Start practicing

Medical Emergencies · patient case with 2 questions

Two chronic conditions and a set of labs

Patient: Male, 47 years old

Chief Complaint: Presents for extraction of a non-restorable molar.

Background: HIV diagnosed nine years ago, on antiretroviral therapy. Type 2 diabetes for six years, on metformin. BMI 34.

Laboratory: CD4+ count 302 cells/µL · HbA1c 9.0% · Viral load undetectable

Vital Signs: BP 138/86 mmHg · HR 80 bpm

Question 1

Which laboratory finding is most significant for the management of this extraction?

  1. The CD4 count of 302, indicating severe immunosuppression requiring deferral
  2. The HbA1c of 9.0%, indicating poorly controlled diabetes
  3. The CD4 count of 302, indicating AIDS
  4. The undetectable viral load, indicating a need for antibiotic prophylaxis
Show answer and explanation

Correct answer: B. The HbA1c of 9.0%, indicating poorly controlled diabetes

  • A. Severe immunosuppression begins below 200. There is no basis to defer treatment on immunological grounds here.
  • B. CORRECT. A CD4 count of 302 is ABOVE the 200 cells/µL threshold and the viral load is undetectable — this patient's HIV is well controlled and routine dental care proceeds without modification. The HbA1c of 9.0% is the number that actually changes management: it reflects an average glucose around 212 mg/dL over the preceding two to three months, meaning impaired neutrophil function, delayed wound healing and a raised risk of post-extraction infection.
  • C. AIDS is defined by a CD4 count BELOW 200 cells/µL, or by the presence of an AIDS-defining illness. At 302 with an undetectable viral load, this patient does not meet that definition.
  • D. An undetectable viral load is the goal of therapy and reassuring. It is not an indication for prophylaxis; HIV status alone never is.

Permanent page for this question

Question 2

Which statement about type 2 diabetes is correct?

  1. Insulin is required from the moment of diagnosis
  2. It results from autoimmune destruction of pancreatic beta cells
  3. The majority of people with the condition are overweight or obese
  4. It presents most often in childhood with ketoacidosis
Show answer and explanation

Correct answer: C. The majority of people with the condition are overweight or obese

  • A. Type 2 is managed first with lifestyle change and oral agents such as metformin. Insulin may be added later as beta-cell function declines, but it is not required at diagnosis.
  • B. Autoimmune destruction of beta cells defines TYPE 1 diabetes, with anti-GAD and islet-cell antibodies.
  • C. CORRECT. Excess adiposity, particularly visceral fat, is the dominant modifiable risk factor for type 2 diabetes — the large majority of patients are overweight or obese at diagnosis, and adipose-driven insulin resistance is the central mechanism. This patient's BMI of 34 fits the pattern. Weight loss can meaningfully improve or even remit early type 2 diabetes.
  • D. Childhood onset with ketoacidosis is the classic type 1 presentation. Type 2 usually presents in adulthood and is often found on screening in an asymptomatic patient.

Permanent page for this question

Practice patient cases Medical Emergencies study notes