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Category: Critical Care Medicine-Endocrine Disorders--->Diabetes Mellitus
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Question 1#Print Question

A 75-year-old male with a history of hypertension, chronic renal insufficiency, and type 2 diabetes mellitus is admitted to the intensive care unit (ICU) with shock secondary to bowel perforation. His blood glucose is 304 mg/dL on presentation and 275 mg/dL on recheck an hour later.

hich of the following is the MOST appropriate for management of hyperglycemia?

a. Start insulin glargine 0.2 mg/kg/d and correction insulin with a sliding scale of regular insulin every 6 hours with a goal glucose target between 80 and 110 mg/dL
b. Start insulin glargine 0.2 mg/kg/d and correction insulin with a sliding scale of regular insulin every 6 hours with a goal glucose target between 140 and 180 mg/dL
c. Start an insulin infusion targeting a blood glucose of 80 to 110 mg/dL
d. Start an insulin infusion targeting blood glucose of 140 to 180 mg/dL


Question 2#Print Question

Which of the following statements is FALSE regarding intensive glucose control (target blood glucose between 81 and 108 mg/dL) compared to conventional glucose control (target blood glucose <180 mg/dL) in critically ill patients.

a. Patients receiving intensive glucose control are 15 times more likely to develop hypoglycemia when compared to patients receiving conventional glucose control
b. Intensive glucose control is not associated with decreased mortality in surgical patients
c. Deaths from cardiovascular causes were more common in the intensive glucose control group than in the conventional glucose control group
d. Patients in the conventional glucose control group were more likely to have blood cultures positive for pathogenic organisms


Question 3#Print Question

Which of the following statements regarding agents used to treat Type 2 diabetes mellitus is FALSE?

a. Metformin is contraindicated in patients with an eGFR of less than 60 mL/min/1.73 m2
b. Sodium-glucose co-transporter 2 (SGLT2) inhibitors can cause hypovolemia and acute kidney injury
c. Sulfonylureas reduce both microvascular and macrovascular complications of diabetes
d. Both glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors are associated with acute pancreatitis


Question 4#Print Question

All of the following contribute to the development of diabetic ketoacidosis (DKA) EXCEPT

a. Insulin deficiency
b. Increased secretion of catecholamines, cortisol, and growth hormone
c. Glucagon deficiency
d. Increased lipolysis


Question 5#Print Question

A 27-year-old man with a history of obesity and substance abuse is found obtunded. His laboratory findings are:

Chemistry:

  • Sodium 135 mmol/L
  • Potassium 3.0 mmol/L
  • Chloride 105 mmol/L
  • CO2 10 mmol/L
  • Blood Urea Nitrogen 42 mg/dL
  • Creatinine 2.1 mg/dL
  • Glucose 570 mg/dL

Arterial Blood Gas:

  • pH 7.21
  • PaCO2 24
  • PaO2 95
  • Serum ketones positive

Initial treatment for him should include all of the following EXCEPT:

a. Normal saline at 500 to 1,000 mL/h during the first 1 to 2 hours
b. Replete potassium by administering potassium chloride
c. Intravenous insulin infusion to correct serum glucose
d. Identify and treat precipitating event




Category: Critical Care Medicine-Endocrine Disorders--->Diabetes Mellitus
Page: 1 of 2