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Old 10-17-2011
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Default Endocrine

A 46-year-old Hispanic woman with diabetes mellitus type 2 comes to the clinic for a routine annual physical examination. She has no current complaints, has been compliant with her medications, and reports good glycemic control based on the results of her home glucose monitor. Her review of systems is unremarkable. Since her last visit, she has had no illnesses. She received an influenza vaccine 6 months prior and had a pneumonia vaccine 9 years ago. An ophthalmology appointment is scheduled for next week, though she has not had any problems with her eyes. She has never had a colonoscopy. Her past medical history, aside from diabetes, is significant for borderline hypertension and elevated cholesterol. Vital signs today are: temperature 37.0 C (98.6 F), blood pressure 133/80 mm Hg, pulse 65/min, and respirations 20/min. Examination, including rectal and diabetic foot examination, is normal. A urinalysis dipstick is normal. Which of the following is an appropriate health maintenance for this patient?



A.

Colonoscopy


B.

Pneumococcal vaccine


C.

Podiatry appointment


D.

Serum creatinine level


E.

Urine microalbumin level
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Old 10-17-2011
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e. urine micro albumen level?
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Old 10-18-2011
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ans E . urine microalbumin level . i thnk..
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Old 10-18-2011
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E. Urine microalbumin level
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Old 10-18-2011
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Correct Answer Answer

The correct answer is E. Early diabetic nephropathy manifests with microalbuminuria (30 to 300 mg), which is below the level that can be detected with a urine dipstick. It is recommended that all patients with diabetes have an annual urine microalbumin checked. If microalbuminuria is present, an ACE inhibitor should be started. The progression of diabetic nephropathy can be slowed with aggressive blood pressure control, an ACE inhibitor, and good glycemic control.
Colonoscopy (choice A) is not necessary until this patient is older than 50 years of age, after which time it should occur every 10 years, barring abnormal results.
A pneumococcal vaccine (choice B) should be given to patients with diabetes. It does not need to be repeated until after age 65 years, at which time a booster should be given.
Podiatry appointments (choice C) do not need to be scheduled annually if the patient has no abnormalities on diabetic foot examination. If there are vascular complications, however (e.g., dystrophic nails, foot infections), or neurologic problems (often manifesting as deformed joints), podiatry assistance can be invaluable.
Serum creatinine (choice D) is an insensitive marker of early renal failure. It does not need to be routinely followed, unless there is suspicion of renal failure or a change in the dose of an ACE inhibitor or diuretic.
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