Vignette - DM

[adagio]

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A basketball player with history of DM type 1 was found laying on the ground in a state of confusion by his colleague, what is the most likely Dx?

1- Hypoglycemia

2- DKA

3- Rhythm disorder

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(all those questions I am reading from a guys notes that he didnt answer, and thats the only information he put)

 

[Fuzuli]

A basketball player with history of DM type 1 was found laying on the ground in a state of confusion by his colleague, what is the most likely Dx?

1- Hypoglycemia

2- DKA

3- Rhythm disorder

---------------

(all those questions I am reading from a guys notes that he didnt answer, and thats the only information he put)

There's no single correct answer based on the information above. This is akin to asking "A basketball player has a temperature of 38.3 C. What is the most likely diagnosis?"

 

[adagio]

well trust me, you will see such questions on the USMLE, so if you would give it a shot, what would you choose

 

[Fuzuli]

well trust me, you will see such questions on the USMLE, so if you would give it a shot, what would you choose

Out of those three, most likely DKA is the answer. Why? Because T1DM is mentioned in the question stem 🙂

 

[adagio]

well would a basketball game (stress and high exhaustion) cause DKA rapidly? thats what i think the question is asking... or would it cause (the stress and the exercise) would it cause hypoglycemia in a DM1 guy?

 

[Fuzuli]

well would a basketball game (stress and high exhaustion) cause DKA rapidly? thats what i think the question is asking... or would it cause (the stress and the exercise) would it cause hypoglycemia in a DM1 guy?

A typical scenario of hypoglycemia would have been an incorrect dosage of drugs.

 

[adagio]

let me ask you my inquiry in another way: would a basketball game be a possible instigator to an episode of diabetic ketoacidosis

 

[OveractiveBrain]

Ok, the question is stupid, and wouldnt be asked. It draws typical presentation for disease against epidemiology of disease against how a question is asked.


So everyone knows the "basketball player that drops dead suddenly" in hypertrophic cardiomyopathy and so a rhythm disorder would be the likely choice from "acute episode of basketball." But the question doesn't say he was playing, it just says that he IS a basketball player. Likewise, there is no

Given the epidemiology of disease, a basketball player on insulin has two effects lowering his blood glucose: insulin and exercise. Since diaebtes is far more common that hypertrophic cardiomyopathy, it is likely a drug reaction to insulin. Hypoglycemia is one of the most common incidents for "found down" and thus would be the right choice here, given so little information. The fact that he is a diabetic and was exercises only fuels the fire.

Given the way the question is asked, the patient could be in DKA because he's a type 1 diabetic. There is no mention of insulin being used, so the presumption must be that no insulin is being used. Maybe he is a new onset type 1 diabetic, maybe he was recently exercise controlled and he stopped exercising. This makes this answer more likely.

Scary Stem: Arrythmia, but no sudden LOC
Epidemiology: Hypoglycemia in a known Type 1 + Exercise
Question: DKA, because no insulin is mentioned.

Please don't post obnoxious questions that are one-liners in the Step 2 forum. This is for step 2, and these questions just dont get asked. You're only confusing people who dont already know, and make people who do know angry.