Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 55-year-old man is evaluated following a screening for type 2 diabetes mellitus

mksap
Conditions
April 23, 2016
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 55-year-old man is evaluated following a screening for type 2 diabetes mellitus. He is asymptomatic. He has a history of hypertension and hyperlipidemia. There is no history of anemia, liver disease, or kidney disease. Medications are lisinopril and rosuvastatin.

On physical examination, blood pressure is 123/76 mm Hg and pulse rate is 72/min. His body-mass index (BMI) is 28. The remainder of the examination is unremarkable.

Laboratory studies show hematocrit 45.6%, creatinine 1.0 mg/dL (88.4 µmol/L), fasting glucose 128 mg/dL (7.1 mmol/L), and HbA1c 5.6%.

Which of the following is the most appropriate diagnostic test to perform next?

A. Fasting plasma glucose
B. HbA1c
C. Oral glucose tolerance test
D. Random blood glucose

MKSAP Answer and Critique

The correct answer is A. Fasting plasma glucose.

A fasting plasma glucose measurement is the most appropriate diagnostic test for this patient. Diabetes mellitus can be diagnosed with an abnormal result of one screening test performed on two separate occasions. Although the HbA1c is normal in this patient, the fasting plasma glucose is abnormally elevated within the diagnostic range for diabetes mellitus. When discrepant results occur among different screening tests for diabetes, the American Diabetes Association recommends repeating the abnormal screening test. If the repeat fasting plasma glucose measurement is abnormal, the diagnosis of diabetes is confirmed. Screening for type 2 diabetes should begin in all asymptomatic patients at age 45 years. In adult patients with a BMI greater than or equal to 25, screening should occur at any age if one or more additional risk factors for diabetes is present.

Use of the HbA1c as an initial screening test in this patient is appropriate as there is no evidence for anemia or kidney or liver disease that could decrease the reliability of the test. The value was normal and does not warrant a repeat measurement as the next diagnostic test to perform in this scenario.

A 2-hour 75-g oral glucose tolerance test can be used as a screening tool for diagnosing diabetes. Since this test was not initially used for screening in this patient, it is most appropriate to repeat the abnormal screening test (fasting plasma glucose) that was already used for comparison.

A random blood glucose measurement would be useful in this patient if he presented with classic hyperglycemic symptoms in the setting of a blood glucose level of 200 mg/dL (11.1 mmol/L) or above, as that would be diagnostic of diabetes. This patient is not symptomatic.

Key Point

  • When discrepant results occur among different screening tests for diabetes mellitus, the American Diabetes Association recommends repeating the abnormal screening test.

This content is excerpted from MKSAP 17 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Drug addiction is a learning disorder

April 22, 2016 Kevin 1
…
Next

Learn the physical exam by following an oncologist

April 23, 2016 Kevin 4
…

ADVERTISEMENT

Tagged as: Diabetes

Post navigation

< Previous Post
Drug addiction is a learning disorder
Next Post >
Learn the physical exam by following an oncologist

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

Related Posts

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 45-year-old woman with type 2 diabetes mellitus

    mksap
  • Type 1 diabetes is no fun

    Ryan Ritchie
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 35-year-old woman with constipation

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 60-year-old woman with persistent constipation

    mksap
  • A Black Panther for diabetics

    Ariel Lawrence
  • When breast cancer screening guidelines conflict: Some patients face real consequences

    Leda Dederich

More in Conditions

  • Why gambling addiction is America’s next health crisis

    Safina Adatia, MD
  • How robotics are reshaping the future of vascular procedures

    David Fischel
  • How the shingles vaccine could help prevent dementia

    Marc Arginteanu, MD
  • Why removing fluoride from water is a public health disaster

    Steven J. Katz, DDS
  • What the research really says about infrared saunas

    Khushali Jhaveri, MD
  • How the cycle of rage is affecting physicians—and how to break free

    Alexandra M.P. Brito, MD and Jennifer L. Hartwell, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why being a physician mom is harder than anyone admits

      Cynthia Chen-Joea, DO, MPH | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
  • Recent Posts

    • Why physician voices matter in the fight against anti-LGBTQ+ legislation [PODCAST]

      The Podcast by KevinMD | Podcast
    • The man in seat 11A survived, but why don’t our patients?

      Dr. Vivek Podder | Physician
    • Why gambling addiction is America’s next health crisis

      Safina Adatia, MD | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • How robotics are reshaping the future of vascular procedures

      David Fischel | Conditions
    • Medicalizing burnout misses the real problem

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...