03-23-2010, 04:52 PM
24. A 56-year-old Native American man returns to the office to discuss results of studies
obtained during a previous visit 8 weeks ago. The patient has a 19-year history of diabetes
mellitus treated with sulfonylurea. He checks his serum glucose concentration
approximately once daily. He does not smoke cigarettes and rarely drinks alcoholic
beverages. He is 183 cm (6 ft) tall and weighs 76 kg (168 lb); BMI is 23 kg/m2. Vital signs
during the previous visit were temperature 36.9°C (98.4°F), pulse 82/min, and blood
pressure 130/85 mm Hg. Physical examination of the neck disclosed a right-sided carotid
bruit. Examination of the extremities disclosed diminished pulses with associated hair loss
over both legs. Hemoglobin A1c was 7.2%. Urine albumin-creatine ratio was 62 mg/g/24 h.
Ankle-brachial index (ABI) was 0.89 on the left and 0.98 on the right; duplex carotid
ultrasonography showed nonulcerated plaque with 70% stenosis in the right internal carotid
artery. The patient was referred to an ophthalmologist, who diagnosed him with
nonproliferative background diabetic retinopathy. Which of the following findings in this
patient is of most concern?
[A) 70% stenosis of the right carotid artery]
B) Hemoglobin A1c of 7.2%
C) Left ABI of 0.89
D) Nonproliferative diabetic retinopathy
E) Urine albumin-creatine ratio of 62 mg/g/24 h
obtained during a previous visit 8 weeks ago. The patient has a 19-year history of diabetes
mellitus treated with sulfonylurea. He checks his serum glucose concentration
approximately once daily. He does not smoke cigarettes and rarely drinks alcoholic
beverages. He is 183 cm (6 ft) tall and weighs 76 kg (168 lb); BMI is 23 kg/m2. Vital signs
during the previous visit were temperature 36.9°C (98.4°F), pulse 82/min, and blood
pressure 130/85 mm Hg. Physical examination of the neck disclosed a right-sided carotid
bruit. Examination of the extremities disclosed diminished pulses with associated hair loss
over both legs. Hemoglobin A1c was 7.2%. Urine albumin-creatine ratio was 62 mg/g/24 h.
Ankle-brachial index (ABI) was 0.89 on the left and 0.98 on the right; duplex carotid
ultrasonography showed nonulcerated plaque with 70% stenosis in the right internal carotid
artery. The patient was referred to an ophthalmologist, who diagnosed him with
nonproliferative background diabetic retinopathy. Which of the following findings in this
patient is of most concern?
[A) 70% stenosis of the right carotid artery]
B) Hemoglobin A1c of 7.2%
C) Left ABI of 0.89
D) Nonproliferative diabetic retinopathy
E) Urine albumin-creatine ratio of 62 mg/g/24 h