QuestionSBA
QuestionChoice
This patient is presenting with classical symptoms of type II diabetes (T2DM). To investigate for T2DM, we would test HbA1c levels, along with a fasted serum glucose level, random serum glucose and an oral glucose tolerance test (OGTT).

HbA1c should be under 42mmol/mol in patients who do **not** already have diabetes. It measures the proportion of red blood cells that have glucose bound to them - giving a 3-month average of how a person's blood sugar is being controlled.

Increased blood sugar levels prompt the body to increase its water levels (to dilute the blood sugar levels), explaining the polydipsia (increased thirst).

The kidneys also compensate by excreting more glucose - bringing fluids with it - explaining the nocturia (urinating at night) and polyuria (increased urine output).
10001852
a
HbA1c (Glycated haemoglobin)
QuestionChoice
Liver Function Tests are performed to investigate liver and gallbladder pathologies.

The patient's symptoms are not classically indicative of liver pathology - this would not be a first-line investigation.

We would investigate for Type II Diabetes in a patient with these symptoms.
10001854
c
Liver Function Tests (LFTs)
QuestionChoice
Iron studies (iron, ferritin, transferrin & total iron binding capacity) blood tests are done to investigate Iron Deficiency Anaemia (IDA), which can lead to fatigue.

However, due to the urinary symptoms that this patient is also experiencing - the **most likely** diagnosis is Type II Diabetes, not IDA. We would not do an Iron Studies as a first-line investigation.
10001853
b
Iron Studies
QuestionChoice
Thyroid Function Tests investigate hypo or hyperthyroidism. The patient is not presenting with any symptoms of hyperthyroidism, and the only symptom indicative of hypothyroidism is fatigue.

We would investigate this patient for Type II Diabetes as a first-line option due to this patient's urinary symptoms.
10001855
d
Thyroid Function Tests (TFTs)
QuestionChoice
An Antinucleated antibody test investigates the presence of autoimmune conditions, such as Systemic Lupus Erythematous, Rheumatoid Arthritis, Scleroderma, and Sjögren's syndrome.

This patient's symptoms are classically indicative of Type II Diabetes - we would perform an HbA1c to investigate for this.
10001856
e
Antinucleated antibody test (ANA)
Concept
Chapter
2693
3761
Type 2 Diabetes Mellitus
Topic
133
Endocrinology
12917
A 58-year-old man presents to General Practice complaining of increased thirst, waking up at night to use the toilet, increased urinary frequency during the day, and feeling very tired.

Which investigation would you carry out to illicit the **most likely** diagnosis?
a