AMBULATORY CARE AND ED
QUESTIONS AND ANSWERS UPDATED
2026-2027
# Term Definition
1 2000 mg
What is the maximum daily dose of
Metformin?
2 Which is the best Sulphonylurea? Gliclazide (good trial evidence, less hypos)
3 What is the next step after
Metformin and Gliclazide (SU), if HbA1c Either... -DPP4 inhibitor eg Sitagliptin, Saxagliptin- no
remains elevated? hypoes or weight gain -GLP-1 analogue (requires
injection) eg Exenatide, Liraglutide- weight loss, no
hypos -Glitazone eg Pioglitazone or Rosiglitazone
(weight gain, fluid retention, bone loss)
4 Dpp-4 inhibitor eg Sitagliptin
What might you use as a second line
treatment in Type 2 diabetes if
sulphonylureas were contraindicated?
5 A GLP-1 analogue eg Exenatide, as they cause weight
What is the best second or third line loss
treatment after Metformin to use in an
obese Type 2 diabetes patient?
6 What are some precipitating factors for
ketoacidosis? New onset Type 1 diabetes Inadequate or inappropriate
insulin therapy Alcohol abuse Infection AMI or CVA
Pancreatitis Drugscorticosteroids and thiazides
7 Describe the management of
-Rehydration (IV NS 1 L/30 mins, then 1L/hour then 1L/2
ketoacidosis?
hours. -Correct electrolyte imbalanceaim to maintain
potassium at 3.5-5 mmol. -Insulin therapy -Search for
underlying cause
, 8 What are the four rules for
management of DKA? 1. Rehydrate 2. Don't give insulin until u know the K+
level 3. Correct the hypeglycaemia 4.
Diagnose and treat the cause
9 What is HONK/HHS?
Hyperglycaemic Hyperosmolar State or Hyperosmolar
Non-Ketotic Coma is severe hyperglycaemia with
minimal ketosis, profound dehydration, coma, and
osmolarity >330 m Osm/kg. Occurs in Type 2 Diabetes
typically, in older patients.
# Term Definition
10 What is the treatment for
HONK/HHS? -Fluids- IV hypotonic saline -Monitor urine output/CVP -
Insulin -Adjust potassium -Consider prophylactic heparin
-Search for underlying cause
11
How does insulin deficiency cause Insulin deficiency -> increased lipolysis -> ketone bodies -
ketoacidosis? > DKA
12 HOw does insulin deficiency cause
HHS? Insulin deficiency -> hyperglycaemia -> glycosuria ->
polyuria -> volume depletion -> hyperosmolar state
13 How should you treat a patient with a
BSL of 1.8 mmol? If conscious and cooperating, give oral fluids containing
sugar eg juice or soft drink. If unconscious give IV 50%
dextrose (25-50ml), or IM/SC Glucagon if no venous
access. Next give longer acting carbs eg a sandwich. Look
for an underlying cause.
14 What are some causes of sellar
masses? -Benign tumours eg pituitary adenoma or meningioma. -
Malignant tumours- primary or mets -Cysts eg Rahke's
cleft, arachnoid/dermoid cysts -Carotid aneurism
QUESTIONS AND ANSWERS UPDATED
2026-2027
# Term Definition
1 2000 mg
What is the maximum daily dose of
Metformin?
2 Which is the best Sulphonylurea? Gliclazide (good trial evidence, less hypos)
3 What is the next step after
Metformin and Gliclazide (SU), if HbA1c Either... -DPP4 inhibitor eg Sitagliptin, Saxagliptin- no
remains elevated? hypoes or weight gain -GLP-1 analogue (requires
injection) eg Exenatide, Liraglutide- weight loss, no
hypos -Glitazone eg Pioglitazone or Rosiglitazone
(weight gain, fluid retention, bone loss)
4 Dpp-4 inhibitor eg Sitagliptin
What might you use as a second line
treatment in Type 2 diabetes if
sulphonylureas were contraindicated?
5 A GLP-1 analogue eg Exenatide, as they cause weight
What is the best second or third line loss
treatment after Metformin to use in an
obese Type 2 diabetes patient?
6 What are some precipitating factors for
ketoacidosis? New onset Type 1 diabetes Inadequate or inappropriate
insulin therapy Alcohol abuse Infection AMI or CVA
Pancreatitis Drugscorticosteroids and thiazides
7 Describe the management of
-Rehydration (IV NS 1 L/30 mins, then 1L/hour then 1L/2
ketoacidosis?
hours. -Correct electrolyte imbalanceaim to maintain
potassium at 3.5-5 mmol. -Insulin therapy -Search for
underlying cause
, 8 What are the four rules for
management of DKA? 1. Rehydrate 2. Don't give insulin until u know the K+
level 3. Correct the hypeglycaemia 4.
Diagnose and treat the cause
9 What is HONK/HHS?
Hyperglycaemic Hyperosmolar State or Hyperosmolar
Non-Ketotic Coma is severe hyperglycaemia with
minimal ketosis, profound dehydration, coma, and
osmolarity >330 m Osm/kg. Occurs in Type 2 Diabetes
typically, in older patients.
# Term Definition
10 What is the treatment for
HONK/HHS? -Fluids- IV hypotonic saline -Monitor urine output/CVP -
Insulin -Adjust potassium -Consider prophylactic heparin
-Search for underlying cause
11
How does insulin deficiency cause Insulin deficiency -> increased lipolysis -> ketone bodies -
ketoacidosis? > DKA
12 HOw does insulin deficiency cause
HHS? Insulin deficiency -> hyperglycaemia -> glycosuria ->
polyuria -> volume depletion -> hyperosmolar state
13 How should you treat a patient with a
BSL of 1.8 mmol? If conscious and cooperating, give oral fluids containing
sugar eg juice or soft drink. If unconscious give IV 50%
dextrose (25-50ml), or IM/SC Glucagon if no venous
access. Next give longer acting carbs eg a sandwich. Look
for an underlying cause.
14 What are some causes of sellar
masses? -Benign tumours eg pituitary adenoma or meningioma. -
Malignant tumours- primary or mets -Cysts eg Rahke's
cleft, arachnoid/dermoid cysts -Carotid aneurism
