthyroid syndrome

D. Familial dysalbuminemic hyperthyroxinemia

E. Familial excess thyroid-binding globulin

X-20. Which of the following is the most common cause of hypothyroidism worldwide?

A. Graves’ disease

B. Hashimoto’s thyroiditis

C. Iatrogenic hypothyroidism

D. Iodine deficiency

E. Radiation exposure

X-21. A 75-year-old woman is diagnosed with hypothyroidism. She has long-standing coronary artery disease and is wondering about the potential consequences for her cardiovascular system. Which of the

following statements is true regarding the interaction of hypothyroidism and the cardiovascular system?

A. Myocardial contractility is increased with hypothyroidism.

B. A reduced stroke volume is found with hypothyroidism.

C. Pericardial effusions are a rare manifestation of hypothyroidism.

D. Reduced peripheral resistance is found in hypothyroidism and may be accompanied by
hypotension.

E. Blood flow is diverted toward the skin in hypothyroidism.

X-22. A 38-year-old mother of three presents to her primary care office with complaints of fatigue. She feels that her energy level has been low for the past 3 months. She was previously healthy and was taking no medications. She does report that she has gained about 5 kg and has severe constipation, for which she has been taking a number of laxatives. A TSH is elevated at 25 mU/L. Free T₄ is low. She is

wondering why she has hypothyroidism. Which of the following tests is most likely to diagnose the etiology?

A. Antithyroglobulin antibody

B. Antithyroid peroxidase antibody

C. Radioiodine uptake scan

D. Serum thyroglobulin level

E. Thyroid ultrasound

X-23. A 54-year-old woman with long-standing hypothyroidism is seen in her primary care physician’s office for a routine evaluation. She reports feeling fatigued and somewhat constipated. Since her last visit, her other medical conditions, which include hypercholesterolemia and systemic hypertension, are stable. She was diagnosed with uterine fibroids and started on iron recently. Her other medications include levothyroxine, atorvastatin, and hydrochlorothiazide. A TSH is checked and it is elevated to 15 mU/L. Which of the following is the most likely reason for her elevated TSH?

A. Celiac disease

B. Colon cancer

C. Medication noncompliance

D. Poor absorption of levothyroxine due to ferrous sulfate

E. TSH-secreting pituitary adenoma

X-24. An 87-year-old woman is admitted to the intensive care unit with depressed level of consciousness, hypothermia, sinus bradycardia, hypotension, and hypoglycemia. She was previously healthy with the exception of hypothyroidism and systemic hypertension. Her family recently checked in on her and found that she was not taking any of her medications because of financial difficulties. There is no evidence of infection on exam, urine microscopy, or chest radiograph. Her serum chemistries are notable for mild hyponatremia and a glucose of 48. TSH is above 100 mU/L. All of the following statements regarding this condition are true EXCEPT:

A. External warming is a critical feature of therapy in patients with a temperature above 34°C
(93.2°F).

B. Hypotonic intravenous solutions should be avoided.

C. IV levothyroxine should be administered with IV glucocorticoids.

D. Sedation should be avoided if possible.

E. This condition occurs almost exclusively in the elderly and often is precipitated by an unrelated
medical illness.

X-25. A 29-year-old woman is evaluated for anxiety, palpitations, and diarrhea and is found to have Graves’ disease. Before she begins therapy for her thyroid condition, she has an episode of acute chest pain and presents to the emergency department. Although a CT angiogram is ordered, the radiologist calls to notify the treating physician that this is potentially dangerous. Which of the following best explains the radiologist’s recommendation?

A. Iodinated contrast exposure in patients with Graves’ disease may exacerbate hyperthyroidism.

B. Pulmonary embolism is exceedingly rare in Graves’ disease.

C. Radiation exposure in patients with hyper-thyroidism is associated with increased risk of
subsequent malignancy.

D. Tachycardia with Graves’ disease limits the image quality of CT angiography and will not
allow accurate assessment of pulmonary embolism.

E. The radiologist was mistaken; CT angiography is safe in Graves’ disease.

X-26. What percentage of patients with hyperthyroidism and atrial fibrillation convert to sinus rhythm after treatment of thyroid state alone?

A. 20%

B. 30%

C. 50%

D. 70%

E. 90%

X-27. Which of the following statements best describes Graves’ ophthalmopathy?

A. Although a cosmetic problem, Graves’ ophthalmopathy is rarely associated with major ocular
complications.

B. Diplopia may occur from periorbital muscle swelling.

C. It is never found without concomitant hyperthyroidism.

D. The most serious complication is corneal abrasion.

E. Unilateral disease is not found.

X-28. Which of the following is the most important mechanism of action of propylthiouracil in the treatment of Graves’ disease?

A. Impaired production of transthyretin

B. Inhibition of production of thyroid-stimulating immunoglobulins

C. Inhibition of the function of thyroid peroxidase

D. Reduced peripheral conversion of T₄ to T₃

E. Reversal of iodine organification

X-29. A 44-year-old male is involved in a motor vehicle collision. He sustains multiple injuries to the face, chest, and pelvis. He is unresponsive in the field and is intubated for airway protection. An intravenous line is placed. The patient is admitted to the intensive care unit (ICU) with multiple orthopedic injuries. He is stabilized medically and on hospital day 2 undergoes successful open reduction and internal fixation of the right femur and right humerus. After his return to the ICU, you review his laboratory values. TSH is 0.3 mU/L, and the total T₄ level is normal. T₃ is 0.6 μg/dL. What

is the most appropriate next management step?

A. Initiation of levothyroxine

B. Initiation of prednisone

C. Observation

D. Radioiodine uptake scan

E. Thyroid ultrasound

X-30. A 29-year-old woman presents to your clinic complaining of difficulty swallowing, sore throat, and tender swelling in her neck. She has also noted fevers intermittently over the past week. Several weeks prior to her current symptoms she experienced symptoms of an upper respiratory tract infection. She has no past medical history. On physical examination, she is noted to have a small goiter that is painful to the touch. Her oropharynx is clear. Laboratory studies are sent and reveal a white blood cell count of 14,100 cells/μL with a normal differential, erythrocyte sedimentation rate (ESR) of 53 mm/h, and a thyroid-stimulating hormone (TSH) of 21 μIU/mL. Thyroid antibodies are negative. What is the most likely diagnosis?

A. Autoimmune hypothyroidism

B. Cat-scratch fever

C. Graves’ disease

D. Ludwig’s angina

E. Subacute thyroiditis

X-31. What is the most appropriate treatment for the patient described in question X-30?

A. Iodine ablation of the thyroid

B. Large doses of aspirin

C. Local radiation therapy

D. No treatment necessary

E. Propylthiouracil

X-32. Which of the following is consistent with a diagnosis of subacute thyroiditis?

A. A 38-year-old female with a 2-week history of a painful thyroid, elevated T₄, elevated T₃, low

TSH, and an elevated radioactive iodine uptake scan

B. A 42-year-old male with a history of a painful thyroid 4 months ago, fatigue, malaise, low free
T₄, low T₃, and elevated TSH

C. A 31-year-old female with a painless enlarged thyroid, low TSH, elevated T₄, elevated free T₄,
and an elevated radioiodine uptake scan

D. A 50-year-old male with a painful thyroid, slightly elevated T₄, normal TSH, and an ultrasound showing a mass

X-33. A healthy 53-year-old man comes to your office for an annual physical examination. He has no complaints and has no significant medical history. He is taking an over-the-counter multivitamin and no other medicines. On physical examination he is noted to have a nontender thyroid nodule. His thyroid-stimulating hormone (TSH) level is checked and is found to be low. What is the next step in his evaluation?

A. Close follow-up and measure TSH in 6 months

B. Fine-needle aspiration

C. Low-dose thyroid replacement

D. Positron emission tomography followed by surgery

E. Radionuclide thyroid scan

X-34. A patient has neurosurgery for a pituitary tumor that requires resection of the gland. Which of the following functions of the adrenal gland will be preserved in this patient immediately postoperatively?

A. Morning peak of plasma cortisol level

B. Release of cortisol in response to stress

C. Sodium retention in response to hypovolemia

D. None of the above

X-35. Which of the following is the most common cause of Cushing’s syndrome?

A. ACTH-producing pituitary adenoma

B. Adrenocortical adenoma

C. Adrenocortical carcinoma

D. Ectopic ACTH secretion

E. McCune-Albright syndrome

X-36. All of the following are features of Conn’s syndrome EXCEPT:

A. Alkalosis

B. Hyperkalemia

C. Muscle cramps

D. Normal serum sodium

E. Severe systemic hypertension

X-37. All of the following statements regarding asymptomatic adrenal masses (incidentalomas) are true EXCEPT:

A. All patients with incidentalomas should be screened for pheochromocytoma.

B. Fine-needle aspiration may distinguish between benign and malignant primary adrenal tumors.

C. In patients with a history of malignancy, the likelihood that the mass is a metastasis is
approximately 50%.

D. The majority of adrenal incidentalomas are non-secretory.

E. The vast majority of adrenal incidentalomas are benign.

X-38. A 43-year-old man with episodic, severe hypertension is referred for evaluation of possible secondary causes of hypertension. He reports feeling well generally, except for episodes of anxiety, palpitations, and tachycardia with elevation in his blood pressure during these episodes. Exercise often brings on these events. The patient also has mild depression and is presently taking sertraline, labetalol, amlodipine, and lisinopril to control his blood pressure. Urine 24-hour total metanephrines are ordered and show an elevation of 1.5 times the upper limit of normal. Which of the following is the next most appropriate step?

A. Hold labetalol for 1 week and repeat testing.

B. Hold sertraline for 1 week and repeat testing.

C. Immediately refer for surgical evaluation.

D. Measure 24-hour urine vanillymandelic acid level.

E. Send for MRI of the abdomen.

X-39. A 45-year-old man is diagnosed with pheochromocytoma after presentation with confusion, marked hypertension to 250/140 mmHg, tachycardia, headaches, and flushing. His fractionated plasma metanephrines show a normetanephrine level of 560 pg/mL and a metanephrine level of 198 pg/mL (normal values: normetanephrine: 18–111 pg/mL; metanephrine: 12–60 pg/mL). CT scanning of the abdomen with IV contrast demonstrates a 3-cm mass in the right adrenal gland. A brain MRI with gadolinium shows edema of the white matter near the parietooccipital junction consistent with reversible posterior leukoencephalopathy. You are asked to consult regarding management. Which of the following statements is true regarding management of pheochromocytoma is this individual?

A. Beta-blockade is absolutely contraindicated for tachycardia even after adequate alpha-blockade
has been attained.

B. Immediate surgical removal of the mass is indicated, because the patient presented with
hypertensive crisis with encephalopathy.

C. Salt and fluid intake should be restricted to prevent further exacerbation of the patient’s
hypertension.

D. Treatment with phenoxybenzamine should be started at a high dose (20–30 mg three times daily)
to rapidly control blood pressure, and surgery can be undertaken within 24–48 hours.

E. Treatment with IV phentolamine is indicated for treatment of the hypertensive crisis.
Phenoxybenzamine should be started at a low dose and titrated to the maximum tolerated dose over
2–3 weeks. Surgery should not be planned until the blood pressure is consistently below 160/100
mmHg.

X-40. Which of the following ethnic populations in the United States has the highest risk of diabetes mellitus?

A. Asian American

B. Hispanic

C. Non-Hispanic black

D. Non-Hispanic white

X-41. Which of the following defines normal glucose tolerance?

A. Fasting plasma glucose below 100 mg/dL

B. Fasting plasma glucose below 126 mg/dL following an oral glucose challenge

C. Hemoglobin A1C below 5.6% and fasting plasma glucose below 140 mg/dL

D. Hemoglobin A1C below 6.0%

E. Fasting plasma glucose below 100 mg/dL, plasma glucose below 140 mg/dL following an oral
glucose challenge, and hemoglobin A1C below 5.6%

X-42. A 37-year-old woman with obesity presents to the clinic for a routine health evaluation. She reports that over the last year she has had two yeast infections treated with over-the-counter remedies and frequently feels thirsty. She does report waking up at night to urinate. Which of the following studies is the most appropriate first test in evaluating the patient for diabetes mellitus?

A. Hemoglobin A1C

B. Oral glucose tolerance test

C. Plasma C-peptide level

D. Plasma insulin level

E. Random plasma glucose level

X-43. All of the following are risk factors for type 2 diabetes mellitus EXCEPT:

A. BMI above 25 kg/m²

B. Delivery of a baby more than 3.5 kg

C. HDL level below 35 mg/dL

D. Hemoglobin A1C 5.7–6.4%

E. Systemic hypertension

X-44. A 27-year-old woman with mild obesity is seen in her primary care office for increased thirst and polyuria. Diabetes mellitus is suspected, and a random plasma glucose of 211 mg/d confirms this diagnosis. Which of the following tests will strongly indicate that she has type 1 diabetes mellitus?

A. Anti–GAD-65 antibody.

B. Peroxisome proliferator-activated receptor γ-2 polymorphism testing.

C. Plasma insulin level.

D. Testing for HLA-DR3.

E. There is no laboratory test indicating type 1 diabetes mellitus.

X-45. In patients with impaired fasting glucose, all of the following interventions have been proven to decrease progression to type 2 diabetes mellitus EXCEPT:

A. Diet modification

B. Exercise

C. Glyburide

D. Metformin

X-46. A patient is evaluated in the emergency department for complications of diabetes mellitus with an episode of life stressors. All of the following laboratory tests are consistent with the diagnosis of diabetic ketoacidosis EXCEPT:

A. Arterial pH 7.1

B. Glucose 550 mg/dL

C. Markedly positive plasma ketones

D. Normal serum potassium

E. Plasma osmolality 380 mosm/mL

X-47. All of the following are consistent with nonproliferative diabetic retinopathy EXCEPT:

A. Blot hemorrhages

B. Cotton-wool spots

C. Neovascularization

D. Occurs in first or second decade of diabetes mellitus

E. Retinal vascular microaneurysms

X-48. A 68-year-old man with poorly controlled type 2 diabetes mellitus is admitted to the hospital with an ulcer on the lateral surface of his right lower extremity that has been painful and appears purulent. He has had 3 days of fever. All of the following interventions are recommended to improve wound healing in a patient with a diabetic wound EXCEPT:

A. Appropriate use of antibiotics

B. Debridement

C. Hyperbaric oxygen

D. Off-loading

E. Revascularization

X-49. Pick the correct combination of onset of action and duration of action for the following insulins:

A. Aspart: 1 hour, 6 hours

B. Detemir: 2 hours, 12 hours

C. Lispro: 0.5 hour, 2 hours

D. NPH: 2 hours, 14 hours

E. Regular: 0.25 hour, 6 hours

X-50. A 54-year-old woman is diagnosed with type 2 diabetes mellitus after a routine follow-up for impaired fasting glucose showed that her hemoglobin A1C is now 7.6%. She has attempted to lose weight and to exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and no other medical conditions. Which of the following is the most appropriate first-line therapy?

A. Acarbose

B. Exenatide

C. Glyburide

D. Metformin

E. Sitagliptin

X-51. The Diabetes Control and Complications Trial (DCCT) provided definitive proof that reduction in chronic hyperglycemia:

A. Improves microvascular complications in type 1 diabetes mellitus

B. Improves macrovascular complications in type 1 diabetes mellitus

C. Improves microvascular complications in type 2 diabetes mellitus

D. Improves macrovascular complications in type 2 diabetes mellitus

E. Improves both microvascular and macrovascular complications in type 2 diabetes mellitus

X-52. A patient is seen in the clinic for follow-up of type 2 diabetes mellitus. Her hemoglobin A1C has been poorly controlled at 9.4% recently. The patient can be counseled to expect all the following improvements with improved glycemic control EXCEPT:

A. Decreased microalbuminuria

B. Decreased risk of nephropathy

C. Decreased risk of neuropathy

D. Decreased risk of peripheral vascular disease

E. Decreased risk of retinopathy

X-53. A 21-year-old female with a history of type 1 diabetes mellitus is brought to the emergency department with nausea, vomiting, lethargy, and dehydration. Her mother notes that she stopped taking insulin 1 day before presentation. She is lethargic, has dry mucous membranes, and is obtunded. Blood pressure is 80/40 mmHg, and heart rate is 112 beats/min. Heart sounds are normal. Lungs are clear. The abdomen is soft, and there is no organomegaly. She is responsive and oriented × 3 but diffusely weak. Serum sodium is 126 meq/L, potassium is 4.3 meq/L, magnesium is 1.2 meq/L, blood urea nitrogen is 76 mg/dL, creatinine is 2.2 mg/dL, bicarbonate is 10 meq/L, and chloride is 88 meq/L. Serum glucose is 720 mg/dL. All of the following are appropriate management steps EXCEPT:

A. 3% sodium solution

B. Arterial blood gas

C. Intravenous insulin

D. Intravenous potassium

E. Intravenous fluids

X-54. Which of the following studies is the most sensitive for detecting diabetic nephropathy?

Date: 2016-04-22; view: 654