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insulin

Practice targeted AMC-style multiple-choice questions on insulin.

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adverse drug reactionalcohol use disorderaltered mental statusamlodipineaspirinchronic kidney disease (CKD)diabetes mellituselectrolyte imbalanceemergency managementemergency medicine

A 72-year-old man with a history of hypertension, type 2 diabetes, and chronic kidney disease (CKD) presents to his general practitioner for a routine check-up. His current medications include metformin, insulin, amlodipine, and aspirin. His blood pressure today is 150/90 mmHg. Laboratory results show a serum creatinine of 2.5 mg/dL (221 micromol/L) and a potassium level of 5.4 mEq/L. The GP decides to add an ACE inhibitor to his treatment regimen to help manage his blood pressure and provide renal protection. One week later, the patient returns complaining of fatigue and muscle weakness. Repeat laboratory tests reveal a serum creatinine of 3.1 mg/dL (274 micromol/L) and a potassium level of 6.2 mEq/L. Which of the following is the most appropriate next step in managing this patient?

A. Add a potassium-binding resin (e.g., sodium polystyrene sulfonate) and continue the ACE inhibitor.
B. Prescribe a loop diuretic to counteract the hyperkalemia and continue the ACE inhibitor.
C. Refer the patient to a nephrologist for urgent dialysis.
D. Reduce the dose of the ACE inhibitor by 50% and recheck renal function and potassium levels in one week.
E. Discontinue the ACE inhibitor and monitor renal function and potassium levels.
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A 43-year-old is unconscious with low blood glucose (1.8 mmol/L), has a history of insulin use and alcohol intake. What is the next step?

A. 16G IV + 10% glucose, 150-200 ml over 15 minutes.
B. Give oral glucose.
C. Give 1 mg of glucagon intramuscularly.
D. Give IV 50% glucose.
E. Give subcutaneous insulin.
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