2. Treatment of Diabetes Mellitus.

***) All of the following are hypoglycemic agents, except:

1. Glibenclamide

2. Chlorpropamide

3. Gliclazide

4. Chlorpromazine

5. Glipizide

Answer: D* Chlorpromazine

***) There is an association between the use of biguanide oral hypoglycemia agent metformin (Glucophage) and the development of:

1. Lactic acidosis

2. Respiratory acidosis

3. Metabolic acidosis with normal anion gap

4. Metabolic alkalosis

5. Marked respiratory alkalosis

Answer: A* Lactic acidosis

***) Which of the following insulins can be given IV:

1. NPH

2. Ultralente

3. Lent

4. Mixtard

5. Regular

Answer: E* Regular

3. Complications of Diabetes Mellitus.

***) One of the following is most suited for detection of diabetic nephropathy: Q2012

1. Renal US

2. Urine analysis for casts

3. Urine albumin

4. Intravenous pyelography

5. Serum creatinine

Answer: C* Urine albumin

***) 63 years old woman with DM type 2, which is small controlled. Her physical examination is positive for peripheral neuropathy in the feet and non proliferative retinopathy. Urinalysis is positive for proteinuria. One of the following treatments is positive for attenuate the course of renal disease: Q2012

1. Beta blockers

2. ACE inhibitors

3. HMG-CoA

4. Dietary carbohydrate restriction

5. Weight reduction

Answer: B* ACE inhibitors

***) All of the following are complications of diabetes mellitus, except:

1. Macroglossia

2. Background retinopathy

3. Cataracts

4. Mononeuritis multiplex

5. Impotence

Answer: A* Macroglossia

***) All of the following are complications of diabetes mellitus, except:

1. 6^th cranial nerve palsy

2. Cataract

3. Alopecia

4. Albuminuria

5. Painful neuropathy

Answer: C* Alopecia

***) The following gastrointestinal manifestations can be related to diabetes mellitus, except:

1. Constipation

2. Diarrhea

3. Fecal incontinence

4. Duodenal ulcer

5. Gastric atonia

Answer: D* Duodenal ulcer

***) Hyperglycemic hyperosmolar non-ketonic coma:

1. May be presenting feature of diabetes mellitus

2. Has a better prognosis than diabetic ketoacidosis

3. Usually a feature of type I diabetes mellitus

4. Is an indication for long term insulin therapy

5. Requires larger doses of insulin than diabetic ketoacidosis

Answer: A* May be presenting feature of diabetes mellitus

***) Neuropathic (Charcot) joints may be seen in all of the following, except:

1. Diabetes mellitus

2. Syringomyelia

3. Leprosy

4. Tabes dorsalis

5. Huntington chorea

Answer: E* Huntington chorea

4. Diabetic Ketoacidosis dka.

***) In diabetic ketoacidosis all of the following are true, except: Q2012

1. Low dose insulin therapy is needed

2. Leukocytosis almost always means infection

3. At least 6 liters of fluids is estimated

4. Potassium deficit is present and needs replacement

5. The acid base presentation is metabolic acidosis

Answer: B* Leukocytosis almost always means infection

***) 55 years old male presented with DKA (diabetes type 2), ABGs showed pH 7.05, HCO₃ 12, K 3.1. The best treatment is: Q2012

1. Fluids, insulin, K, HCO₃

2. Fluids, insulin, K

3. Fluids, insulin, HCO₃

4. Insulin only

5. Fluids, K, HCO₃

Answer: A* Fluids, insulin, K, HCO₃

***) In diabetic ketoacidosis all of the following are true, except:

1. May be precipitated by infection

2. May occur in type II diabetes (insulin independent)

3. Dehydration may be very severe

4. Total body potassium is high

5. Bicarbonate may be needed

Answer: D* Total body potassium is high

***) The following about diabetic ketoacidosis are true, except:

1. May be initial manifestation of diabetes

2. Recovery is invariable

3. Heparin may be used prophylactically

4. May complicate insulin pump therapy

5. Abdominal pain and tenderness may be present

Answer: C* Recovery is invariable

***) The following about diabetic ketoacidosis are true, except:

1. Hypotension with tachycardia indicates profound fluid and electrolytes depletion

2. Thromboembolic pnenomenon is recognized complication

3. Total body potassium is high

4. More common in type I diabetes

5. Causes Kussmaul breathing

Answer: C* Total body potassium is high

***) In diabetic ketoacidosis all are true, except:

1. Abdominal pain

2. Leukocytosis

3. Sweating

4. Increased anion gap

5. Pseudohyponatremia

Answer: C* Sweating

***) Management of diabetic ketoacidosis may include the following, except:

1. Give 2/3 fluid maintenance to decrease brain edema

2. Give K

3. Monitor intake – output

4. Correct acidosis when pH is less than 7.1

5. Monitoring ketones in the blood is more important than in urine

Answer: A* Give 2/3 fluid maintenance to decrease brain edema