Ite Questions With 100% Verified And Explained Answers (Graded A+)

ITE QUESTIONS WITH 100% VERIFIED AND EXPLAINED ANSWERS (GRADED A+) A 63-year-old male with a medical history of diabetes mellitus presents to an urgent care clinic with nausea, vomiting, and abdominal pain. His spouse reports that the patient began having trouble breathing during the short drive to the clinic. He has an insulin pump, and his spouse says it has been malfunctioning. On examination the patient is lethargic, tachycardic, and appears volume depleted. You note Kussmaul respirations and abdominal tenderness. Glucose 190 mg/dL Sodium 135 mEq/L (N 135-145) Potassium 5.1 mEq/L (N 3.5-5.2) Chloride 102 mEq/L (N 98-107) Creatinine 1.30 mg/dL (N 0.50-1.04) Osmolality 300 mOsm/kg H2O (N 280-305) Bicarbonate 10 mEq/L (N 19-29) Anion gap 23 mEq/L (N 18) Urine ketones 4+ Urine glucose 4+ Which one of the following medications may be contributing to this clinical picture? A) Atorvastatin (Lipitor) B) Canagliflozin (Invokana) C) Lisinopril (Zestril) D) Metformin E) Semaglutide - ANSWER: B This patient has classic symptoms of diabetic ketoacidosis (DKA) triggered by a malfunctioning insulin pump, but he appears euglycemic on presentation due to taking an SGLT2 inhibitor. Glycosuria occurs and can even persist 10-14 days after discontinuation of an SGLT2 inhibitor. Further evaluation of this patient would reveal an elevated urine glucose level despite his relatively normal serum glucose level. With a high anion gap, a low arterial pH and a high serum β-hydroxybutyrate level should also be expected. Atorvastatin is not implicated in acute metabolic problems. Lisinopril can cause hyperkalemia, but not DKA. Metformin can cause lactic acidosis in acutely ill patients, but the risk is low and lactic acid rather than ketone bodies would be high. GLP-1 receptor agonists such as semaglutide are not associated with an increased risk for euglycemic DKA. A 45-year-old gravida 2 para 2 with a history of irregular menses and bilateral tubal ligation presents with a 2-month history of bilateral milky nipple discharge. Her last menstrual period was 1 week ago. She does not take any medications. A physical examination reveals a small amount of milky nipple discharge bilaterally with no breast masses. A urine pregnancy test is negative. Laboratory testing reveals normal thyroid and kidney function, and a prolactin level of 95 ng/mL (N 5-20). Pituitary MRI with ...