Diabetes Mellitus Type 2 (Study Outline) For study only—this…

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Diаbetes Mellitus Type 2 (Study Outline) Fоr study оnly—this is nоt medicаl аdvice or a substitute for professional care. 1. Background Definition: Chronic hyperglycemia resulting from insulin resistance and progressive β-cell dysfunction. Pathophysiology: Peripheral tissues (muscle, liver, adipose) become resistant to insulin’s effects. Pancreatic β-cells initially increase insulin output but eventually fail. Associated metabolic disturbances: ↑ hepatic glucose production, ↓ peripheral glucose uptake. Epidemiology: 90% of diabetes cases. Typically develops after age 40, but increasing prevalence in adolescents with obesity. Strongly linked to obesity, sedentary lifestyle, and family history. Risk Factors: Obesity (especially central/visceral). Family history, hypertension, dyslipidemia, polycystic ovary syndrome. Certain ethnicities: African American, Hispanic, Native American, Pacific Islander. 2. History Gradual Onset Symptoms: Polyuria, polydipsia, polyphagia. Fatigue, blurred vision. Recurrent infections (e.g., skin, vaginal, urinary). Poor wound healing, acanthosis nigricans. Often Asymptomatic: May be discovered incidentally on labs. Associated Conditions: Metabolic syndrome (obesity, hypertension, dyslipidemia, insulin resistance). DKA Rare: Hyperosmolar hyperglycemic state (HHS) more common. 3. Exam Findings General: Overweight or obese body habitus. Blood pressure often elevated. Skin: Acanthosis nigricans: hyperpigmented, velvety plaques (neck, axilla). Skin tags (acrochordons). Complications: Peripheral neuropathy (sensory loss, paresthesias). Retinopathy signs on fundoscopic exam (microaneurysms, exudates). Decreased vibratory sense or absent reflexes in feet. 4. Making the Diagnosis Diagnostic Criteria (any of the following): Fasting plasma glucose ≥126 mg/dL (×2). A1C ≥6.5%. 2-hour OGTT glucose ≥200 mg/dL after 75 g glucose load. Random glucose ≥200 mg/dL with classic symptoms. Laboratory Findings: Elevated or normal C-peptide (reflects continued endogenous insulin production). No pancreatic autoantibodies (distinguishes from Type 1 DM). Screening Recommendations: Adults ≥35 years, or earlier if overweight with additional risk factors. Repeat every 3 years if normal. Gold Standard: Biochemical confirmation of hyperglycemia (fasting glucose or A1C). Common Associated Labs: Dyslipidemia: ↑ triglycerides, ↓ HDL, ↑ LDL. Possible hepatic steatosis on imaging. 5. Management (Exam Concepts) Lifestyle Modifications: Weight loss (5–10% body weight), healthy diet, regular exercise. First-line for all patients and may normalize glucose in early disease. Pharmacologic Therapy: First-line: Oral antihyperglycemics (mechanisms emphasized on PANCE): Biguanides (e.g., metformin): ↓ hepatic glucose output, ↑ insulin sensitivity. Other classes: SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, sulfonylureas. Insulin may be required for severe hyperglycemia or β-cell exhaustion. Monitoring: A1C every 3 months until stable (

Pаssаge Eleven (Questiоns 66-68) Cuаndо yо esperaba mi cuarto hijo, dio la casualidad que la perra de mis vecinos iba a tener perritos. Se me ocurrío entonces que aquélla sería una oportunidad ideal para explicarles a mis niños cómo vienen al mundo los bebés. Por eso, llevé a mis tres niños a ver nacer a los perritos, ¡siete perritos preciosos! Algunos meses después, al nacer mi cuarto hijo, mi esposo llevó a los niños al hospital para que conocieran a su nuevo hermanito. Y, mientras toda la familia miraba a los recién nacidos por la ventana de la sección maternal, nuestro hijo de tres años me preguntó: -- Mamá, ¿son todos estos bebés nuestros? La persona que habla esperaba

**Pleаse nоte thаt fоr Pаssages Five, Six, and Seven (questiоns 50-60), each passage is a continuation of the same story but the questions following each passage relate only to that passage. Passage Five (Questions 50 - 53) Cuando el niño estudiaba su carrera sucedió uno de esos cambios que tan comunes son en la edad juvenil. De perezoso se volvió trabajador. Cumplía bien sus deberes escolásticos. No sólo iba a clase puntualmente, sino que se ponía en la primera fila para mirar mejor al profesor. Al terminar la clase el niño era uno de los que interrumpían al profesor para pedirle que les explicara un punto oscuro de la lección. El niño hacía sus tareas.