A 45-year-old woman with type II diabetes mellitus and a history of hypertension, on maximum-dose metformin, was started on gliclazide three weeks ago. Since then she has had recurrent hypoglycaemic events requiring Accident and Emergency (A&E) attendance.
Investigation Result Normal values
HbA1c 72 mmol/mol (8.7%) 20-42 mmol/mol (4.2-6.2%)
Which of the following is the best action to take?
Select the SINGLE action from the list below.
A 35-year-old woman has Addison’s disease.
Which of the following medications is she likely to be taking long term?
An 18-year-old girl is referred to the Endocrine Clinic with primary amenorrhoea. On examination, her height and weight are normal. She has moderate hirsutism and acne, small breast buds and an enlarged clitoris. Bimanual pelvic examination is normal. A male cousin was seen in the clinic at the age of nine years with precocious puberty.
Which is the most likely cause of her primary amenorrhoea?
A 32-year-old woman has been referred by her General Practitioner (GP), as she is passing a substantial volume of urine. She complains that she is continuously thirsty.
Random plasma reveals the following:
Investigation Result Normal values
Sodium (Na+) 155 mmol
Osmolality 300 mOsmol/kg
Glucose 4.5 mmol
Urine analysis reveals the following:
Investigation Result
Osmolality 90 mOsmol/kg
Glucose 0.1 mmol/l
In healthy patients, the urine : plasma osmolality ratio is > 2.
A water deprivation test reveals the following:
After 6.5 hours of fluid deprivation, the patient’s weight had dropped by > 3%, and the serum osmolality was 310 mOsmol/kg. Urine osmolality at this stage was 210 mOsmol/kg. The patient was then given desmopressin intramuscularly (IM) and allowed to drink. The urine osmolality increased to 700 mOsmol/kg, and her plasma osmolality was 292 mOsmol/kg.
Which of the following is the most likely diagnosis?
A 42-year-old man presents with a six-month history of anorexia and weight loss, excess pigmentation and dizziness on standing. He has a previous history of autoimmune hypothyroidism that is managed with thyroxine.
Examination reveals postural hypotension and skin discolouration. Initial investigations reveal hyponatraemia: Na+ 118 mmol/l (135-145 mmol/l) and hyperkalaemia: K+ 5.6 mmol/l (normal range: 3.6-5.2 mmol/l).
Which of the following tests will be most useful to confirm the diagnosis?
A 42-year-old woman presents to her General Practitioner with polyuria, weight loss and tiredness for six months. Full blood count, urea and electrolytes (U&Es), liver function tests, thyroid function test and calcium are all normal. Glycosylated haemoglobin (HbA1c) is 48 mmol/mol and repeat sample is 50 mmol/mol. On examination, her body mass index is 35 kg/m2, she is normotensive and urinalysis is normal.
Which of the following investigations should be arranged urgently?
Select ONE investigation from the list below.
A 27-year-old woman presents with new-onset diabetes. She has no past drug or treatment history. Her fasting blood glucose is 7.3 mmol/l. Other significant medical history included occasional diarrhoea in the last four months, for which she took repeated courses of tinidazole. She also had an episode of severe leg pain three months ago, for which she takes warfarin. She is presently very depressed, as her sister has had renal calculus surgery, which has not gone well; she is in the Intensive Care Unit (ICU) with sepsis.
What is the most appropriate next test?
A 45 year-old-woman of African origin is diagnosed with type II diabetes by her General Practitioner. Her haemoglobin A1c was found to be 58 mmol/mol (normal range < 48 mmol/mol) on routine bloods for her annual hypertension review. Her body mass index (BMI) is 30 kg/m2.
Along with Metformin (an oral hypoglycaemic agent), which of the following is the most appropriate dietary recommendation for this patient?
A 67-year-old woman has just been prescribed gliclazide for her T2DM. What is the mechanism of action of gliclazide?
A 42-year-old man is being evaluated for possible diabetes mellitus and undergoes an oral glucose tolerance test using the standard WHO protocol. The results are as follows:
Time (hours) Blood glucose (mmol/l)
0 5.9
2 8.2
What is the interpretation of these findings?