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diabetes mellitus

Practice targeted AMC-style multiple-choice questions on diabetes mellitus.

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A 32-year-old woman, currently 28 weeks pregnant, presents to the antenatal clinic for a routine check-up. She has a history of gestational diabetes mellitus (GDM) diagnosed at 24 weeks of gestation. Her current treatment includes dietary modifications and regular blood glucose monitoring. Her recent fasting blood glucose levels have been consistently between 5.5 and 6.0 mmol/L, and her postprandial levels are between 7.5 and 8.0 mmol/L. She reports feeling well and has no symptoms of hypoglycemia. Her obstetric history includes one previous pregnancy complicated by GDM, which was managed with insulin. Her current pregnancy is otherwise uncomplicated. What is the most appropriate next step in the management of her gestational diabetes?

A. Increase dietary carbohydrate intake
B. Start metformin therapy
C. Schedule an early induction of labor
D. Initiate insulin therapy
E. Continue current management and monitor closely
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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 62-year-old male with a history of poorly controlled diabetes presents with fever, RUQ pain, and night sweats for 3 weeks. Initial blood cultures are negative. Imaging is performed, as shown. What is the MOST appropriate next step in management?

A. Albendazole therapy
B. Percutaneous drainage and culture of the lesion
C. Surgical resection of the affected liver segment
D. Empiric broad-spectrum antibiotics
E. Observation with serial imaging
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A 45-year-old male with poorly controlled diabetes mellitus and ischaemic heart disease, living in a rural Indigenous community, presents with fevers, cough, lethargy, night sweats, and occasional hemoptysis. What is the most appropriate initial investigation for suspected tuberculosis in this patient if he is unable to produce sputum spontaneously?

A. Interferon-Gamma Release Assay (IGRA)
B. Sputum GeneXpert
C. Try hypertonic saline to get sputum.
D. CT chest
E. Empirical anti-TB treatment
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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 62-year-old male with a history of poorly controlled diabetes presents with right upper quadrant pain, fever, and night sweats for 3 weeks. He is on immunosuppressants following a renal transplant 5 years ago. Blood cultures are pending. Imaging is performed, as shown. What is the MOST appropriate next step in management?

A. Empiric antifungal therapy
B. Observation and serial imaging
C. Metronidazole and supportive care
D. Albendazole and surgical resection
E. Percutaneous drainage and antibiotics
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A patient is on metformin 1g BD, with a blood pressure of 135/85 mmHg, HbA1c of 8.5%, no history of cardiovascular disease, fasting blood sugar of 9 mmol/L, and an albumin/creatinine ratio of 500. Which drug should be added to their treatment regimen?

A. Pioglitazone
B. Ramipril
C. Sitagliptin
D. Gliclazide
E. Insulin
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Acute cholecystitis with gallbladder wall thickening, a large gallstone, and a large gallbladder
Image by James Heilman, MD CC BY-SA 4.0 · Source

A 58-year-old woman with poorly controlled diabetes presents with severe RUQ pain, fever, and vomiting for 3 days. The provided CT was performed. What is the MOST appropriate initial management strategy?

A. Urgent cholecystectomy
B. Oral ursodeoxycholic acid
C. IV antibiotics and bowel rest
D. Percutaneous cholecystostomy tube placement
E. ERCP with stone extraction
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A 40-year-old Aboriginal man presents for a health check. He has a strong family history of diabetes and cardiovascular disease. What is the most appropriate initial screening test to assess his risk?

A. Liver function tests
B. Urine analysis
C. Fasting blood glucose and lipid profile
D. Full blood count
E. ECG
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A 28-year-old woman presents to the clinic with a 2-week history of polyuria, polydipsia, and weight loss. She has no significant past medical history. On examination, she appears dehydrated, and her blood pressure is 100/60 mmHg. Laboratory tests reveal a blood glucose level of 18 mmol/L and ketones in the urine. What is the most likely diagnosis?

A. Type 1 diabetes mellitus
B. Diabetes insipidus
C. Hyperthyroidism
D. Type 2 diabetes mellitus
E. Cushing's syndrome
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A 55-year-old man with a history of type 2 diabetes presents for a routine check-up. His last HbA1c level, measured three months ago, was 8.2%. He reports no new symptoms and is currently on metformin. What is the most appropriate next step in managing his diabetes?

A. Start insulin therapy
B. Add a sulfonylurea
C. Increase the dose of metformin
D. Order a fasting blood glucose test
E. Refer to a diabetes educator
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A 43-year-old is unconscious with low blood glucose (1.8 mmol/L), has a history of insulin use and alcohol intake. What is the next step?

A. 16G IV + 10% glucose, 150-200 ml over 15 minutes.
B. Give oral glucose.
C. Give 1 mg of glucagon intramuscularly.
D. Give IV 50% glucose.
E. Give subcutaneous insulin.
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A 16-year-old boy is diagnosed with Type 1 diabetes mellitus after presenting with polyuria, polydipsia, and weight loss. His blood tests show elevated blood glucose levels and the presence of autoantibodies against pancreatic beta cells. In contrast, a 55-year-old woman is diagnosed with Type 2 diabetes mellitus, characterized by insulin resistance and obesity. Which of the following best describes the pathophysiological differences between Type 1 and Type 2 diabetes?

A. Type 1 diabetes involves insulin resistance and obesity, whereas Type 2 diabetes is due to genetic mutations affecting insulin production.
B. Type 1 diabetes is caused by insulin resistance due to obesity, while Type 2 diabetes results from autoimmune destruction of pancreatic beta cells.
C. Type 1 diabetes is characterized by insulin resistance, while Type 2 diabetes involves absolute insulin deficiency due to beta-cell destruction.
D. Both Type 1 and Type 2 diabetes are primarily caused by autoimmune destruction of pancreatic beta cells.
E. Type 1 diabetes involves autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency, whereas Type 2 diabetes is characterized by insulin resistance and relative insulin deficiency.
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A 55-year-old man with a history of type 2 diabetes mellitus presents with polyuria, polydipsia, and fatigue. His blood tests reveal a fasting blood glucose level of 15 mmol/L and HbA1c of 9.5%. He is currently on metformin. What is the most appropriate next step in management?

A. Increase the dose of metformin
B. Switch to insulin therapy
C. Add a DPP-4 inhibitor
D. Add a sulfonylurea
E. Start lifestyle modifications
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A 40-year-old Aboriginal man presents for a health check. He reports feeling well but has a strong family history of diabetes and cardiovascular disease. What is the most appropriate initial screening test?

A. PSA
B. Full blood count
C. Fasting blood glucose and lipid profile
D. ECG
E. Urine albumin creatinine ratio
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A 55-year-old man with a 15-year history of type 2 diabetes presents with numbness and tingling in his feet. On examination, there is reduced sensation to light touch and vibration in a stocking distribution. What is the most appropriate initial management for his symptoms?

A. Prescribe metformin
B. Start gabapentin
C. Recommend daily foot exercises
D. Increase insulin dosage
E. Advise on dietary changes
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A 55-year-old man with type 2 diabetes mellitus presents for a routine follow-up. His HbA1c is 9.0% despite being on metformin 1000 mg twice daily. He has a BMI of 32 kg/m² and no history of cardiovascular disease. What is the most appropriate next step in his management?

A. Add a DPP-4 inhibitor
B. Increase the dose of metformin
C. Add a GLP-1 receptor agonist
D. Start basal insulin therapy
E. Add a sulfonylurea
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Figure 3 of paper: Alveolar echinococcosis in a patient with immunosuppression.

(a) Abdominal gray-scale US shows an abscess-like hepatic image.
(b) Axial unenhanced CT shows a typical aspect of pyogenic liver abscess.
Image by Wenya Liu, Éric Delabrousse, Oleg Blagosklonov, Jing Wang, Hongchun Zeng, Yi Jiang, Jian Wang, Yongde Qin, Dominique Angèle Vuitton, Hao Wen CC BY 4.0 · Source

A 62-year-old male with a history of poorly controlled diabetes presents with fever, RUQ pain, and recent travel to a rural area. Lab results show elevated ALP and GGT. Imaging is performed. What is the MOST appropriate next step in management?

A. Metronidazole
B. Observation and serial imaging
C. Percutaneous drainage and antibiotics
D. Albendazole and surgical resection
E. Ceftriaxone and doxycycline
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