Diabetes: monogenic diabetes (MODY): practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Diabetes: monogenic diabetes (MODY)

Sample item

A lean 19-year-old woman has mild hyperglycaemia found at screening, with no ketosis. Her father was diagnosed with diabetes at 25 and her grandmother at 30, both treated with tablets. Anti-GAD antibodies are negative and there is no pancreatic calcification. What is the most likely diagnosis and treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Monogenic diabetes (HNF1A MODY), responsive to low-dose sulfonylurea

MODY is an autosomal dominant monogenic diabetes presenting before 25 to 30 years in non-obese people with a multigenerational family history, no autoimmunity and no ketosis. HNF1A and HNF4A types are sensitive to low-dose sulfonylureas, while GCK mutations cause mild stable hyperglycaemia that needs no treatment. Genetic testing confirms the diagnosis.

Option by option

  • A. Monogenic diabetes (HNF1A MODY), responsive to low-dose sulfonylurea (correct)

    Early onset across three generations without autoimmunity or ketosis indicates MODY, and HNF1A is sulfonylurea-sensitive.

  • B. Latent autoimmune diabetes, needing early insulin

    Latent autoimmune diabetes needs positive islet antibodies, which are negative here.

  • C. Fibrocalculous pancreatic diabetes, needing enzymes and insulin

    Fibrocalculous pancreatic diabetes requires pancreatic calcification, which is absent.

  • D. Type 1 diabetes, needing basal-bolus insulin

    Type 1 diabetes shows autoimmunity, ketosis and rapid insulin dependence, which are absent.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Monogenic diabetes (HNF1A MODY), responsive to low-dose sulfonylurea. MODY is an autosomal dominant monogenic diabetes presenting before 25 to 30 years in non-obese people with a multigenerational family history, no autoimmunity and no ketosis.

Why is "Latent autoimmune diabetes, needing early insulin" not the answer?

Latent autoimmune diabetes needs positive islet antibodies, which are negative here.

Why is "Fibrocalculous pancreatic diabetes, needing enzymes and insulin" not the answer?

Fibrocalculous pancreatic diabetes requires pancreatic calcification, which is absent.

Why is "Type 1 diabetes, needing basal-bolus insulin" not the answer?

Type 1 diabetes shows autoimmunity, ketosis and rapid insulin dependence, which are absent.

What concept does this question test?

It tests Diabetes: monogenic diabetes (MODY) in General Medicine. HNF1A and HNF4A types are sensitive to low-dose sulfonylureas, while GCK mutations cause mild stable hyperglycaemia that needs no treatment. Genetic testing confirms the diagnosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Diabetes: monogenic diabetes (MODY)?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.