MRCPH/FCPS PEDIATRIC MCQS: DIABETIC ACIDOSIS

DIABETIC KETOACIDOSIS:
MRCPH/FCPS MCQS: LEARN ABOUT DIABETES KETOACIDOSIS (DKA)

PEDIATRIC MCQS: DIABETIC KETOACIDDOSIS

Quiz

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1. A 14-year-old girl with type 1 diabetes mellitus (T1DM) is seen in the clinic for recurrent episodes of diabetic ketoacidosis (DKA). She is 5 ft 6 in (168 cm) tall and weighs 100 lb (45.4 kg). She is a well-adjusted honor roll student, and her teachers say she is a very pleasant
   person and gets along very well with her peers. Which of the following is most likely to be associated with her recurrent episodes of DKA?
   1.   Fear of weight gain.
   2.   Inadequately prescribed dosing of insulin.
   3.   Low socioeconomic status.
   4.   Misunderstanding insulin administration instructions.
   5.   Underlying immune disorder predisposing to infection.
2. A 3-year-old girl with new-onset T1DM is admitted to the hospital with a diagnosis of DKA. On initial evaluation in the emergency department she was assessed to be severely dehydrated. Her parents report that she has been ill for a week. Laboratory studies show
   mild acidosis, high urine specific gravity, glucosuria, and ketonuria. Which of the following factors is least likely to place this patient at risk for cerebral edema?
   1.   Age of 3 years.
   2.   Mild acidosis.
   3.   New onset of T1DM.
   4.   Prolonged nature of her illness.
   5.   Severe dehydration.
3. A 10-year-old girl with no significant medical history is brought to the emergency department because of vomiting, abdominal pain, polyuria, polydipsia, dehydration, and weight loss. She is diagnosed as having DKA. In addition to blood glucose, blood ketone, and serum electrolyte levels, which of the following laboratory studies is not recommended as part of the initial routine evaluation of this patient?
   1.   Erythrocyte sedimentation rate.
   2.   Glutamic acid decarboxylase antibody level.
   3.   Hemoglobin A1c level.
   4.   Islet cell antibody.
   5.   Thyroperoxidase antibodies
4. A 15-year-old boy, with a history of vomiting and 10% dehydration is brought to the emergency department by ambulance after his parents called 911 when they noticed that he has been progressively becoming more “lethargic” for the past few hours. On arrival at the emergency department he is noted to have clinical signs of dehydration. He is sleepy but arousable and responds to painful stimuli. His initial laboratory evaluation is significant for a blood glucose level of 250 mg/dL (13.9 mmol/L) with serum pH 7.05 and a bicarbonate level of 4 mEq/L (4 mmol/L). A normal saline bolus is started, and a computed tomographic scan of the brain is ordered. Which of the following is the most likely finding to be seen on computed tomographic scan in this patient?
   1.   Brain atrophy.
   2.   Dural thrombosis.
   3.   Effacement of cerebral sulci consistent with cerebral edema.
   4.   Intraparenchymal hemorrhage.
   5.   Ischemic stroke.
5. A 14-year-old girl with known T1DM has been noncompliant with her insulin dosing regimen. She is brought to the emergency department in DKA. Bicarbonate therapy should most likely be considered in which of the following clinical and laboratory findings?
   1.   Serum pH 7.2, potassium level of 5 mEq/L (5 mmol/L), and normal cardiac output.
   2.   Serum pH 7.0, potassium level of 6 mEq/L (6 mmol/L), and decreased cardiac output.
   3.   Serum pH 6.7, potassium level of 7 mEq/L (7 mmol/L), and decreased cardiac output.
   4.   Serum pH 7.1, potassium level of 4.5 mEq/L (4.5 mmol/L), and normal cardiac output.
   5.   Serum pH 7.0, potassium level of 6 mEq/L (6 mmol/L), and normal cardiac output.