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Old 10-17-2011
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Question Health care maintenance in Type II diabetes

A 50-year-old man was recently diagnosed with diabetes mellitus type 2 after targeted screening revealed persistently elevated fasting blood glucose levels. Since being diagnosed, he has started metformin and an ACE inhibitor, and has his statin therapy adjusted to reach a goal of an LDL-cholesterol of 100 mg/dL. Despite counseling, he continues to smoke, but is following a diabetic diet and exercising regularly. He is currently healthy, and is up to date with his vaccinations, having received a pneumonococcal vaccination five years prior, and an influenza vaccine earlier this year. Which of the following is an appropriate strategy for health care maintenance in this patient?

A. Annual monitoring of hemoglobin A1C
B. Dilated eye exams on a six-month basis
C. Empiric use of daily aspirin therapy
D. Nerve conduction screen for neuropathy
E. Repeat pneumococcal vaccination yearly
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Old 10-18-2011
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i go wid ans A. HbA1c monitering. but chance for B also there. uncont DM . to moniter dm retinopathy also.
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Old 10-18-2011
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I think ,it should be > C. Empiric use of daily aspirin therapy
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Old 10-18-2011
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the ans is B eye examination...
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Old 10-18-2011
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I'l go for A
B is wrong bcoz u check eye annually not in 6 months.
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Old 10-18-2011
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Correct Answer Answer

The correct answer is C. Aspirin should be used for primary prevention in patients with diabetes who do not have contraindications to the use of the medication. A baby aspirin once daily is a simple, efficacious strategy to reduce the risk of heart disease, and is recommended for diabetics, particularly if other cardiac risk factors, such as smoking, are present.
Hemoglobin A1C (choice A) should be monitored every three to six months to ensure adequate glycemic control. As the natural progression of diabetes mellitus type 2 is increasing medication requirements, it cannot be assumed that even compliant patients will have adequate glycemic control over a prolonged period of time. Monitoring on a more frequent basis than annually is essential.
A dilated eye exam (choice B) by an ophthalmologist should be performed annually. There is no need for more frequent eye examinations unless the patient has known disease or visual complaints.
Neuropathy (choice D) should be screened for at least annually, during the annual diabetic foot exam. Nerve conduction studies are not used to screen asymptomatic patients for neuropathy.
In general, the pneumococcal vaccination (choice E) does not need to be repeated, though patients who receive the vaccine before age 65 may wish to have it repeated once they are over age 65.
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Endocrinology-, Preventive-Medicine-, Step-2-Questions

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