Which is not a potential etiology of hypoglycemia in adults?
|Answer» B. salbutamol|
Which is the major precipitant of DKA?
|B.||missed doses of insulin|
|Answer» A. infection|
Which is not usually a feature of DKA?
|A.||seen type 1 diabetics mainly|
|B.||serum osmalality 275-295mmol/l|
|C.||fluid deficit usually less than that in HHNS|
|D.||glucose usually lower than that in HHNS|
|Answer» B. serum osmalality 275-295mmol/l|
Which is not true regarding the management of DKA?
|A.||the administration of IV fluid immediately on arrival is the life saving event|
|B.||fluid replacement should be 3-4 litres over the first four hours in a pt who is not shocked|
|C.||even if the K+ is >5.5 poatssium replacemnt should be commenced|
|D.||the insulin bolus should be about 0.1 units/kg, with subsequent infusion at 0.1units/kg/hr|
|E.||cerebral oedema responds to mannitol|
|Answer» C. even if the K+ is >5.5 poatssium replacemnt should be commenced|
Which is not a feature of Hyperosmolar, hyperglycemic non ketotic states?
|A.||very high glucose, often greater than 40 mmol/l|
|C.||serum osmalality often greater than 350 mmol/L|
|E.||lack of ketones in the urine|
|Answer» D. low bicarbonate|
Which statement is false about the fluid deficit in HHNS?
|A.||it is usually 5L|
|B.||if not shocked then 0.45% saline should be given|
|C.||fluid replacement should always precede insulin therapy in the non shocked pt|
|D.||fluid replacement should be done over a longer period of time than in DKA|
|E.||normal saline should be given to the shocked patient|
|Answer» A. it is usually 5L|
Which is not true about non ketotic hyperosmolar states?
|A.||these patients usually present with a GCS >8|
|B.||total body potassium is not reduced as in DKA as there is no acidosis|
|C.||focal neurological deficits are sometimes seen|
|D.||they are prone to arterial and vascular thrombosis|
|E.||insulin administration should be at the same rate as in DKA|
|Answer» B. total body potassium is not reduced as in DKA as there is no acidosis|
Which is not true regarding drug therapy in diabetes?
|A.||the use of ACEI even in normotensive patients, delays the onset of diabetic nephropathy|
|B.||the use of simvistatin in pts with CHD significantly reduces the risk of future CHD|
|C.||sulphonylureas stimulate the pancreatic secretion of insulin|
|D.||Acorbase(Glucobay) interferes with GIT absorption of carbohydrate|
|E.||Metformin is an oral insulin analogue|
|Answer» E. Metformin is an oral insulin analogue|
The nitroprusside dipstick test of the urine measures?
|D.||A and C|
|E.||All of the above|
|Answer» D. A and C|
Which is not a feature of alcoholic ketoacidosis?
|B.||Positive dipstick for ketones|
|C.||ABG = acidosis, alkalsos or normal|
|D.||Increased anion gap, regardless of pH|
|Answer» E. hyperglycemia|
Which is false regarding alcoholic ketoacidosis?
|A.||it is usually seen in chronic alcoholics|
|B.||usually there has been a recent cessation in drinking with several days of vomiting and poor oral intake|
|C.||Thiamine should be given|
|D.||Mainstay of treatment is IV fluids, including dextrose|
|E.||Low dose insulin given judiciously hastens recovery|
|Answer» E. Low dose insulin given judiciously hastens recovery|
Which is the most common precipitant of alcoholic ketoacidosis?
|C.||Alcohol withdrawl without precipitating illness|
|Answer» A. pancreatitis|
Which may not cause an adrenal crisis?
|A.||Waterhouse Freidrichson syndrome|
|C.||Acute discontinuation of steroids therapy|
|Answer» B. Sheehans syndrome|
What biochemical abnormality is possible in an addisonian crisis?
|D.||normokalemia and normonatremia|
|E.||all of the above|
|Answer» E. all of the above|
Which statement is incorrect with regards to treatment of an addisonian crisis?
|A.||i.v. normal saline should be given to treat shock|
|B.||i.v.dextrose will also be required|
|C.||i.v. fludrocortisone is required|
|D.||i.v. dexamethase or hydrocortisone should be given|
|E.||fluoxymesterone (androgen replacement) does not need to be given|
|Answer» C. i.v. fludrocortisone is required|
Which is false about chronic steroid administration and illness?
|A.||no suppression of the pituatry-adrenal axis occurs if the dose is <10mg regardless of the duration of administration|
|B.||no suppression of the axis occurs regardless of the dose as long axis is taken for less than 3 weeks|
|C.||in a time of physical stress the glucocorticoid dose should be increased 2-3 times for a few days|
|D.||in a time of physical stress the mineralocorticoid dose should be increased 2-3 times for a few days|
|E.||there is no need for glucose supplementation when physical stress occurs|
|Answer» D. in a time of physical stress the mineralocorticoid dose should be increased 2-3 times for a few days|
Which statement is false about pheochromocytomas?
|A.||clinically they may present with attacks of pallor, palpitations, sweating, headache and anxiety|
|B.||clinicaaly they present with hypertension alone, or sometime abdominal pain and vomiting|
|C.||investigations include urinary VMA and catecholamines|
|D.||beta blockade is the temporary treatment of choice and possibly long term|
|E.||the treatment of choice is surgical resection|
|Answer» D. beta blockade is the temporary treatment of choice and possibly long term|
Which is the most common cause of hyperthroidism in Australia?
|B.||Toxic multinodular goiter|
|Answer» A. Graves disease|
Which is not a feature of hyperthroidism?
|Answer» D. peripheral neuropathy|
Which agent should not be used in the treatment of a thyroid storm?
|Answer» D. salicylates|
Which is false regarding the treatment of a myxoedema coma?
|A.||thyroxine should be given i.v. initially|
|B.||thyroxine should be given in full dosage prior to blood results|
|C.||steroids should be given|
|D.||hyponatremia should be treated with fluid restriction|
|E.||dextrose may be required|
|Answer» B. thyroxine should be given in full dosage prior to blood results|
Which is not a feature of hypothyroidism?
|A.||loss of outer third of the eyebrow|
|Answer» C. opthalmopathy|
Which drug is not a possible precipitant of myxoedema coma?
|Answer» E. ranitidine|
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