Christine Smith iHuman Case Study

Christine Smith is a 52-year-old female presenting with increased urination, excessive thirst, and blurred vision that has been progressively worsening over the past 3 weeks.

In this comprehensive guide, we’ll walk you through how to approach her case, from initial history-taking through physical examination to the final diagnosis of diabetes mellitus type 2 with complications. You’ll learn the key clinical reasoning steps, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this endocrine case simulation.

Christine Smith Ihuman Case Overview (Doorway Information)

Patient Overview: Christine Smith is a 52-year-old African American female presenting with a chief complaint of “increased urination, thirst, and blurred vision” that has been occurring over the past 3 weeks. She describes experiencing polyuria, polydipsia, and intermittent blurred vision, particularly when reading. The patient also reports fatigue and unintentional weight loss of approximately 15 pounds over the past month despite maintaining her usual appetite.

Key Background Information:

• Age/Gender: 52-year-old female
• Chief Complaint: Increased urination, excessive thirst, and blurred vision
• Duration: 3 weeks of progressive symptoms
• Symptom Characteristics: Polyuria, polydipsia, blurred vision, fatigue, weight loss
• Associated Symptoms: Frequent infections, slow-healing wounds
• Significant History: Hypertension, obesity (BMI 34), family history of diabetes
• Current Medications: Lisinopril 10mg daily, Hydrochlorothiazide 25mg daily
• Occupation: Office manager with sedentary lifestyle
• Lifestyle: Limited physical activity, high-carbohydrate diet, high stress levels

The patient appears alert but fatigued, currently experiencing mild symptoms at presentation, with elevated vital signs. Her presentation is classic for new-onset diabetes mellitus, making this an excellent case for learning systematic endocrine assessment and diabetes management skills.

Christine Smith (52 y/o female) – Endocrine Assessment

• CC: Increased urination, excessive thirst, and blurred vision
• MSAP: Progressive polyuria, polydipsia, and visual changes over 3 weeks with associated fatigue and weight loss
• Associated symptoms: Frequent infections, delayed wound healing
• History: HTN, obesity, family history of diabetes, sedentary lifestyle
• High-stress occupation

History Questions:

− How can I help you today?

− Any other symptoms we should discuss?

− Do you have any allergies?

− Are you taking any OTC or herbal medications?

− Any new or recent changes in medications?

− How often are you urinating during the day and night?

− How much water are you drinking daily?

− Have you noticed any changes in your vision?

− How severe (scale 1−10) is your fatigue?

− Have you experienced any weight changes recently?

− Do you have any wounds that are healing slowly?

− Have you had any recent infections?

− Do you experience any abdominal pain or nausea? − Do you have unusual sensations in your hands or feet?

− Does anyone in your family have diabetes?

− Do you drink alcohol? If so, what do you drink and how many drinks per day?

− Do you have any of the following problems: fatigue, difficulty sleeping, unintentional weight loss or gain, fevers, night sweats?

− Do you experience: headaches, dizziness, fainting episodes?

− Do you have any of the following: heat or cold intolerance, increased sweating, tremors?

− Do you have any of the following: nausea, vomiting, constipation, diarrhea, changes in appetite? − How is your overall health?

− Tell me about your work.

− Tell me about your daily diet and exercise habits.

Physical Exam:

• Vitals: pulse, BP, respirations, temperature, weight
• Examine skin
• HEENT examination
• Neck: thyroid examination
• Chest wall & lungs:
  • Visual inspection of anterior & posterior chest
  • Palpate anterior & posterior chest
  • Auscultate lungs
• Heart:
  • Palpate for PMI (Point of Maximal Impact)
  • Auscultate heart
• Abdomen:
  • Visual inspection
  • Palpate abdomen
• Extremities:
  • Visual inspection of extremities
  • Neurological assessment
  • Foot examination

Assessment note: C.S. is a 52 y/o African American female presenting with 3−week h/o progressive polyuria, polydipsia, and blurred vision associated with fatigue and 15-pound weight loss. On physical exam she appears fatigued with stable vital signs except for elevated glucose. PMH risk factors include: obesity (BMI 34), hypertension, family history of diabetes, and sedentary lifestyle.

Laboratory Results: Random glucose: 345 mg/dl, HbA1c: 11.2%, Urine: glucose 3+, ketones negative Diagnosis: Diabetes Mellitus Type 2, newly diagnosed

Plan:

• Determine immediate management needs based on glucose levels and symptoms
• Initiate metformin 500 mg BID with gradual titration
• Diabetes education and lifestyle counseling
• Ophthalmology referral for diabetic retinopathy screening
• Continue current antihypertensive medications
• Encourage lifestyle modifications:
  • Dietary consultation for carbohydrate counting
  • Gradual increase in physical activity
  • Blood glucose monitoring education
• f/u in 1−2 weeks

Christine Smith SOAP Note

Patient: Christine Smith

Subjective Data

CC: 52-year-old female presents with “increased urination, excessive thirst, and blurred vision”

HPI: 52-year-old female presents today with complaints of progressive polyuria, polydipsia, and intermittent blurred vision that has been occurring for the past 3 weeks. The patient describes urinating every 1-2 hours throughout the day and waking up 4-5 times per night to urinate. She reports drinking 4-5 liters of water daily but still feeling thirsty. The patient states that her vision becomes blurry, especially when reading, and she has been experiencing significant fatigue. The patient reports unintentional weight loss of 15 pounds over the past month despite maintaining her usual appetite. She also mentions having frequent yeast infections and that a small cut on her finger has been slow to heal. The patient has a family history of diabetes and reports a sedentary lifestyle with a high-carbohydrate diet.

Medications: Lisinopril 10mg daily, Hydrochlorothiazide 25mg daily

Allergies: (medication, environmental, food) The patient denies any medication, environmental or food allergies

PMH: Hypertension and obesity. Denies other chronic medical conditions.

LNMP/OB History (if indicated): G3P3, last menstrual period 2 weeks ago, regular cycles.

PSH: Denies any surgical procedures.

Sexual History (if indicated): Deferred for this exam.

Hospitalizations: None.

Health Maintenance: Reports going to primary care provider annually for routine check-ups and blood pressure monitoring.

Immunizations: Immunizations are up to date. Completed all childhood vaccines.

Family History: Maternal history of diabetes type 2. Paternal history of hypertension and stroke. Sister diagnosed with diabetes at age 45.

Substances (Tobacco, alcohol, illicit drugs, caffeine): The patient denies tobacco use and illicit drug use. Reports occasional alcohol consumption (1-2 drinks on weekends). Reports moderate caffeine intake with 2-3 cups of coffee daily.

Home environment: The patient lives with her husband and teenage daughter and reports a safe home environment.

Employment type: Currently an office manager with long sedentary work hours. Reports work is “moderately stressful.”

Diet: High-carbohydrate diet with frequent processed foods, limited vegetables, and irregular meal timing.

Sleep: Sleep disrupted by frequent urination at night, otherwise adequate sleep quality.

Exercise: Sedentary lifestyle with minimal physical activity due to work demands and fatigue.

Safety: Reports feeling safe at home. Denies history of physical or verbal abuse.

Objective Data

ROS: (Perform an appropriate ROS based on the C/C and HPI; documented in i-Human assignment; performed in final focused exam)

General: Reports decreased energy and fatigue over the past 3 weeks. Denies fever, chills, but confirms unintentional weight loss of 15 pounds. Eye contact is appropriate with clear speech. Reports feeling “tired all the time” and difficulty concentrating at work.

Skin, Hair and Nails: Reports slow healing of minor cuts and frequent yeast infections. Denies new rashes or lesions but mentions dry skin.

HEENT: Reports blurred vision, especially with reading. Denies headaches, double vision, or eye pain. Denies ear problems, sinus issues, or sore throat. Denies difficulty swallowing or jaw pain.

NECK: Denies pain or stiffness of the neck. Denies swollen glands or neck masses.

Thorax and Lungs: Denies shortness of breath, chest pain, or cough. Reports no history of lung disease or respiratory problems.

Cardiovascular: Reports history of hypertension managed with medications. Denies chest pain, palpitations, or syncope. Reports no leg swelling or decreased exercise tolerance.

Peripheral Vascular: Denies leg cramps, coldness in extremities, or varicose veins.

Abdomen: Denies nausea, vomiting, constipation, or diarrhea. Reports normal bowel movements and no abdominal pain.

Genitourinary: Reports frequent urination and increased thirst. Mentions recurrent yeast infections over the past month.

Metabolic/Hematologic: Reports significant fatigue, increased thirst, and frequent urination. Confirms unintentional weight loss despite normal appetite.

Psychiatric: Denies depression, anxiety, or mood changes. Reports some irritability due to fatigue and sleep disruption from frequent urination.

Musculoskeletal: Denies joint pain or muscle weakness. Reports feeling generally weak due to fatigue.

Neurologic: Denies numbness, tingling, headaches, or dizziness. No history of seizures or syncope.

Vital Signs:

Temperature: 98.2°F, Pulse: 78, BP: 138/86, Respirations: 16 SpO2: 98%, Weight: 185 lbs, Height: 5’4″, BMI: 34

Assessment

General: Obese middle-aged female, appears stated age, alert, and oriented x 4. Appears fatigued but no acute distress noted.

Skin, Hair and Nails: Skin is warm and dry with normal texture. No acute lesions noted. Small healing cut on right index finger noted. Capillary refill less than 3 seconds.

HEENT: The head is normocephalic and atraumatic. Eyes: pupils equal, round, reactive to light. No acute eye findings. Ears: normal appearing external ears, clear canals. Mouth: oral mucosa appears dry, no lesions noted.

NECK: No lesions or masses noted. Full range of motion. Thyroid non-palpable, moves with swallowing.

Thorax and Lungs: Thorax symmetric, no deformities. Lung fields clear to auscultation bilaterally. No wheezing, crackles, or abnormal sounds noted.

Cardiovascular: Regular rate and rhythm, normal S1 and S2 without murmur, gallop, or rub. PMI non-displaced. No peripheral edema noted.

Peripheral Vascular: Extremities warm and dry. Pulses 2+ bilaterally in radial and dorsalis pedis. No peripheral edema or varicosities noted.

Abdomen: Abdomen soft, non-tender to palpation. Bowel sounds normoactive in all 4 quadrants. No masses or organomegaly noted.

Genitourinary: Deferred for this exam.

Psychiatric: Affect appropriate, speech clear. Appears tired but cooperative throughout examination.

Musculoskeletal: No obvious deformities. Gait steady, posture normal. Strength 5/5 in all extremities.

Neurologic: Alert, oriented to person, place, time, and situation. Cranial nerves grossly intact. Deep tendon reflexes 2+ bilaterally.

Differential Diagnoses

Diabetes Mellitus Type 2: The patient presents with classic symptoms of diabetes including polyuria, polydipsia, blurred vision, fatigue, and unintentional weight loss. Risk factors include obesity, family history, sedentary lifestyle, and age. This is the most likely diagnosis given the symptom constellation and risk factors.

Diabetes Mellitus Type 1: While less likely at age 52, adult-onset Type 1 diabetes can occur. The patient’s symptoms are consistent, but her age, obesity, and gradual onset make Type 2 more probable. Further testing including autoantibodies would help differentiate.

Diabetes Insipidus: Could explain the polyuria and polydipsia but would not account for blurred vision, weight loss, or glucose-related symptoms. This is a less likely diagnosis given the clinical presentation.

Hyperthyroidism: Could cause weight loss, fatigue, and increased urination, but typically presents with heat intolerance, tremors, and palpitations which this patient denies. The visual symptoms are not typical for hyperthyroidism.

Urinary Tract Infection: Could cause frequent urination but would not explain the polydipsia, blurred vision, or weight loss. The absence of dysuria makes this less likely.

Most Likely Diagnosis: Diabetes Mellitus Type 2 evidenced by classic triad of polyuria, polydipsia, and polyphagia with associated blurred vision, fatigue, and unintentional weight loss. Laboratory findings show significantly elevated glucose (345 mg/dl) and HbA1c (11.2%), confirming the diagnosis.

Plan

Health Promotion: (appropriate screening, disease prevention, and health promotion according to the patient’s age, gender, and identified risk factors…not diagnosis specific)

✓ Diabetes Management – Initiate comprehensive diabetes education including blood glucose monitoring, carbohydrate counting, and recognition of hyperglycemic symptoms.

✓ Weight Management – Referral to nutritionist for structured meal planning and gradual weight reduction goals.

✓ Blood Pressure Monitoring – Continue current antihypertensive therapy and monitor for diabetes-related hypertension complications.

Screening

✓ Diabetic Complications Screening – Annual ophthalmology exams, nephropathy screening with microalbumin, neuropathy assessment

✓ Cardiovascular Risk Assessment – Lipid panel, ECG, assessment for coronary artery disease risk

✓ Cancer Screening – Age-appropriate screening including mammogram, cervical cancer screening, colonoscopy

Immunizations

✓ Seasonal Flu vaccine

✓ Covid-19 vaccine

✓ Pneumococcal vaccine (recommended for diabetic patients)

Complete Step-by-Step Guide to Writing the Christine Smith iHuman Case Study

Completing the Christine Smith iHuman case requires a systematic approach that mirrors real clinical practice. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, take a moment to review the doorway information and formulate your initial clinical approach.

Key Information to Note:

• 52-year-old female with “increased urination, excessive thirst, and blurred vision”
• 3-week duration of progressive symptoms
• Consider immediate endocrine risk factors: age, obesity, family history

Initial Clinical Mindset: Approach this case with diabetes mellitus as your primary consideration. The age, symptoms (classic triad), and risk factors immediately suggest new-onset diabetes, making this a high-priority assessment requiring systematic evaluation.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for establishing the foundation of your diagnosis. Use the OLDCARTS method systematically:

Onset: Ask about when symptoms started and progression

• Key points to elicit: Started 3 weeks ago, gradually worsening

Location: Determine systemic nature of symptoms

• Target response: Polyuria, polydipsia, visual changes

Duration: How long do symptoms persist

• Important detail: Constant throughout day and night

Character: Detailed description of each symptom

• Critical descriptors: “Excessive urination,” “constant thirst,” “blurry vision”

Aggravating factors: What makes symptoms worse

• Essential findings: High-carbohydrate meals, stress

Relieving factors: What provides temporary relief

• Key response: Nothing provides consistent relief

Timing/Treatment: Pattern and any attempted treatments

• Important pattern: Progressive worsening, no treatments tried

Severity: Impact on daily activities

• Typical response: Significantly affecting work and sleep

Associated Symptoms:

• Ask specifically about: weight loss, fatigue, infections, wound healing
• Key findings: 15-pound weight loss, severe fatigue, slow-healing wounds

Step 3: Review of Systems (ROS)

Conduct a thorough but focused ROS, paying special attention to endocrine and related systems:

Endocrine:

• Classic diabetes symptoms (already covered in HPI)
• Heat/cold intolerance, sweating patterns
• Energy levels, sleep patterns

Neurologic:

• Numbness, tingling (peripheral neuropathy)
• Vision changes, headaches
• Cognitive changes, concentration issues

Genitourinary:

• Urination patterns, infections
• Sexual dysfunction

General:

• Weight changes, appetite changes
• Fatigue patterns, mood changes

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

• Hypertension (managed with ACE inhibitor and diuretic)
• Obesity (BMI 34)
• Previous pregnancies and gestational diabetes screening
• Previous hospitalizations, surgeries

Family History:

• Critical finding: Strong family history of diabetes
• Maternal diabetes type 2
• Sister diagnosed with diabetes at age 45

Social History:

• Occupation: Office manager with sedentary work
• Diet habits: High-carbohydrate, processed foods
• Exercise: Minimal physical activity
• Stress levels: Moderate work-related stress
• Alcohol: Occasional social drinking

Step 5: Physical Examination Strategy

Perform a comprehensive endocrine-focused physical exam:

Vital Signs:

• Expected findings: Mild hypertension, normal other vitals
• Note: Weight documentation important for BMI calculation

Endocrine Examination:

• General appearance: Note fatigue, dehydration signs
• Skin: Check for infections, slow-healing wounds
• Eyes: Fundoscopic exam if trained, visual acuity
• Thyroid: Palpation for enlargement

Additional Key Exams:

• Neurologic: Check for peripheral neuropathy signs
• Foot Examination: Inspect for diabetic foot complications
• Cardiovascular: Assess for diabetes-related complications
• Abdominal: Check for hepatomegaly or other masses

Step 6: Developing Differential Diagnoses

Propose at least 3-4 appropriate differentials with rationales:

Primary Consideration: Diabetes Mellitus Type 2

• Supporting evidence: Classic triad of symptoms, risk factors, age

Secondary Considerations:

• Diabetes Mellitus Type 1
  • Rationale to consider: New-onset diabetes with weight loss
  • Rationale against: Age, obesity, gradual onset
• Hyperthyroidism
  • Rationale to consider: Weight loss, fatigue, frequent urination
  • Rationale against: No heat intolerance, tremors, or palpitations
• Diabetes Insipidus
  • Rationale to consider: Polyuria and polydipsia
  • Rationale against: No explanation for visual changes or weight loss

Step 7: Diagnostic Test Interpretation

Interpret provided test results to support your diagnosis:

Expected Key Findings:

• Random Glucose: >200 mg/dl (345 mg/dl in this case)
• HbA1c: >6.5% (11.2% indicates poor control over 2-3 months)
• Urine: Glucose positive, ketones negative (distinguishes from DKA)
• Basic metabolic panel: Normal electrolytes

Clinical Correlation: Use test results to confirm diabetes diagnosis and rule out diabetic ketoacidosis.

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Diabetes Mellitus Type 2, newly diagnosed

Justification:

• Classic symptom triad (polyuria, polydipsia, polyphagia)
• Associated symptoms (blurred vision, weight loss, fatigue)
• Multiple risk factors (obesity, family history, sedentary lifestyle)
• Laboratory confirmation with elevated glucose and HbA1c

MSAP Selection: Choose “Diabetes Mellitus Type 2” as your Most Significant Active Problem, as this represents the primary condition requiring immediate management and long-term care.

Step 9: Comprehensive Management Plan

Develop a multi-faceted treatment approach:

Immediate Management:

• Blood glucose stabilization
• Diabetes education initiation
• Symptom monitoring

Pharmacological Interventions:

• Metformin: First-line therapy, start 500mg BID
• Continue Lisinopril: ACE inhibitor beneficial in diabetes
• Continue HCTZ: May need adjustment based on glucose control

Lifestyle Modifications:

• Dietary counseling: Carbohydrate counting, portion control
• Exercise prescription: Gradual increase in physical activity
• Weight management: Structured weight loss program
• Blood glucose monitoring: Self-monitoring education

Screening and Prevention:

• Ophthalmology referral: Diabetic retinopathy screening
• Podiatry consultation: Foot care education
• Lipid panel: Cardiovascular risk assessment
• Nephropathy screening: Microalbumin testing

Follow-up Plan:

• Return visit in 1-2 weeks to assess glucose control
• HbA1c recheck in 3 months
• Regular monitoring for diabetes complications

Step 10: Documentation and Submission Tips

Writing Your Summary:

• Create a concise 350-word summary explaining your clinical reasoning
• Include how you arrived at the problem list
• Cite specific assessment findings and lab correlations
• Use professional medical terminology

Key Documentation Elements:

• Assessment Statement: Brief patient summary with key findings
• Clinical Reasoning: Explain diagnostic thought process
• Evidence Correlation: Link physical findings to test results
• Management Rationale: Justify treatment choices

Final Submission Checklist:

• ✓ Complete history with OLDCARTS method
• ✓ Comprehensive endocrine physical exam
• ✓ Appropriate differential diagnoses with rationales
• ✓ Correct final diagnosis and MSAP
• ✓ Evidence-based management plan
• ✓ Professional documentation with proper citations

Christine Smith iHuman Case Summary

Grading Criteria:

The Christine Smith iHuman case will evaluate you across several critical domains to ensure comprehensive endocrine assessment skills. Here’s what you need to focus on to maximize your score:

(1) History Taking (Major Points):

You must ask targeted questions about the classic diabetes symptom triad to get full credit. Essential questions include: urination patterns (frequency, volume), fluid intake (amount, frequency), vision changes (timing, severity), weight changes (amount, timeline), and associated symptoms (fatigue, infections). Don’t miss asking about: diabetes risk factors (family history, weight history, exercise habits), previous glucose testing, and impact on daily activities. The rubric specifically rewards students who ask about symptom onset and progression patterns.

(2) Physical Examination (High Weight):

Focus your exam on endocrine and related systems. Must-do components: vital signs (including weight for BMI), skin examination for infections/wounds, basic neurologic assessment for neuropathy, cardiovascular examination, and foot inspection. Pro tip: The rubric awards points for checking visual acuity and examining for signs of dehydration – many students forget these key endocrine exam elements.

(3) Differential Diagnosis (Critical for Scoring):

You need to propose at least 3 appropriate differentials with brief rationales. Expected differentials include: diabetes mellitus type 2, diabetes mellitus type 1, hyperthyroidism, and diabetes insipidus. Scoring secret: The rubric rewards students who can distinguish between Type 1 and Type 2 diabetes based on age, onset pattern, and risk factors.

(4) Final Diagnosis & MSAP:

You must correctly identify diabetes mellitus type 2 as your Most Significant Active Problem (MSAP). Justification is key – cite the classic triad, risk factors, and laboratory confirmation as supporting evidence.

(5) Management Plan (Heavily Weighted):

The rubric expects comprehensive management including: immediate glucose control, medication initiation (metformin), lifestyle modifications, diabetes education, and screening for complications. High-scoring responses mention: the importance of diabetes education, ophthalmology referral, and long-term complication prevention strategies.

(6) Patient Communication:

Demonstrate empathy and clear explanation of the condition. Bonus points for: discussing lifestyle modifications specifically (diet changes, exercise recommendations, blood glucose monitoring) and explaining the chronic nature of diabetes management.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Christine Smith

Situation: 52-year-old female presenting with 3-week history of classic diabetic symptoms including polyuria, polydipsia, and blurred vision.

Background: Significant diabetes risk factors including obesity (BMI 34), strong family history of diabetes, sedentary lifestyle, and high-carbohydrate diet. Currently managed hypertension with ACE inhibitor and diuretic.

Assessment: Physical examination notable for fatigue and mild dehydration signs. Laboratory findings demonstrate significantly elevated glucose (345 mg/dl) and HbA1c (11.2%), confirming diabetes diagnosis. Primary Diagnosis: Diabetes Mellitus Type 2, newly diagnosed.

Recommendation:

• Initiate metformin 500mg BID for glucose control
• Comprehensive diabetes education including blood glucose monitoring
• Lifestyle modifications: dietary consultation, exercise prescription, weight management
• Ophthalmology referral for diabetic retinopathy screening
• Continue current antihypertensive therapy
• Follow-up in 1-2 weeks to assess initial glucose control and medication tolerance

Patient Education Provided: Explained diabetes pathophysiology, importance of medication compliance, blood glucose monitoring techniques, dietary modifications, and clear instructions for recognizing hyperglycemic symptoms requiring immediate medical attention.

Conclusion

By following this comprehensive approach to the Christine Smith case, you’ll demonstrate the clinical reasoning skills that iHuman evaluates. Remember, success in endocrine cases requires systematic thinking: gather detailed history about classic symptoms, perform focused but thorough physical examination, consider appropriate differentials, and develop evidence-based management plans. The key is treating each iHuman simulation as you would a real patient encounter – be thorough, think critically, and always prioritize patient education and long-term management. With this guide, you’re well-prepared to excel in this challenging but rewarding case simulation.

Frequently Asked Questions

What is the correct diagnosis for Christine Smith’s symptoms?

Christine Smith’s primary diagnosis is diabetes mellitus type 2, newly diagnosed. The key distinguishing features that point to diabetes include the classic triad of polyuria, polydipsia, and polyphagia, along with associated symptoms like blurred vision, fatigue, and unintentional weight loss. Students often struggle between Type 1 and Type 2 diabetes, but remember that Type 2 is more common in adults over 45, especially those with obesity and family history, whereas Type 1 typically presents at a younger age with more acute onset and requires insulin immediately.

What are the critical physical exam components I need to perform to score well?

Essential physical exam elements include measuring vital signs (including accurate weight for BMI calculation), comprehensive skin examination for infections or slow-healing wounds, basic neurologic assessment for early neuropathy signs, cardiovascular examination, and detailed foot inspection. Many students miss points by skipping the foot examination and neurologic assessment, which are crucial for establishing baseline function in newly diagnosed diabetics. Don’t forget to assess visual acuity and check for signs of dehydration such as dry mucous membranes.

How do I pass the Christine Smith case and meet the 70% requirement?

You must score a cumulative 70% on the iHuman assessments to successfully complete the required lab component. To achieve this score, focus on thorough history-taking using systematic questioning about the classic diabetes triad (polyuria, polydipsia, polyphagia), complete all recommended physical exam components with attention to diabetes-related complications, propose appropriate differential diagnoses (including both Type 1 and Type 2 diabetes), and develop a comprehensive management plan that includes both immediate glucose control and long-term diabetes management. The key is being systematic and demonstrating understanding of diabetes as a chronic condition requiring ongoing management.

What management interventions should I include in my treatment plan?

The comprehensive management plan should address both immediate glucose stabilization and long-term diabetes management. Include laboratory confirmation with glucose and HbA1c testing, initiate first-line therapy with metformin, provide comprehensive diabetes education including blood glucose monitoring and carbohydrate counting, arrange ophthalmology referral for retinopathy screening, and establish a structured follow-up plan. Students often forget to address the importance of diabetes education and screening for complications, which are critical components for comprehensive diabetes care and can significantly impact your overall score. Also include lifestyle modifications such as dietary counseling, exercise prescription, and weight management strategies.