Which of the following complications best describes a microvascular complication of diabetes mellitus?

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Question 1 of 5

Which of the following complications best describes a microvascular complication of diabetes mellitus?

Correct Answer: C

Rationale: The correct answer is C: Diabetic retinopathy. This is a microvascular complication of diabetes mellitus affecting the small blood vessels in the retina. It is caused by prolonged high blood sugar levels damaging the blood vessels, leading to vision problems and potentially blindness. Explanation: 1. Diabetic retinopathy specifically involves the microvasculature of the eye. 2. Abdominal aortic aneurysm (Choice A) and Coronary heart disease (Choice B) are macrovascular complications affecting larger blood vessels. 3. Peripheral artery disease (Choice D) involves blockages in larger arteries, not the microvasculature. In summary, diabetic retinopathy is the best description of a microvascular complication of diabetes mellitus as it involves damage to the small blood vessels in the retina, distinguishing it from macrovascular complications listed in the other options.

Question 2 of 5

All of the following statements about Helicobacter pylori (H. pylori) are true except

Correct Answer: C

Rationale: The correct answer is C. Eradication of H. pylori prevents adenocarcinoma of the stomach. This statement is incorrect because eradication of H. pylori has been shown to decrease the risk of gastric cancer but does not completely prevent it. A: H. pylori can invade the gastric epithelium, leading to inflammation. B: H. pylori actually reduces gastric acid secretion to help it survive in the stomach. D: H. pylori does produce urease, which helps it survive in the acidic stomach environment by neutralizing urea into ammonia and CO2.

Question 3 of 5

A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?

Correct Answer: D

Rationale: The correct answer is D: Calcium channel-blocker. The crater above the gastroesophageal junction is likely due to a peptic ulcer, which can be caused by NSAIDs and alendronate due to their potential to irritate the gastric mucosa. Iron sulfate can also contribute to gastrointestinal irritation but is less common compared to NSAIDs and alendronate in causing ulcers. Calcium channel-blockers, on the other hand, do not have a direct irritant effect on the gastrointestinal mucosa and are not associated with peptic ulcers. Therefore, calcium channel-blockers are the least likely contributor to the formation of the crater in this scenario.

Question 4 of 5

A 42-year-old accountant is referred to your office for evaluation of progressive weight loss. He has lost 20 pounds over the last 6 months. He has a long history (16 years) of insulin-dependent diabetes mellitus. He denies alcohol abuse but admits to heavy smoking (2 packs of cigarettes per day for 20 years). Three days ago he noticed that his urine became dark and that his skin started to itch. He had a CT scan of the abdomen last week that revealed fullness in the head of the pancreas with dilatation of intra- and extrahepatic biliary ducts. The CT scan did not demonstrate a discrete mass in the pancreas or liver, gallstones, or pancreatitis. His physical examination is normal except for obvious jaundice. His blood work reveals WBC count 6.4, total bilirubin 5.7 mg/dL, alkaline phosphatase 340 U/L, amylase 64 U/L, and lipase 47 U/L. Which of the following tests would you order next?

Correct Answer: C

Rationale: The correct answer is C: Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is the next appropriate step for this patient due to the presence of jaundice, dark urine, and dilatation of the biliary ducts on CT scan, which indicate a likely biliary obstruction. ERCP allows direct visualization of the biliary tree and pancreatic duct, as well as therapeutic interventions such as stent placement or stone removal. This procedure can help identify the cause of the jaundice and guide further management. Choice A (Hepatobiliary scintigraphy) is used to evaluate gallbladder function but is not the most appropriate test in this scenario where biliary obstruction is suspected. Choice B (Abdominal ultrasound) can help identify biliary dilatation but does not provide direct visualization or therapeutic options like ERCP. Choice D (Transcutaneous transhepatic cholangiography) is an invasive test that is typically reserved

Question 5 of 5

A 25-year-old dental technician has noticed a 10-pound weight loss despite increased appetite, generalized weakness, and constipation with infrequent but unusually voluminous and malodorous stools. On physical examination, he is thin, pale, and appears tired. His abdomen is protuberant but soft. Labs reveal a microcytic anemia. Which of the following is least likely to be helpful?

Correct Answer: D

Rationale: The correct answer is D: Colonoscopy. In this scenario, the patient's symptoms point towards malabsorption, which is typically associated with issues in the small intestine, not the colon. Therefore, a colonoscopy, which examines the large intestine, would be least likely to be helpful in diagnosing the underlying cause of his symptoms. Choices A, B, and C would be more beneficial as they can help identify potential causes of malabsorption such as celiac disease, pancreatic insufficiency, or small bowel abnormalities.

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