Diabetes LEIK Flashcards
1
Q
- An 8-year-old boy with type 1 diabetes is being seen for a 3-day history of urinary
frequency and nocturia. He denies flank pain and is afebrile. The urinalysis result is
negative for blood and nitrites but is positive for a large amount of leukocytes and
ketones. He has a trace amount of protein. Which of the following is the best test to
order initially?
A) Urine for culture and sensitivity
B) 24-hour urine for protein and creatinine clearance
C) 24-hour urine for microalbumin
D) Intravenous pyelogram
A
- A) Urine for culture and sensitivity An 8-year-old male patient with the
diagnosis of diabetes has a high risk of urinary tract infections (UTIs). A large
amount of leukocytes in the urinalysis is abnormal, and he has been having
symptoms of frequency and nocturia for the past 3 days. The urine culture would be
ordered because he has a high risk of infection. The urine culture and sensitivity
(C&S) is the best evaluation for diagnosing a UTI.
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2
Q
- A 73-year-old patient complains of recent episodes of acute-onset left-sided
facial asymmetry, slurred speech, weakness, and dizziness, accompanied by
weakness of the left arm and left leg. She reports that the episodes occur at random
and last from 30 minutes to about 2 hours. Each episode resolved completely. The
patient has type 2 diabetes with hyperlipidemia, peripheral arterial disease,
hypertension, and osteoporosis. Her symptoms suggest:
A) Benign paroxysmal positional vertigo
B) Ménière’s disease
C) Transient ischemic attack (TIA)
D) Cerebrovascular accident (CVA)
A
- C) Transient ischemic attack (TIA) Transient ischemic attack (TIA) is a
transient episode of ischemia in the brain, retina, or spinal cord without acute
infarction. About 10% to 20% of patients with TIA will have a stroke within 90
days. TIA signs and symptoms are acute onset of facial asymmetry, slurred speech,
weakness, monocular visual loss, headache, and hemiplegia that resolves within
minutes to several hours. TIA is a neurological emergency; should undergo brain
imaging (MRI preferred) within 24 hours of onset.
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3
Q
- A 55-year-old woman who has had type 2 diabetes for 20 years is concerned about
her kidneys. She has a history of three urinary tract infections (UTIs) within the past
8 months, but is currently asymptomatic. Which of the following is the best course
to follow?
A) Recheck urine during the visit, send a urine specimen for culture and sensitivity,
and refer to a nephrologist
B) Order a urinalysis dipstick test to be repeated monthly
C) Order a CT scan of the kidneys
D) Provide empiric treatment for a UTI
A
- A) Recheck urine during the visit, send a urine specimen for culture and
sensitivity, and refer to a nephrologist Although the patient is currently
asymptomatic, her history of three urinary tract infections (UTIs) in 8 months
warrants testing while she is in the office. A UTI is defined as the presence of
100,000 organisms per milliliter of urine in asymptomatic patients or greater than
100 organisms per milliliter of urine with pyuria (>7 WBCs/mL) in a symptomatic
patient. Diabetic patients are at higher risk for UTIs and over time may develop
bladder damage (cystopathy) and nephropathy. A nephrology consult is prudent.
4
Q
- A 68-year-old woman with hypertension and diabetes is seen by the nurse
practitioner for a dry cough that worsens at night when she lies in bed. She has
shortness of breath, which worsens when she exerts herself, and has gained 6 lbs
during the past 2 months. Her pulse rate is 90 beats/min and regular. She is on a
nitroglycerine patch and furosemide daily. The best explanation for her symptoms is:
A) Kidney failure
B) Congestive heart failure
C) ACE inhibitor-induced coughing
D) Thyroid disease
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A
- B) Congestive heart failure In congestive heart failure (CHF), the heart’s
ventricular function is inadequate. Symptoms include fatigue, diminished exercise
capacity, shortness of breath, hemoptysis, cough, orthopnea, hypertension, nocturnal
dyspnea, and edema. The kidneys begin to lose their normal ability to excrete
sodium and water, leading to fluid retention. Lung congestion/pulmonary edema
causes shortness of breath and a decreased ability to tolerate exercise.
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5
Q
- A 30-year-old woman with type 2 diabetes uses regular and NPH (neutral protein
Hagedorn) insulin in the morning and in the evening. She denies changes in her diet
or any illness, but recently started attending aerobic classes in the afternoon. Her
fasting blood glucose level before breakfast is now elevated. Which of the following is
best described?
A) Somogyi phenomenon
B) Dawn phenomenon
C) Raynaud’s phenomenon
D) Insulin resistance
A
- A) Somogyi phenomenon This is caused by too much insulin (or missing a meal
or snack) in the evening, which results in hypoglycemia in the early morning (2 a.m.
to 3 a.m.). The body compensates by secreting glucagon (from the liver) and
epinephrine, which results in high blood glucose levels in the morning. The Somogyi
phenomenon (or Somogyi effect) is also known as the rebound effect.
6
Q
168. Which of the following would you recommend on an annual basis for an elderly patient with type 2 diabetes? A) Eye exam with an ophthalmologist B) Follow-up visit with a urologist C) Periodic visits to an optometrist D) Colonoscopy
A
- A) Eye exam with an ophthalmologist Elderly patients with type 2 diabetes
should have a dilated eye exam done annually by an ophthalmologist. They should
also see a podiatrist once or twice a year. Preventive care also includes receiving a flu
shot annually, receiving a Pneumovax vaccine if older than 60 years of age, and
taking a 81-mg baby aspirin each day.
7
Q
- A male patient has type 2 diabetes mellitus and a “sensitive stomach.” Which
medication is least likely to cause him gastrointestinal distress?
A) Naproxen sodium (Anaprox)
B) Aspirin (Bayer’s aspirin)
C) Erythromycin (E-mycin)
D) Sucralfate (Carafate)
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A
- D) Sucralfate (Carafate) Naproxen sodium, aspirin, and erythromycin all have
gastrointestinal side effects. Sucralfate is used to protect the stomach lining by
building a protective layer over the stomach lining; it allows healing to occur.
8
Q
203. An obese Asian patient with BMI (body mass index) of 33 complains of fatigue, and excessive thirst and hunger. You suspect type 2 diabetes mellitus. Initial testing to confirm diagnosis can include: A) Fasting plasma glucose level B) Glycated hemoglobin level (A1C) C) Oral glucose tolerance testing D) All of the above 794
A
- D) All of the above Type 2 diabetes mellitus screening tests include fasting
plasma glucose level (>126 mg/dL), random plasma glucose level (>200 mg/dL), and
oral glucose tolerance testing (2-hour blood glucose level >200 mg/dL) with a 75-g
glucose load. Normal A1C levels are less than 6%.
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9
Q
218. Which chronic illness disproportionately affects the Hispanic population? A) Diabetes mellitus B) Hypertension C) Alcohol abuse D) Skin cancer
A
- A) Diabetes mellitus The risk of diabetes mellitus is two to three times higher in
Mexican Americans than in non-Hispanic Americans.
10
Q
- A 65-year-old Hispanic woman has a history of type 2 diabetes. A routine
urinalysis reveals a few epithelial cells and is negative for leukocytes, nitrites, and
protein. The serum creatinine is 1.5 mg/dL. Which of the following actions would
you recommend next?
A) Order a urine test for culture and sensitivity (C&S)
B) Order a spot urine for microalbumin-to-creatinine ratio
C) Because the urinalysis is negative, no further tests are necessary
D) Recommend a screening intravenous pyelogram (IVP)
A
- B) Order a spot urine for microalbumin-to-creatinine ratio The American
Diabetes Association (ADA) now prefers a spot urine for the microalbumin-tocreatinine
ratio (ACR) test instead of a urine albumin test. Use the first morning
void sample. The ACR has high predictive value for albuminuria and early kidney
disease in patients with prediabetes, diabetes, and hypertension (McCulloch &
Bakris, 2016). Because the patient has type 2 diabetes, both an annual urinalysis and
an annual ACR test are recommended. Regarding the urinalysis result, a few
epithelial cells is within normal limits.
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11
Q
- A 10-year-old boy has type 1 diabetes. His late afternoon blood sugars over the
past 2 weeks have ranged between 210 mg/dL and 230 mg/dL. He currently
injects 10 units of regular insulin and 25 units of NPH in the morning and 15 units
of regular insulin and 10 units of NPH insulin in the evening. Which of the
following is the best treatment plan for this patient?
A) Increase both types of the morning dose
B) Increase only the NPH insulin in the morning
C) Decrease the afternoon dose of NPH insulin
D) Decrease both NPH and regular insulin doses in the morning
A
- B) Increase only the NPH insulin in the morning Regular insulin is
rapid/short-acting insulin. Depending on the type of regular insulin, the onset is 10
to 15 minutes and peaks within an average of 1.5 hours, with a duration of 3 to 5
hours. NPH insulin is an intermediate-acting insulin. Depending on the type of
NPH insulin, the onset is 1.5 to 3 hours. NPH peaks in 4 to 12 hours, and the
duration is from 18 to 24 hours. By increasing the morning NPH, the peak will
occur in the afternoon, bringing down the blood glucose.
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12
Q
- A middle-aged patient newly diagnosed with type 2 diabetes wants to start an
exercise program. All of the following statements are true except:
A) If the patient is unable to eat due to illness, antidiabetic agents can be continued
with frequent glucose monitoring
B) Strenuous exercise is contraindicated for most patients with type 2 diabetes
because of a higher risk of hypoglycemic episodes
C) Exercise increases the body’s ability to metabolize glucose
D) Patients who exercise vigorously in the afternoon may have hypoglycemic
episodes in the evening or at night if they do not eat
A
- B) Strenuous exercise is contraindicated for most patients with type 2 diabetes
because of a higher risk of hypoglycemic episodes Exercise is recommended
because exercise helps to use the glucose stores and reduce blood sugar. When
exercising, the patient should monitor blood sugar closely, especially if using insulin,
to avoid hypoglycemia.
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13
Q
446. There is a higher risk of balanitis in which of the following conditions? A) Renal insufficiency B) Diabetes mellitus C) Graves’ disease D) Asthma
A
- B) Diabetes mellitus Balanitis is a yeast infection of the glans of the penis. Men
who are not circumcised and who have diabetes mellitus are at higher risk for
developing balanitis.
14
Q
- All of the following patients should be screened for diabetes mellitus except:
A) An obese man of Hispanic descent
B) An overweight middle-aged Black woman whose mother has type 2 diabetes
C) A woman who delivered an infant weighing 9.5 lbs
D) A 30-year-old White man with hypertension
A
- D) A 30-year-old White man with hypertension
The 30-year-old White
man with hypertension would be the last patient to be screened for diabetes.
Not having any information about him also puts him lower on the list. Obesity,
ethnicity (Hispanic/Latino Americans, African Americans, Native Americans, Asian
Americans, Pacific Islanders, and Alaska natives), family history of diabetes, and
gestational diabetes (mother of the infant weighing 9.5 lbs) are all risk factors. These
were present in all of the other selections. Other risk factors for diabetes include
impaired glucose tolerance test, sedentary lifestyle, polycystic ovary syndrome
(PCOS), and hypertension.
15
Q
576. Acanthosis nigricans is associated with all of the following disorders except: A) Obesity B) Diabetes C) Colon cancer D) Tinea versicolor
A
- D) Tinea versicolor Acanthosis nigricans is a benign skin condition that is a
sign of insulin resistance. It appears as hyperpigmented velvety areas that are
usually located on the neck and the axillae. It is rarely associated with some types of
adenocarcinoma of the gastrointestinal tract. Tinea versicolor is a superficial infection
of the skin (stratum corneum layer) that is caused by dermatophytes (fungi) of the
tinea family. Another name for it is sunspots.
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