I think every medical student appreciates the importance of understanding the principles of diabetes mellitus in the 21st century healthcare environment. Have a crack at these three patients … good luck!
Reviewed by: awaiting review
Approach to the Patient with Abnormal Blood Sugar Levels - Part One
Stem 1 of 4
A 9YOF is brought to hospital by her parents because of a half-day history of significant fatigue and regular vomiting. History is notable for increasing thirst, loss of weight, and increased urine output.
NICE states a random plasma glucose, of which figure, to be classed as the metabolic disorder of diabetes mellitus? (units:mmol/L)
Stem 2 of 4Which of the following represents a known microvascular complication of type one diabetes?
Peripheral artery disease
Stem 3 of 4Which of the following is not a classic presentation of type one diabetes?
Increased heart rate
Stem 4 of 4What is the target HbA1c level for patients being treated for diabetes mellitus type one?
This is also the target HbA1c level in the management of Type 2 diabetes, unless the patient is on a drug that carries a risk of hypoglycaemia (such as sulfonylureas), in which case the target is less than 53 mmol/mol (see NICE guidelines). The same guidelines also suggest that an HbA1c of 58 mmol/mol or more should be an indication for reviewing and intensifying the anti-diabetic treatment.
Stem 1 of 4
A patient presents for a GP check-up. She has a BMI of 33, diagnosis of poorly controlled primary hypertension, and elevated HbAlC.
Which of the following drugs have the greatest link to type two diabetes?
Stem 2 of 4On physical examination you note discoloration of the armpit. What is this sign classically called?
Cullen/Grey Turner sign
Stem 3 of 4What is the most appropriate first line management in this patient?
Basal bolus insulin
Physical activity changes
Stem 4 of 4The patient returns three months later for a “check up” and is placed on a medication. Three months after the “check up” (six months after initial diagnosis), she returns for a second-line pharmacotherapy agent. She is concerned about her obesity. Which of the following diabetic agents are most likely to cause weight gain?
Stem 1 of 4
A patient presents to ED with extreme acute abdominal pain (generalised), vomiting copiously and is difficult to rouse. His respiration pattern is described as deep and rapid, with his temperature elevated. His accompanying partner states the patient is a type one diabetic - poorly concordant with his regular medication.
In this patient, which hormone is least likely elevated?
A hormone, that when deficient, causes acromegaly
A hormone activating glucose utilisation
A hormone released from the zona fasciculata
Monoamines circulating in the periphery
Protein released from pancreatic alpha cells
Stem 2 of 4Which of the following physiological hallmarks is least representative of insulin deficiency?
Breakdown (catalysis) of adipocyte
Fatty acid oxidation at hepatocytes
Formation of beta-hydroxybutyrate
Hypoosmolar serum state
Release of free fatty acid
Stem 3 of 4What is the eponymous term for the breathing described in the patient above?
Stem 4 of 4Which of the following is not a first line investigation in DKA?
Amylase and lipase
Urea and electrolytes
Venous blood gas