MKSAP: 71-year-old man with new dyspnea on exertion

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide to 10 mg/d, and pioglitazone to 45 mg/d. Within the past week, bedtime insulin glargine was initiated.On physical examination, blood pressure is 140/90 mm Hg, pulse rate is 90/min, and respiration rate is 20/min. Jugular venous distention, an S3, basilar pulmonary crackles, and 3+ pitting edema at the ankles are noted.Besides the initiation of insulin glargine, which of the following most likely contributed to these findings?A. Increased glyburide dosage B. Increased metformin dosage C. Increased pioglitazone dosage D. Medication-associated hypoglycemiaContinue reading ... Follow KevinMD.com on Facebook, Twitter, Google+, and LinkedIn.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Meds Diabetes Heart Source Type: blogs