Diabetic emergencies
1. Which condition generally has the faster recovery time?

Hyperosmolar hyperglycemic state
Diabetic ketoacidosis

2. A state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism.

Hyperosmolar hyperglycaemic state
Diabetic ketoacidosis
Non-ketotic hyperosmolar hyperglycaemia
Diabetes insipidus
Hypoglycaemia

3. When treating Hyperosmolar hyperglycemic state, initially use ____ saline.

0.6%
0.7%
0.9%
0.5%
0.8%

4. Bicarbonate infusion...

Should be used in all cases of ketoacidosis
Should be used freely in diabetic ketoacidosis
Should be used in all cases of acidosis
Should be reserved for profound acidosis with secondary myocardial depression
Should be used when pH < 7.4

5. What is not normally required for a diagnosis of diabetic ketoacidosis?

test for ketones
blood gas measurement
suspicion of diabetes
consideration of signs and/or symptoms
venous HCO3 measurement

6. This condition is associated with very high blood glucose (> 30mmol/l) but only a trace or +1 ketones in plasma or urine, and very high plasma osmolality (>350 mosmol/kg). It accounts for about 10-15% of cases of diabetic decompensation.

Hypoglycaemia
Non-ketotic hyperosmolar hyperglycaemia
Diabetic ketoacidosis
Diabetes insipidus
Hyperosmolar hyperglycaemic state

7. May result result from hyperketonaemia

C. Lowered concentrations of ketones in the blood
B. Peripheral vasodilation
A. Cardiac impairment
D. A or B
E. B or C

8. When replacing fluids in diabetic ketoacidosis,

Initially use 0.7% saline
Initially use 0.9% saline
Initially use 0.6% saline
Initially use 0.5% saline
Initially use 0.8% saline

9. Which of the following is UNCHARACTERISTIC of Hyperosmolar hyperglycemic state?

very dehydrated
onset = weeks
presentation = moribund
plasma HCO3- = extremely low
ketones rasied or normal

10. Which of the following is NOT a clinical finding in diabetic ketoacidosis?

hyperthermia
Kussmaul breathing
acetone on breath
abdominal tenderness
dehydration

11. When treating Hyperosmolar hyperglycemic state, aim for a blood glucose decline of

< 5 mmol/hour
< 15 mmol/hour
< 10 mmol/hour
< 0.5 mmol/hour
< 20 mmol/hour

12. Which of these is an appropriate treatment for hypoglycaemia?

A. glucose 15-25 g oral or iv
C. food
D. A & B
E. All of these may be appropriate
B. glucagon 1mg im or sc

13. Which of the following is an autonomic symptom of hypoglycaemia?

seizures
coma
drowsiness
tremor
confusion

14. Hyperosmolar hyperglycemic state is a relatively common, life-threatening endocrine emergency that is reported in all age groups, but it most frequently affects

older patients with type 2 diabetes
younger patients with type 2 diabetes
younger patients with type 1 diabetes
older patients with dibetes insipidus
older patients with type 1 diabetes

15. Which of the following is a neuroglycopenic symptom of hypoglycaemia?

sweating
hunger
palpitations
drowsiness
anxiety

16. Ketosis may be present to some degree. A state of altered consciousness when coma is not present. A complication of steadily increasing hyperglycaemia and polyuria - often with a concurrent infection. Usually occurs in older people, who are confused and dehydrated. Blood glucose rises sharply due to decreased renal perfusion and the inability to excrete excess glucose.

Hypoglycaemia
Non-ketotic hyperosmolar hyperglycaemia
Hyperosmolar hyperglycaemic state
Diabetes insipidus
Diabetic ketoacidosis

17. What is severe hypoglycaemia?

Plasma glucose <4mmol/L.
Plasma glucose <3mmol/L.
Plasma glucose <5mmol/L.
Plasma glucose <6mmol/L.
Hypoglycaemia requiring the assistance of another person

18. Signs & Symptoms: Polyuria, polydipsia, unexplained weight loss, visual blurring, genital thrush, lethargy

Hypoglycaemia
Hyperglycaemia

19. When treating Hyperosmolar hyperglycemic state, aim to normalise body fluid content in

1-2 hours
48-72 hours
6-12 hours
2-4 hours
12-24 hours

20. Which of the following is NOT a true/characteristic of Hyperosmolar hyperglycaemic state?

blood glucose > 35mmol/L
marked dehydration
risk of DVT is high
blood glucose typically lower than DKA
creatinine typically higher than DKA

21. Severe neuroglycopenia = glucose concentration of _______

<  1mmol/l
<  0.25 mmol/l
<  2 mmol/l
<  0.1 mmol/l
<  0.5 mmol/l

22. In order to diagnose ketoacidosis, ketones should be present in the urine (or blood) and Ph should be

<  7.2
<  7.3
<  7.1
<  7.4
<  7.0

23. When replacing potassium for those with diabetic ketoacidosis, on average give ...

2.0 mmol KCl in each litre of fluid
0.2 mmol KCl in each litre of fluid
200 mmol KCl in each litre of fluid
120 mmol KCl in each litre of fluid
20 mmol KCl in each litre of fluid

24. When treating DKA, if blood glucose is > 14 mmol/l give insulin at a rate of

5 units / hour
2 units / hour
1 unit / hour
12 units / hour
15 units / hour

25. When treating Hyperosmolar hyperglycemic state, initially infuse insulin at about ___ units / hour. When blood glucose < 12 mmol/l reduce rate to ___ units / hour. Aim to keep blood glucose between ____ mmol/l

2, 0.5-1, 10 and 15
6, 2-3, 5 and 10
4, 1-2, 5 and 12
8, 4-6, 4 and 8
12, 6-8, 5 and 12

26. When replacing fluids in diabetic ketoacidosis...

change to 0.1% or 0.5% glucose when plasma glucose <14 mmol/l
change to 5% or 10% glucose when plasma glucose <14 mmol/l
change to 1% or 2% glucose when plasma glucose <14 mmol/l
change to 1.5% or 2.0% glucose when plasma glucose <14 mmol/l
change to 2% or 4% glucose when plasma glucose <14 mmol/l

27. Which of the following is NOT characteristic of Hyperosmolar hyperglycaemic state?

clouding of consciousness
gradual onset of thirst
striking mental obtundation
mortality over 30%
sudden onset

28. What is the most common cause of fasting hypoglycaemia?

Pituitary insufficiency
Liver failure
Drugs (e.g. insulin, alcohol)
Malignancy
Addison's disease

29. Causes an osmotic diuresis, leading to loss of water and electrolytes

Glycosilation
Glycogenesis
Glycolation
Glycogenation
Glycosuria

30. Signs & Symptoms: Sweating, anxiety, hunger, tremor, palpitations, confusion, drowsiness, seizures, coma.

Hypoglycaemia
Hyperglycaemia

31. The main cause of death in diabetic subjects aged < 20 years

Diabetes insipidus
Hyperglycaemic ketoacidotic coma
Non-ketotic hyperosmolar hyperglycaemia
Diabetes mellitus
Type 1 diabetes

32. Which of the following is NOT a symptom of diabetic ketoacidosis?

abdominal pain
leg cramps
nausea & ; vomiting
weight gain
polyuria

33. Place the following in the correct order for treating diabetic ketoacidosis; A) consider underlying illness; B) monitor progress; C) replace fluid and electrolyte losses; D) correct acidosis & hyperglycaemia; E) resuscitate and protect airway

E, C, B, D, A
A, C, D, B, E
C, E, D, B, A
E, C, D, B, A
E, D, C, B, A

34. When treating Hyperosmolar hyperglycaemic state, if blood glucose is < 5 mmol/l, give insulin at a rate of ...

2 units / hour
5 units / hour
1 unit / hour
0.5 units / hour
12 units / hour

35. When treating DKA, if blood glucose is 5 - 14 mmol/l, give insulin at a rate of

5 units / hour
12 units / hour
1 unit / hour
0.5 units / hour
2 units / hour

36. Which of the following is UNCHARACTERISTIC of DKA?

dehydration
onset = days
very high ketones
plasma Na normal or high
presentation = unwell

37. May present with 1 to 3 day history of gradual decline into dehydration, acidosis, and coma. Precipitants include: infection, surgery, MI, non-compliance, or wrong insulin dose.

Hyperglycaemic ketoacidotic coma
Diabetes insipidus
Non-ketotic hyperosmolar hyperglycaemia
Type 2 diabetes
Diabetes mellitus

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