A 49-year-old woman is admitted to the surgical ward with severe loin to groin abdominal pain. A CT-KUB reveals a right-sided renal calculus. When you clerk her in she admits to you that she has not felt herself for the past few weeks with polyuria, polydipsia, constipation and altered mood.
You receive a discharge summary for Mr. Chen, a 65-year-old man, who has had an acute surgical admission with pancreatitis. The summary notes that it was thought to be drug-related. His past medical history includes atrial fibrillation and type 2 diabetes. His regular medications are ramipril, warfarin, metformin, sitagliptin, and atorvastatin. He also takes an over-the-counter vitamin D supplement.
Which of his medications might have caused this presentation and should be reported by Yellow Card?
AKT-4699
A 50-year-old woman with type 2 diabetes mellitus is being evaluated. Prior to initiating pioglitazone therapy, what is the most important factor to consider?
AKT-4700
You are a healthcare professional working in a general practice. Your next patient is a 70-year-old man who has come for a follow-up appointment to review his recent blood test results. During his last visit, you had expressed concern about his elevated plasma glucose levels and advised him to make some lifestyle changes. He informs you that he has made some dietary modifications and has started walking to the nearby stores instead of driving.
The patient has a medical history of coeliac disease, osteoarthritis, and chronic kidney disease. His fasting blood test results are as follows:
What would be the most appropriate course of action for managing this patient’s HbA1c levels?
AKT-4698
A 28-year-old female presents with a 2-month history of fatigue and nocturia. On further questioning she also admits to increased thirst. She doesn’t have dysuria or urgency, denies the possibility of pregnancy and has otherwise been well. Her sister was recently diagnosed with diabetes, although she is not sure which type. She has looked at the symptoms online and is worried about a possible diabetes diagnosis; she wants to know how she can distinguish between the types of diabetes.
Her body mass index (BMI) is 29 kg/m².
Which of the following tests would be best in differentiating these diagnoses?
AKT-4672
During his 3-month check-up, a 50-year-old patient with a BMI of 33 reports that he has been unable to adhere to his orlistat prescription due to the side effects he has experienced. The patient has a medical history of psoriasis, hyperlipidaemia, and hypertension. According to NICE, what alternative treatment may be appropriate for this patient?
AKT-4683
Sarah is a 55-year-old woman who visits her GP for a medication review. She was prescribed 75 micrograms of thyroxine 6 months ago due to her TSH level being 6.5mU/L and her T4 level being 3.9 μg/dL. She takes her medication consistently at the same time every day and has not missed a dose. Her other medications include lisinopril, simvastatin, ferrous fumarate, and calcium carbonate.
What is the most likely explanation for Sarah’s continued abnormal thyroid function?
AKT-4680
A 42-year-old man with a history of depression and gastro-oesophageal reflux disease visits his GP complaining of milky discharge from his nipples. His blood test results show a prolactin level of 700 mu/l. Which medication is the most probable cause of this symptom?
AKT-4682
A 56-year-old female arrives at the Emergency Department with complaints of double vision. Upon examination, she displays exophthalmos and conjunctival oedema, leading to a suspicion of thyroid eye disease. What can be inferred about her thyroid condition?
AKT-4679
A woman visits her GP for a check-up of her type 2 diabetes. She is taking metformin at the maximum tolerated dose. Her most recent HbA1c reading is 64 mmol/mol.
The GP prescribes gliclazide and schedules another HbA1c test in 3 months.