Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™
This activity is intended for gastroenterologists, diabetologists, and endocrinologists.
The goal of this activity is for learners to be better able to use appropriate NITs to assess patients for liver fibrosis.
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activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.
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CME Released: 2/28/2023
Valid for credit through: 2/28/2024, 11:59 PM EST
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Carol is a 50-year-old woman who was diagnosed with type 2 diabetes (T2D) 7 years ago. She comes into your endocrinology office for her first visit after recently moving to the area. Her glycated hemoglobin (HbA1c) is 8% on metformin. You note that she has other indicators of metabolic syndrome such as class 2 obesity, low-density lipoprotein (LDL) cholesterol of 130 g/dL, and her blood pressure (BP) is 130/90 mm Hg on ramipril 5 mg. Her alanine transaminase (ALT) is 65 U/L, aspartate aminotransferase (AST) is 45 U/L, and platelet count is 200,000. Carol explains that things have been hard in her personal life. She got divorced 3 years ago, moved twice, and had 3 jobs changes which interrupted her health insurance. She is finally settled into a new home with a good job and wants to get her health back on track.
Carol's medical record and current laboratory results are listed in Table 1.
History | Findings |
---|---|
Medical | T2D × 7 years, HTN × 15 years, dyslipidemia × 10 years, and obesity |
Current medications | Metformin 1000 mg twice daily, ramipril 5 mg/d, metoprolol 100 mg twice daily, simvastatin 20 mg/d |
Social/Occupational | Married; smoker × 30 years, recreational drinker; has 2 adult sons. Sedentary lifestyle. High-fat diet, poor intake of fruit, vegetables, and whole grains |
Physical Exam | Findings |
Vital signs | BP: 130/90 mm Hg Heart rate: 78 bpm |
Body measurements | Weight 90 kg, BMI = 35 kg/m2; class 2 obesity |
Extremities | No edema |
Neck | No distended neck veins |
Heart | LVEF = 60% |
Lungs | No rales |
Abdomen | Soft, nontender |
CBC | Results |
Normal, except platelets 200,000 | |
Metabolic Panel | Results |
FPG | 135 mg/dL |
HbA1c | 8% |
Lipid panel | LDL: 130 mg/dL; HDL: 35 mg/dL; TG: 170 mg/dL |
AST | 45 U/L |
ALT | 65 U/L |
eGFR | 91 mL/min/1.73 m2 |
UACR | 9 mg/g |
BMI, body mass index; CBC, complete blood count; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HDL, high-density lipoprotein; HTN, hypertension; LVEF, left ventricular ejection fraction; TG, triglycerides; UACR, urine albumin-to-creatinine ratio.