A 47-year-old woman presents to the clinic with complaints of lethargy. During a work-up, her fasting plasma glucose level was found to be 6.3 mmol/l. The GP registrar ordered an HbA1c test to confirm the diagnosis of prediabetes. What is the most probable condition/situation that could render the test result invalid?
Which one of the following statements regarding bendroflumethiazide is accurate?
You visit Mrs. Jones, an elderly woman who is suffering from an acute diarrhoeal illness she picked up from her grandchildren. Her past medical history includes: hypertension, type 2 diabetes, hyperlipidemia, and osteoporosis. Her medications are amlodipine 5mg OD, lisinopril 10 mg OD, aspirin 81mg, omeprazole 20 mg OD, metformin 500mg BD, atorvastatin 20 mg ON, and acetaminophen 650mg PRN. Her pulse is 88/min, blood pressure 146/78 mmHg, oxygen saturations 98%, respiratory rate 18/min. Her tongue looks a little dry, abdomen is soft and non-tender, with very active bowel sounds. After examining her, you feel she is well enough to stay at home, and you prescribe some rehydration sachets and arrange telephone review for the following day.
What immediate changes should you advise regarding her medication?
You go on a home visit to see an 80-year-old nursing home resident who was found ‘collapsed’ in his room earlier today. The paramedics were called and made a diagnosis of hypoglycaemia. The record of their visit shows that he was drowsy and the blood glucose was 1.8 mmol/l. After giving him an oral glucose paste the patient’s condition significantly improved. A carer from the nursing home is present and reports that he has had regular ‘hypos’ recently.
His current medication is as follows:
Metformin 1g bd
Gliclazide 160mg od
Pioglitazone 45mg od
Aspirin 75 mg od
Simvastatin 40 mg on
What is the most appropriate immediate action?
A 64-year-old man is being seen in a diabetes clinic due to poor glycaemic control despite weight loss, adherence to a diabetic diet, and current diabetes medications. He has no significant medical history. What medication could be prescribed to increase his insulin sensitivity?
A 67-year-old female has been experiencing fatigue, itching, and yellowing of her skin. She denies any rashes and doesn’t feel feverish or unwell. Her medical history includes well-controlled type 2 diabetes, hypertension, rheumatoid arthritis, and diverticulosis. On examination, she has scleral icterus, a clear chest, normal heart sounds, a soft and non-tender abdomen, and no peripheral edema. Which medication is the most probable culprit for her current symptoms?
You are performing the yearly evaluation of a 42-year-old female patient with type 1 diabetes mellitus. Your objective is to screen for diabetic neuropathy that may be affecting her feet.
Which screening test would be the most suitable to use?
A 40-year-old man has been experiencing difficulty in conceiving with his partner for 2 years and they have undergone clinical evaluation. While his partner’s assessment is normal, he has been diagnosed with hypogonadotrophic hypogonadism.
What are the possible causes of this condition?
Mrs. Smith is a 70-year-old widow who presents with easy bruising. There is no history of abnormal bleeding apart from some gum bleeding when brushing teeth, and no family history of bleeding problems. She rarely drinks alcohol. General examination including examination of the liver and of lymph nodes is normal; there are multiple small bruises on the limbs – no purpura or petechiae. You check her medication list and find no item that might be the cause. You arrange some blood tests including full blood count, blood film, renal profile, bone profile, liver function, and clotting screen, which are all unremarkable. You suspect the cause might be due to a ‘tea and toast’ diet after her husband passed away.
What dietary supplement could you consider as the next step for Mrs. Smith?
A 22-year-old female patient visits the GP complaining of daily headaches that last most of the day. Despite this, she is able to carry out her usual activities. She also reports experiencing clumsiness and frequently bumping into objects on the periphery of her vision, which has been gradually worsening. Apart from these symptoms, she feels fine. The patient is currently taking the COCP and mentions that she had infrequent periods before starting it, and had not had a period for about a year. On examination, her BMI is 19kg/m², vital signs are normal, and her neurological examination is unremarkable. What is the most probable cause of her symptoms?