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WorksheetsDiabetes in primary care
Total questions: 38
Worksheet time: 19mins
A 55-year-old man comes for a medical check-up. His fasting plasma glucose (FPG) is 7.4 mmol/L. He has no symptoms of hyperglycaemia.
What is the MOST appropriate next step?
Diagnose diabetes and start treatment immediately
Repeat fasting plasma glucose on a different day
Perform random plasma glucose test immediately
Perform oral glucose tolerance test (OGTT) today
A 49-year-old woman has an HbA1c result of 6.4% from a certified laboratory. She has no symptoms.
How should this result be interpreted?
Normal
Prediabetes
Diabetes mellitus
Needs OGTT confirmation
A 42-year-old man attends your clinic for dyslipidaemia follow-up. He is overweight (BMI 29 kg/m²) and has a family history of diabetes. He has never been screened before.
What is the MOST appropriate test to screen him for diabetes?
Random plasma glucose
Fasting plasma glucose
Urine glucose dipstick
HbA1c from a point-of-care device
A 50-year-old woman has normal fasting plasma glucose results during a recent screening. She has hypertension and a BMI of 32 kg/m².
When should she be re-screened?
In 1 year
In 3 years
In 5 years
Only if she develops symptoms
A 45-year-old man presents with classic symptoms of polyuria, polydipsia, and weight loss. A random plasma glucose is 13.2 mmol/L.
What is the appropriate diagnosis?
Impaired glucose tolerance
Diabetes mellitus
Prediabetes
Requires fasting test confirmation
Which of the following individuals should be screened for diabetes earlier and more frequently?
30-year-old teacher, BMI 22 kg/m², no family history
35-year-old woman, BMI 25 kg/m², first-degree relative with diabetes
40-year-old man, BMI 23 kg/m², normotensive
45-year-old nurse, BMI 19 kg/m², no risk factors
A 53-year-old man was newly diagnosed with type 2 diabetes mellitus. What is the MOST appropriate next step in his initial assessment?
Start metformin immediately
Evaluate for microvascular and macrovascular complications
Order autoimmune antibody tests
Start insulin therapy for metabolic control
A 58-year-old woman is newly diagnosed with diabetes.
Which of the following laboratory tests is MOST important to assess for target organ involvement at baseline?
Urine albumin-to-creatinine ratio (ACR)
Fasting insulin level
Serum amylase
Thyroid function test
A 60-year-old man with newly diagnosed diabetes also has hypertension and dyslipidaemia.
What is the MOST appropriate cardiovascular assessment to perform in primary care?
Routine treadmill stress test
Baseline ECG
Coronary CT angiography
Echocardiography
A 40-year-old man presents with polyuria and polydipsia for 2 months. His BMI is 31 kg/m², and random plasma glucose is 16 mmol/L. He is managed with lifestyle and oral agents initially.
What is the MOST likely classification of his diabetes?
Type 1 diabetes mellitus
Type 2 diabetes mellitus
Latent autoimmune diabetes of adults (LADA)
Secondary diabetes mellitus
A 56-year-old man has type 2 diabetes with HbA1c 9.0%. He has mild non-proliferative retinopathy and microalbuminuria.
According to the Malaysian CPG, how should this patient be classified?
Newly diagnosed, uncomplicated
Poorly controlled, with microvascular complications
Well controlled, no complication
Controlled diabetes with macrovascular disease
A 47-year-old woman with T2DM has HbA1c 9.5% despite triple oral therapy. She also has progressive microalbuminuria (ACR 50 mg/mmol).
What is the MOST appropriate next step?
Add another oral hypoglycaemic agent
Continue current regimen for 3 more months
Refer to endocrinologist or physician for further management
Start insulin without referral
A 50-year-old man is newly diagnosed with type 2 diabetes mellitus (HbA1c 6.7%). He has no complications and is not on any medications.
What is the MOST appropriate initial management strategy?
Start metformin immediately
Begin insulin therapy
Initiate lifestyle modification and reassess in 3 months
Add sulfonylurea for rapid glucose control
A 58-year-old woman with T2DM, hypertension, and osteoarthritis struggles to adhere to multiple medications.
Which of the following principles is MOST important when planning her management?
Intensify glycaemic targets to HbA1c <6.0%
Simplify the regimen to improve adherence and safety
Add insulin to achieve rapid control
Focus only on glycaemic control and ignore comorbidities
A 70-year-old woman with long-standing diabetes, ischemic heart disease, and mild cognitive impairment has HbA1c 7.4%.
What should be her HbA1c target?
<6.0%
<6.5%
<7.5–8.0%
<9.0%
A 59-year-old man with diabetes has BP 146/90 mmHg and LDL-C 3.2 mmol/L. His HbA1c is 7.0%.
Which statement BEST reflects optimal diabetes management?
Glycaemic control alone is sufficient
Treat blood pressure and lipids aggressively in addition to glucose control
Defer lipid-lowering therapy until HbA1c is <6.5%
Start insulin if HbA1c exceeds 7.0%
A 55-year-old woman was started on metformin and lifestyle advice 3 months ago.
What is the MOST appropriate follow-up plan to assess her glycaemic control?
Repeat HbA1c in 1 month
Check fasting glucose weekly and HbA1c yearly
Repeat HbA1c every 3 months until stable, then every 6 months
Review only if symptomatic
A 50-year-old man with newly diagnosed type 2 diabetes has HbA1c of 8.0%. He has no comorbidities or complications.
What is the MOST appropriate HbA1c target for him?
<6.0%
<6.5%
<7.5%
<8.0%
A 72-year-old woman with long-standing diabetes, ischemic heart disease, and chronic kidney disease has HbA1c 7.8%. She has occasional hypoglycaemic symptoms.
What is the MOST appropriate HbA1c target for her?
<6.0%
<6.5%
<7.5–8.0%
<9.0%
A 56-year-old man was started on metformin and lifestyle modification for diabetes 2 months ago.
When should HbA1c be rechecked to assess treatment response?
Every month
Every 3 months until stable, then every 6 months
Once yearly
Only if fasting glucose is elevated
A 45-year-old woman with type 2 diabetes is on oral agents only. She asks whether she needs to check her blood glucose at home.
What is the MOST appropriate advice?
SMBG is unnecessary unless on insulin
SMBG can be helpful to monitor lifestyle and medication effect
SMBG should be done only before annual clinic visits
SMBG replaces HbA1c testing
A 48-year-old man with newly diagnosed type 2 diabetes has HbA1c 8.2% despite 3 months of lifestyle modification. His renal and hepatic functions are normal.
What is the MOST appropriate initial pharmacological therapy?
Gliclazide
Metformin
Sitagliptin
Pioglitazone
A 65-year-old woman with type 2 diabetes and chronic kidney disease (eGFR 28 mL/min/1.73 m²) is currently on metformin.
What should be done?
Continue metformin at full dose
Increase the dose for better control
Stop metformin and switch to alternative therapy
Add another oral drug without changing metformin
A 52-year-old man has HbA1c 8.5% despite 3 months of metformin 1 g twice daily. He has no cardiovascular or renal disease.
Which of the following is the MOST appropriate next step?
Add gliclazide
Add empagliflozin
Add pioglitazone
Start basal insulin
A 60-year-old man with T2DM, hypertension, and established coronary artery disease has HbA1c 8.0% despite metformin.
Which additional agent is MOST appropriate?
Sitagliptin (DPP-4 inhibitor)
Empagliflozin (SGLT2 inhibitor)
Acarbose (alpha-glucosidase inhibitor)
Gliclazide (sulfonylurea)
A 63-year-old woman with T2DM and stage 3 CKD (eGFR 50 mL/min) has HbA1c 8.3% on metformin.
What is the MOST suitable additional agent?
Dapagliflozin (SGLT2 inhibitor)
Pioglitazone (TZD)
Gliclazide (SU)
Linagliptin (DPP-4 inhibitor)
A 45-year-old man presents with weight loss, polyuria, and HbA1c 11.5%. FPG is 17 mmol/L, and random glucose is 20 mmol/L.
What is the MOST appropriate next step?
Start dual oral therapy
Start insulin therapy immediately
Continue lifestyle therapy for 3 months
Add DPP-4 inhibitor
A 58-year-old man with poorly controlled T2DM (HbA1c 9.2%) despite triple oral therapy is ready for insulin.
Which regimen is most appropriate to start in primary care?
Premixed insulin twice daily
Basal insulin at bedtime
Basal-bolus regimen
Short-acting insulin before meals
A 68-year-old man is on metformin and gliclazide. He reports several episodes of sweating and dizziness before meals.
What is the MOST likely cause?
Lactic acidosis
Hypoglycaemia from sulfonylurea
Insulin resistance
Metformin side effect
A 48-year-old man with type 2 diabetes and BMI 31 kg/m² wants to lose weight. His HbA1c is 7.8% on metformin.
What is the MOST appropriate initial step in managing his obesity?
Start orlistat immediately
Recommend structured lifestyle intervention focusing on calorie restriction and physical activity
Start SGLT2 inhibitor
Refer for bariatric surgery
A 55-year-old woman with T2DM (BMI 33 kg/m²) has failed to achieve weight loss after 6 months of diet and exercise.
Which medication is MOST appropriate to consider?
Orlistat
Glibenclamide
Pioglitazone
Dexamethasone
A 60-year-old man with obesity, type 2 diabetes, and ischemic heart disease has HbA1c 8.5% on metformin. You plan to add a second agent that aids weight reduction.
Which of the following is MOST suitable?
Sulfonylurea
Pioglitazone
SGLT2 inhibitor
Insulin
A 42-year-old woman with T2DM has BMI 41 kg/m² despite multiple lifestyle and pharmacologic interventions. Her HbA1c is 9.5% despite triple oral therapy.
According to the Malaysian CPG, what is the MOST appropriate next management step?
Continue oral medications and monitor
Start premixed insulin
Refer for bariatric (metabolic) surgery assessment
Prescribe orlistat again
A 55-year-old man with type 2 diabetes for 6 years has never had an eye check-up. His HbA1c is 7.3%, and he denies visual symptoms.
What is the MOST appropriate screening test for diabetic retinopathy?
Visual acuity test
Fundus examination or retinal photography
Intraocular pressure measurement
Slit-lamp corneal examination
A 60-year-old woman with T2DM is on metformin and gliclazide. Her serum creatinine is 90 µmol/L.
Which of the following tests is MOST appropriate to screen for diabetic nephropathy?
24-hour urine protein
Urine albumin-to-creatinine ratio (ACR)
Serum electrolytes
Urinalysis for glucose
A 58-year-old man with long-standing T2DM complains of numbness and burning sensation in both feet.
Which of the following findings BEST supports diabetic peripheral neuropathy?
Loss of vibration and monofilament sensation bilaterally
Absent knee reflex with intact ankle reflex
Tender calf muscles with swelling
Unilateral foot drop
A 62-year-old man with diabetic neuropathy attends your clinic. On examination, he has dry, cracked skin and calluses over his plantar area.
What is the MOST appropriate advice to prevent foot ulceration?
Soak feet in warm water daily
Walk barefoot indoors to improve circulation
Inspect feet daily and wear properly fitted shoes
Apply topical steroids to callused areas
A 59-year-old man with T2DM, hypertension, and dyslipidaemia asks how to prevent heart attacks. His HbA1c is 7.1%.
What is the MOST important next management step to reduce his cardiovascular risk?
Aim for HbA1c <6.0%
Initiate statin therapy and optimise blood pressure
Add aspirin for all diabetics regardless of risk
Stop metformin to avoid cardiac strain
