A 46-year-old woman who is passionate about health and fitness visits your GP clinic. She reports experiencing weight loss, increased thirst, and frequent urination. A urine dip test shows glucosuria, and her blood work indicates an HBA1c level of 63 mmol/mol. She mentions that her aunt passed away due to a pancreas problem. Despite receiving treatment for newly diagnosed diabetes, she still complains of weight loss. What factors should you take into account?
A 55-year-old man is hospitalized for a chest infection and undergoes a standard blood test in the emergency room. The results show his HbA1c level as follows:
HbA1c 48 mmol/mol (27-48 mmol/mol)
What medical condition could cause this reading to inaccurately reflect his blood sugar levels?
A 32-year-old woman contacts the endocrinology nurse seeking advice. She has been experiencing vomiting for the past 24 hours and has been unable to take her regular medications due to this. She has a medical history of Addison’s disease and usually takes oral hydrocortisone and fludrocortisone. She denies any other symptoms apart from reduced oral intake and has not experienced dizziness on standing, blackouts, or diarrhea. Her temperature has been normal. She has IM hydrocortisone available at home. What is the most appropriate advice to give regarding her hydrocortisone?
A 62-year-old man presents to the clinic with a history of ischaemic heart disease and a recent diagnosis of type 2 diabetes mellitus. His HbA1c at the time of diagnosis was 7.6% (60 mmol/mol) and he was started on metformin, which was titrated up to a dose of 1g bd. His most recent blood work shows a HbA1c of 6.8% (51 mmol/mol). He has recently retired from the IT industry and has a BMI of 28 kg/m². He is currently taking atorvastatin 80 mg, aspirin 75mg, bisoprolol 2.5 mg, and ramipril 5mg. What would be the most appropriate next step?
A 32-year-old woman with Addison’s disease is seen for a follow-up appointment. She reports a productive cough and feeling feverish for the past three days. Upon examination, her chest is clear, pulse is 84 beats per minute, and temperature is 37.7ºC. Due to her medical history, an antibiotic is prescribed.
What advice should be given regarding her adrenal replacement therapy?
A 25-year-old woman with a history of type 1 diabetes mellitus presents at the emergency department complaining of vomiting and abdominal pain. Upon examination, she appears dehydrated. The following are some of her blood test results:
pH 7.23 (7.35-7.45)
pCO2 2.1 kPa (4.5-6.0)
pO2 11.2 kPa (10-14)
Na+ 135 mmol/L (135-145)
K+ 3.1 mmol/L (3.5-5.0)
Bicarbonate 13 mmol/L (22-28)
Glucose 22.4 mmol/L (<11.1)
Ketones 3.6 mmol/L (<0.6)
Question: What should be done with her regular insulin during her treatment?
A 59-year-old man with type 2 diabetes visits his GP for a check-up. He has discontinued his modified-release metformin due to experiencing nausea and diarrhoea. Lately, he has been feeling increasingly fatigued and thirsty. His blood pressure measures 150/110 mmHg and he reports no issues with his eyesight. Laboratory tests reveal an HbA1c level of 56 mmol/mol. The QRISK score is calculated and shows 23%. He is a non-smoker and non-alcoholic.
What would be the most suitable course of action for his management?
You assess a 75-year-old patient with a complex medical history and taking multiple medications. The patient presents with significant bilateral breast tissue growth. Which medication is the most probable cause of this condition?
As a foundation doctor in the endocrine department, if you were to assess a patient with hypoparathyroidism resulting in hypocalcaemia, what findings may you discover during your investigation?
A 55-year-old man arrives at the emergency department with complaints of abdominal pain, nausea, and vomiting. His urine and serum tests reveal elevated ketone levels, and his serum glucose level is 3 mmol/L. An ABG is conducted, and the results are as follows:
pH 7.24
PaO2 14.7 kPa
PCO2 3.5 kPa
HCO3 13 mEq/L
What is the most probable cause of these findings?