A 25-year-old nurse collapses at the end of a night shift and is admitted to the hospital. Her capillary blood glucose is measured at 1.2mmol/L and she quickly recovers after receiving IV glucose. A CT scan of her abdomen and pelvis reveals a hypervascular lesion in her pancreas that enhances with contrast. What additional finding would provide the strongest evidence for the probable diagnosis?
You assess a 67-year-old patient in the diabetic clinic who has been diagnosed with type 2 diabetes for 27 years. He has been on various antiglycemic agents including biguanides, sulfonylureas, thiazolidinediones, and insulin. The patient reports painless macroscopic hematuria and is concerned about bladder cancer associated with one of his medications. He requests a referral to a urologist. Which of the following antiglycemic agents is linked to bladder cancer?
A 65-year-old man with a history of ischaemic heart disease and type 2 diabetes mellitus presents for his annual review and is found to have non-visible haematuria. He reports feeling well and is not experiencing any symptoms. Upon urine dipstick testing, blood ++ is detected, with no presence of protein or leucocytes. The test is repeated one week later.
The patient is currently taking aspirin, bisoprolol, atorvastatin, ramipril, metformin, and pioglitazone. Which medication should be discontinued while awaiting further investigations?
A 67-year-old man is referred to the urology clinic due to experiencing macroscopic haematuria for three weeks. He has a medical history of type 2 diabetes and recently received treatment for a threadworm infection. His current medications include linagliptin, metformin, and pioglitazone. The patient does not smoke or drink alcohol and works as a dairy farmer. He originally comes from Jamaica. During a cystoscopy, an exophytic lesion is discovered in his bladder. What is the most significant risk factor for the development of this condition in this patient?
A 55-year-old male presents with a six month history of weight loss and thirst. He has a past history of hypertension and is currently taking bendroflumethiazide and ramipril. He has lost approximately 4 kg in weight over this time and finds that he needs to get up in the night to pass urine twice.
On examination, his pulse is 80 bpm regular, his blood pressure is 138/84 mmHg and he has a BMI of 23.5 kg/m2. Dipstick urine analysis reveals ++ glucose.
His investigations reveal:
– Fasting plasma glucose 13.3 mmol/L (3.5-6)
– HbA1c 74 mmol/mol (20-46)
– 8.9% (<6)
What is the most appropriate investigation to determine the cause of this patient’s diabetes?
An 84-year-old man presents with fatigue and a history of hypertension and type 2 diabetes mellitus. He takes lisinopril and metformin. His blood pressure is 140/80 mmHg and he appears to be clinically hydrated. Routine blood tests show:
Test Result Normal Range
Sodium (Na+) 128 mmol/L 135-145 mmol/L
Potassium (K+) 4.2 mmol/L 3.5-5.0 mmol/L
Urea 6.8 mmol/L 2.5-6.5 mmol/L
Creatinine 90 µmol/L 50-120 µmol/L
Which laboratory test would be most helpful in determining his fluid balance status?
A 28-year-old female patient presents to her GP with complaints of ongoing fatigue and struggles with weight loss. She frequently feels cold and has been experiencing constipation. After discussing her symptoms with her family, she was advised to seek medical attention as her mother had similar symptoms when diagnosed with Hashimoto’s thyroiditis. What autoantibody is most likely to be present in her blood?
A 30-year-old woman presents to the Emergency Department with complaints of increasing fatigue over the past few weeks. She is now unable to leave her house due to exhaustion, has significant nausea, and has not been able to eat for the past 48 hours. The patient has a history of Hashimoto’s thyroiditis and type 1 diabetes, for which she takes thyroxine and insulin. On examination, her blood pressure is 100/70 mmHg, with a postural drop of 20 mmHg on standing, and her pulse is 90 bpm and regular. Laboratory investigations reveal low haemoglobin, low sodium, high potassium, and high creatinine levels. What is the most likely diagnosis?
A 12-year-old boy is presenting with nocturnal enuresis, poor academic performance, and easy fatigue with physical activity. A full examination, including blood pressure, is unremarkable. Laboratory results show elevated WBC count and high bicarbonate levels. The 24-hour urine test reveals high potassium levels and low sodium levels. What is the likely diagnosis?
A 50-year-old man visits the endocrine clinic with difficulty in managing his type 2 diabetes. He has been diagnosed with the condition for five years and is currently taking Metformin 1g BD, Gliclazide 160 mg BD, and Sitagliptin 100 mg OD. As a bus driver, he finds it challenging to control his weight due to his busy shifts, resulting in a BMI of 34 kg/m².
Upon conducting investigations, his serum creatinine levels are at 120 µmol/L (60-110), and his Haemoglobin A1c levels are at 66 mmol/mol (8.2%). What would be the most appropriate next step?