Rosh Internal Medicine Boost Practice Exam

In the context of diabetes diagnosis, which glucose measurement is most alarming despite the patient being asymptomatic?

1. Fasting glucose of 130 mg/dL

2. Random glucose of 250 mg/dL

3. Fasting plasma glucose of 125 mg/dL

4. Hemoglobin A1C of 6.0 percent

The correct answer is: Random glucose of 250 mg/dL

In the context of diagnosing diabetes, a random glucose measurement of 250 mg/dL is particularly concerning even in an asymptomatic patient. The rationale behind this is that a random glucose level of 200 mg/dL or higher is one of the criteria for diagnosing diabetes, indicating that the body is struggling to regulate blood glucose levels effectively. A value of 250 mg/dL significantly exceeds this threshold, raising the suspicion of diabetes mellitus. Other glucose measurements provided, while indicative of potential glucose metabolism issues, reflect less urgent concerns. For example, a fasting glucose of 130 mg/dL is just above the normal threshold but does not immediately necessitate urgent action, although it is indicative of a state of impaired fasting glucose. Similarly, a fasting plasma glucose of 125 mg/dL is a marker for prediabetes and suggests a need for lifestyle changes and monitoring but does not point to diabetes with the same level of urgency as the random glucose measurement. A Hemoglobin A1C of 6.0 percent, although significant as a metric for chronic glucose control, falls within the range typically associated with normal or prediabetic status, depending on the guidelines referenced, and does not demand immediate concern compared to the acute nature of a random glucose of