[MCQ] Diabetes Mellitus- Part 4

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Diabetes Mellitus- Part 4

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Question 1

Enzyme mediating increased ketone body formation in DKA is ?

A	HMG CoA reductase
B	CPT - I
C	CPT - II
D	Acyl CoA transferase

Question 1 Explanation:

In DKA, hyperglucagonemia alters hepatic metabolism to favor ketone body formation, through activation of enzyme carnitine palmitoyltransferase I. This enzyme is crucial for regulating fatty

Question 2

In DKA, the elevated amylase is usually of which origin ?

A	Salivary
B	Gastric
C	Pancreatic
D	All of the above

Question 2 Explanation:

in DKA the amylase is usually of salivary origin and thus is not diagnostic of pancreatitis

Question 3

In DKA, elevation in serum amylase is due to ?

A	Acute pancreatitis
B	Acidemia
C	infection
D	All of the above

Question 4

In DKA, interference from which of the following may falsely elevate serum creatinine measurement?

A	Acetoacetate
B	Hypertriglyceridemia
C	Hyperglycemia
D	Blood Urea

Question 4 Explanation:

Interference from acetoacetate may falsely elevate the serum creatinine measurement in DKA.

Question 5

For every 100 mg/dL rise in serum glucose, serum sodium is reduced by ?

A	1.0 meq/L
B	1.2 meq/L
C	1.4 meq/L
D	1.6 meq/L

Question 5 Explanation:

For every 100 mg/dL rise in serum glucose, serum sodium is reduced by 1.6 mmol/L (1.6 meq).

Question 6

Serum osmolality is calculated by which of the following formula ?

A	[2 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]
B	[3 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]
C	[4 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]
D	[4 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]

Question 6 Explanation:

Serum osmolality is calculated by [2 x (serum sodium + serum potassium) + plasma glucose (mg/ dL)/18 + BUN/2.8]

Question 7

Which of the following is not a precipitating event in DKA ?

A	Cerebral infarction
B	Cocaine
C	Pregnancy
D	Hypothyroidism

Question 7 Explanation:

Precipitating events in DKA are inadequate insulin administration, infection, infarction (cerebral, coronary, mesenteric, peripheral), cocaine & pregnancy.

Question 8

Nitroprusside reaction does not detect which of the following ?

A	Acetoacetate
B	Acetone
C	Beta-hydroxybutyrate
D	All of the above

Question 8 Explanation:

Acetoacetate is preferentially detected by the commonly used nitroprusside ketosis detection reagent. Nitroprusside reaction only detects acetoacetate and acetone and not betahydroxybutyrate.

Question 9

Which of the following drug may cause false-positive reactions in the nitroprusside test used to detect urine ketones ?

A	Captopri
B	Atorvastatin
C	Aspirin
D	All of the above

Question 10

Which of the following drug may cause false-positive reactions in the nitroprusside test used to detect urine ketones ?

A	Penicillamine
B	Azithromycin
C	Cephalosporin
D	All of the above

Question 10 Explanation:

Captopril or penicillamine may cause false-positive nitroprusside test used to detect urine ketones.

Question 11

Which of the following intravenous solution is preferred for initial use in DKA to reduce hyperchloremia ?

A	0.45% saline
B	Normal saline
C	Lactated Ringer’s IV solution
D	Any of the above

Question 11 Explanation:

Initial use of lactated Ringer’s IV solution reduces hyperchloremia that occurs with normal saline

Question 12

In DKA, with insulin therapy, hyperglycemia improves due to ?

A	Insulin-mediated glucose disposal
B	Reduced hepatic glucose release
C	Rehydration
D	All of the above

Question 12 Explanation:

Hyperglycemia usually improves at a rate of 75 to 100 mg/dL per hour as a result of insulinmediated glucose disposal, reduced hepatic glucose release, and rehydration

Question 13

In DKA, following insulin therapy, the decline in plasma glucose within the first 1 to 2 hours is mostly related to ?

A	Insulin-mediated glucose disposal
B	Reduced hepatic glucose release
C	Rehydration
D	All of the above

Question 13 Explanation:

The decline in the plasma glucose within the first 1 to 2 hours may be more rapid and is mostly related to volume expansion.

Question 14

With insulin therapy in DKA, which of the following resolves first ?

A	Acidosis
B	Ketosis
C	Hyperglycemia
D	All of the above

Question 14 Explanation:

In DKA, following insulin therapy, acidosis and ketosis resolve more slowly than hyperglycemia

Question 15

In DKA, which salt of potassium should be avoided for replacement ?

A	Chloride
B	Phosphate
C	Acetate
D	Any of the above

Question 15 Explanation:

To reduce the amount of chloride administered, potassium phosphate or acetate can be substituted for the chloride salt.

Question 16

In DKA, insulin should not be administered until potassium level is ?

A	> 3.0 meq/L
B	> 3.1 meq/L
C	> 3.2 meq/L
D	> 3.3 meq/L

Question 16 Explanation:

In DKA, insulin should not be administered until potassium level is >3.3 meq/L.

Question 17

During treatment of DKA, very large changes occur in the serum levels of all except ?

A	Sodium
B	Potassium
C	Chloride
D	Magnesium

Question 18

Total-body stores which of the following elements is not reduced in DKA ?

A	Sodium
B	Chloride
C	Calcium
D	Magnesium

Question 18 Explanation:

Total-body stores of sodium, potassium, chloride, phosphorous & magnesium are reduced in DKA.

Question 19

In treatment of DKA, glucose should be added to 0.45% saline infusion when plasma glucose level is around ?

A	100 mg/dL
B	150 mg/dL
C	200 mg/dL
D	250 mg/dL

Question 19 Explanation:

When plasma glucose reaches 250 mg/dL, glucose should be added to 0.45% saline infusion to maintain plasma glucose in 200 to 250 mg/dL range & insulin infusion should be continued.

Question 20

Which of the following drugs should be withheld well before intravenous contrast administration ?

A	Pioglitazone
B	Metformin
C	Acarbose
D	Glipizide

Question 21

In hyperglycemic hyperosmolar state (HHS), the blood glucose level is usually above ?

A	300 mg%
B	400 mg%
C	500 mg%
D	600 mg%

Question 22

In HHS, moderate ketonuria, if present, is secondary to ?

A	Starvation
B	Infection
C	Oliguria
D	All of the above

Question 22 Explanation:

In HHS, moderate ketonuria, if present, is secondary to starvation.

Question 23

All are features of hyperglycemic hyperosmolar state except ?

A	Normal Na+, K+, Cl-
B	Glucose between 600-1200 mg %
C	Normal PCO2
D	pH < 7.3

Question 23 Explanation:

In contrast to DKA, acidosis and ketonemia are absent or mild.

Question 24

Which of the following symptom is absent in HHS ?

A	Nausea, vomiting
B	Abdominal pain
C	Kussmaul respiration
D	All of the above

Question 24 Explanation:

In HHS, nausea, vomiting, abdominal pain & Kussmaul respirations characteristic of DKA are notably absent.

Question 25

Which of the following statements is false ?

A	Dehydration in HHS > DKA
B	HHS patient is usually young
C	Mortality higher in HHS than DKA
D	None of the above

Question 25 Explanation:

Typical patient of HHS is an elderly type 2 DM individual, with a several week history of polyuria, weight loss & diminished oral intake that culminates in mental confusion, lethargy, or coma. In HHS, fluid losses & dehydration are more pronounced than in DKA. HHS has a substantially higher mortality than DKA.

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See all quizzes of Diabetes Mellitus at here:

1.Enzyme mediating increased ketone body formation in DKA is ?
A. HMG CoA reductase
B. CPT – I
C. CPT – II
D. Acyl CoA transferase

2. In DKA, the elevated amylase is usually of which origin ?
A. Salivary
B. Gastric
C. Pancreatic
D. All of the above

3. In DKA, elevation in serum amylase is due to ?
A. Acute pancreatitis
B. Acidemia
C. Infection
D. All of the above
4. In DKA, interference from which of the following may falsely
elevate serum creatinine measurement?
A. Acetoacetate
B. Hypertriglyceridemia
C. Hyperglycemia
D. Blood Urea

5. For every 100 mg/dL rise in serum glucose, serum sodium is
reduced by ?
A. 1.0 meq/L
B. 1.2 meq/L
C. 1.4 meq/L
D. 1.6 meq/L

6. Serum osmolality is calculated by which of the following
formula ?
A. [2 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]
B. [3 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]
C. [4 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]
D. [4 x (S. Na+ + K+) + P. glucose (mg/dL)/18 + BUN/2.8]

7. Which of the following is not a precipitating event in DKA ?
A. Cerebral infarction
B. Cocaine
C. Pregnancy
D. Hypothyroidism

8. Nitroprusside reaction does not detect which of the following ?
A. Acetoacetate
B. Acetone
C. Beta-hydroxybutyrate
D. All of the above

9. Which of the following drug may cause false-positive reactions in
the nitroprusside test used to detect urine ketones ?
A. Captopril
B. Atorvastatin
C. Aspirin
D. All of the above
10. Which of the following drug may cause false-positive reactions in
the nitroprusside test used to detect urine ketones ?
A. Penicillamine
B. Azithromycin
C. Cephalosporin
D. All of the above

11. Which of the following intravenous solution is preferred for initial
use in DKA to reduce hyperchloremia ?
A. 0.45% saline
B. Normal saline
C. Lactated Ringer’s IV solution
D. Any of the above

12. In DKA, with insulin therapy, hyperglycemia improves due to ?
A. Insulin-mediated glucose disposal
B. Reduced hepatic glucose release
C. Rehydration
D. All of the above

13.In DKA, following insulin therapy, the decline in plasma glucose
within the first 1 to 2 hours is mostly related to ?
A. Insulin-mediated glucose disposal
B. Reduced hepatic glucose release
C. Rehydration
D. All of the above

14.With insulin therapy in DKA, which of the following resolves
first ?
A. Acidosis
B. Ketosis
C. Hyperglycemia
D. All of the above

15. In DKA, which salt of potassium should be avoided for
replacement ?
A. Chloride
B. Phosphate
C. Acetate
D. Any of the above

16. In DKA, insulin should not be administered until potassium level
is ?
A. > 3.0 meq/L
B. > 3.1 meq/L
C. > 3.2 meq/L
D. > 3.3 meq/L

17. During treatment of DKA, very large changes occur in the serum
levels of all except ?
A. Sodium
B. Potassium
C. Chloride
D. Magnesium
18. Total-body stores which of the following elements is not reduced
in DKA ?
A. Sodium
B. Chloride
C. Calcium
D. Magnesium

19. In treatment of DKA, glucose should be added to 0.45% saline
infusion when plasma glucose level is around ?
A. 100 mg/dL
B. 150 mg/dL
C. 200 mg/dL
D. 250 mg/dL

20. Which of the following drugs should be withheld well before
intravenous contrast administration ?
A. Pioglitazone
B. Metformin
C. Acarbose
D. Glipizide
21.In hyperglycemic hyperosmolar state (HHS), the blood glucose
level is usually above ?
A. 300 mg%
B. 400 mg%
C. 500 mg%
D. 600 mg%
22. In HHS, moderate ketonuria, if present, is secondary to ?
A. Starvation
B. Infection
C. Oliguria
D. All of the above

23. All are features of hyperglycemic hyperosmolar state except ?
A. Normal Na+, K+, Cl-
B. Glucose between 600-1200 mg %
C. Normal PCO2
D. pH < 7.3

24. Which of the following symptom is absent in HHS ?
A. Nausea, vomiting
B. Abdominal pain
C. Kussmaul respiration
D. All of the above

25. Which of the following statements is false ?
A. Dehydration in HHS > DKA
B. HHS patient is usually young
C. Mortality higher in HHS than DKA
D. None of the above

Diabetes Mellitus

[MCQ] Diabetes Mellitus- Part 4

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Diabetes Mellitus- Part 4

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