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NO.1 A 58-year-old man presented with tiredness and breathlessness. He had been treated for type
2 diabetes mellitus and hypertension for the past 10 years. He was free of complications. His current
medication included ramipril 10 mg daily, rosuvastatin 10 mg daily, metformin 500 mg three times
daily, dapagliflozin 10 mg once daily and exenatide 10 micrograms twice daily.
On examination, his body mass index was 36 kg/m2 (18-25).
Investigations:
haemoglobin93 g/L (130-180)
MCV110 fL (80-96)
white cell count3.6 ? 109/L (4.0-11.0)
platelet count140 ? 109/L (150-400)
reticulocyte count0.5% (0.5-2.4)
serum ferritin250 ug/L (15-300)
serum vitamin B1240 ng/L (160-760)
serum folate3.0 ug/L (2.0-11.0)
Which medication is most likely to be contributing to his anaemia?
A. exenatide
B. dapagliflozin
C. ramipril
D. metformin
E. rosuvastatin
Answer: D

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NO.2 A 19-year-old man was seen in the diabetes clinic. He had lost 2 kg in weight since the diagnosis
of diabetes mellitus 18 months previously. At presentation, his body mass index was 33 kg/m2 (18-
25), his random plasma glucose was 18.0 mmol/L and his haemoglobin A1c was 56 mmol/mol (20-
42). He was taking gliclazide, and metformin had been added later. His father and grandfather had
developed diabetes mellitus during their twenties.
Investigations:
haemoglobin A1c56 mmol/mol (20-42)
serum C-peptide301 pmol/L (180-360)
anti-glutamic acid decarboxylase (GAD)
antibodiesnegative
What is the most likely diagnosis?
A. maturity-onset diabetes of the young
B. chronic pancreatitis
C. type 1 diabetes mellitus
D. type 2 diabetes mellitus
E. latent-onset diabetes of autoimmunity
Answer: A

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