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Type 1 diabetes mellitus — USMLE Step 2 CK MCQ

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ModeratePediatricsType 1 diabetes mellitusUSMLE Step 2 CK

A 5-year-old White boy comes to the hospital nursery because of new symptoms noticed by a caregiver. History and focused examination are notable for weight loss, polyuria, polydipsia, ketonuria, and hyperglycemia. Temperature is 100.6°F (38.1°C), blood pressure is age appropriate, pulse is 128/min, respirations are 32/min, and oxygen saturation is 96% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Growth parameters, hydration status, and focused testing are consistent with the described pediatric presentation. Which of the following is the most appropriate next step in management?

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Correct answer: D — Basal-bolus insulin therapy

The vignette describes Type 1 diabetes mellitus, supported by weight loss, polyuria, polydipsia, ketonuria, and hyperglycemia. Basal-bolus insulin therapy is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: ADA Standards of Care in Diabetes 2026