A 55-year-old man is scheduled for a CT scan with intravenous contrast as part of his medical evaluation. He has a medical history of hypertension, type 2 diabetes mellitus, and depression. The patient is currently taking the following medications:
– Amlodipine 10 mg once daily
– Metformin 1g twice daily
– Simvastatin 20 mg once nightly
– Citalopram 20 mg once daily
According to the BNF guidelines, what is the most appropriate advice to provide regarding his metformin treatment?
A 55-year-old woman, with type 2 diabetes, has been successful in controlling her HbA1c through diet alone. She has lost 5 kilograms in the past 6 months by making changes to her diet and exercising regularly. Despite her progress, she is aware that her BMI categorizes her as ‘obese’ and wants to continue losing weight. During her clinic visit, she inquired about foods she should avoid.
What foods should this patient steer clear of?
A 17-year-old male presents with worries about delayed pubertal development, despite being 1.75m tall. He has minimal pubic hair and decreased testicular size. The following laboratory results are obtained:
Testosterone 7.2 nmol/l (9 – 30)
LH 3.5 mu/l (3 – 10)
FSH 5.9 mu/l (3 – 10)
What is the probable diagnosis?
A 25-year-old patient schedules a visit with her GP to ask for a prescription for orlistat. What is the most probable comorbid condition that would prevent the prescription of this medication?
A 50-year-old man is seen in the diabetes clinic and presents with the following results:
– Urinalysis NAD
– HbA1c 69 mmol/mol
The patient is currently taking metformin and gliclazide is added to his treatment regimen. What is the earliest time frame for repeating the HbA1c test?
A 70-year-old man comes to the clinic complaining of fatigue, low mood, and difficulty passing stools. Upon conducting a set of initial blood tests, the following results are obtained:
Calcium 3.2 mmol/l
Albumin 38 g/l
What is the most effective diagnostic test to identify the underlying reason for his elevated calcium levels?
A middle-aged male with type 2 diabetes comes in for a check-up. He is currently on metformin and has a HbA1c of 52. He has experienced multiple episodes of hypoglycemia in the past. The healthcare team decides to prescribe canagliflozin as an additional treatment.
What information should be conveyed to the patient regarding his new medication?
Mrs. Smith is a 65-year-old lady who has been prescribed once-daily insulin for her type 2 diabetes by the secondary care diabetes team a few months ago. During her routine medication review, you observe that she is not utilizing many lancets or blood sugar (BM) testing strips. She confesses to not checking her sugars every day. You inquire if she drives; she frequently uses the car for running errands around town.
What guidance should you provide to Mrs. Smith regarding blood glucose (BM) monitoring and driving?
A 50-year-old woman is undergoing a routine health assessment. She admits to consuming at least 5 standard alcoholic drinks each weekday evening and even more on the weekend. The risks of this intake are discussed with her and a plan is made to reduce her intake.
Which of the following actions is the most appropriate?
As the on-call physician, you receive a lab report for a 75-year-old man who has undergone routine blood tests to monitor his Antihypertensive medication.
The blood results are as follows:
Na+ 126 mmol/l
K+ 4.8 mmol/l
eGFR 85 ml/min/1.73m2
Upon calling the patient, he reports no symptoms and confirms that he is taking his regular lisinopril and amlodipine.
What would be the most appropriate course of action to manage this situation?