MEDICINE PRACTICE 3

         INSTRUCTION: SELECT THE SINGLE BEST OPTION

1.        The following are the usual laboratory findings in a patient with diabetic ketoacidosis except:
   a.       Random plasma glucose  greater than 250mg/dl but usually less than 600 mg/dl
   b.      Serum osmolality greater than 320mOsm/kg
   c.       Serum bicarbonate less than 15mEq/L
   d.      Arterial P^H less than 7.3
   e.      Ketonuria of greater than or equal to ++
   2.       Which of the following is incorrect about anion gap?
   a.       It is low in diabetic ketoacidosis
   b.       It is the difference in the measured cations and the measured anions in the serum.
   c.       Na^+, K⁺, Cl^- and HCO₃^- are used when calculating it
   d.      In normal health, the anion gap is usually positive
   e.      It is high in uraemia
   3.       The following  intravenous fluids and electrolytes are usually needed when managing a patient with diabetic ketoacidosis except:
   a.       Normal saline and 5% dextrose water
   b.      Glucose/potassium/insulin (GKI) infusion
   c.       50% dextrose water
   d.      Potassium chloride
   e.      Isotonic sodium bicarbonate
   4.       The infection screen usually needed  in a patient with diabetic ketoacidosis include the following except:
   a.       Full blood count
   b.      C-reactive protein
   c.       Chest X-ray
   d.      Urine microscopy, culture and sensitivity
   e.      Lumbar puncture
   5.       The aim/target for fall in blood glucose when managing a patient with diabetic ketoacidosis, is usually......................
   a.       55-110 mg/dl/hour
   b.      180 mg/dl/hour
   c.       180-200 mg/dl/hour
   d.      126-200mg/dl/hour
   e.      20 mg/dl/hour
   6.       The following may cause cerebral oedema when treating a patient with diabetic ketoacidosis except:
   a.       Use of hypotonic intravenous fluids for rehydration
   b.      Use of sodium bicarbonate
   c.       Rapid reduction of blood glucose
   d.      Use of intravenous potassium chloride
   e.      None of the above
   7.       Considering the most appropriate, during the management of diabetic ketoacidosis,
   10% dextrose water is best given when...............
   a.       The blood glucose concentration  is still very high
   b.      When the blood glucose  concentration is exactly normal
   c.       When the blood glucose concentration approaches normal
   d.      When the exact precipitant of the diabetic ketoacidosis is known
   e.      When the patient is cooperative
   8.       The mainstay of initial management of diabetic ketoacidosis is:
   a.       Fluid therapy
   b.      Antibiotics
   c.       Nasogastric aspiration
   d.      Catheterisation
   e.      Thromboprophylaxis
   9.       The following are the principles of management of diabetic ketoacidosis except:
   a.       Fluid rehydration
   b.      Insulin therapy
   c.       Correction of electrolyte derangement
   d.      Identifying and treating the precipitant
   e.      None of the above
   10.   The typical fluid requirement of an adolescent with only diabetic ketoacidosis is:
   a.       3 litres in the first 24 hours
   b.      4 litres in the first 24 hours
   c.       5 litres in the first 24 hours
   d.      6 litres in the first 24 hours
   e.      10 litres in the first 24 hours
   
   
   
   
   
   
   
   
   ANSWERS:
   1. b
   2. a
   3. c
   4. e
   5. a
   6. d
   7. c
   8. a
   9. e
   10. d