The free, daily medical game.
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4,800+ questions, each with detailed explanations.
A new run every day to build your streak.
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Will you make it through?
A 56-year-old woman with type 2 diabetes on dapagliflozin and metformin presents with 48 hours of vomiting and polyuria. Glucose is 9.8 mmol/L, ketones 4.2 mmol/L, pH 7.18, bicarbonate 12 mmol/L, anion gap 22. What is the most likely diagnosis?
This is euglycaemic DKA — anion-gap acidosis with ketosis in a patient on an SGLT2 inhibitor. SGLT2 inhibitors lower blood glucose by dumping it into the urine, masking the hyperglycaemia of DKA without preventing the underlying insulin deficiency that drives ketogenesis. HHS would show glucose >30 mmol/L with minimal ketones; metformin-induced lactic acidosis would have raised lactate rather than ketones as the gap-driver.
Daily, in a sprint. How fast can you go?
A 70-year-old man collapses with syncope after climbing stairs. Examination reveals an ejection systolic murmur at the right sternal edge radiating to the carotids. What is the most likely diagnosis?
Make it revision. Make it stick.
Unlimited preclinical and UKMLA questions. Spaced repetition. A live readiness score.
A 62-year-old man attends his GP with a 3-month history of exertional chest pain relieved by rest. Resting ECG shows 1mm ST depression in V4–V6. He is started on aspirin. Which drug class should be added for symptom control?
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