Download DB QS

1- which of the following statements regarding general principles of glucose metabolism are
correct?
Please select all that apply.
a) Gluconeogenesis is the formation of glucose from glycogen.
b) Glycogen may be stored as glucose or converted to fat.
c) Glycogenolysis and gluconeogenesis are functions of the liver.
d) Gluconeogenesis is stimulated when plasma glucose is low.
e) Glycogenesis is stimulated when cellular ATP reserves are low.
Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from
certain non-carbohydrate carbon substrates. From breakdown of proteins, these substrates
include glucogenic amino acids (although not ketogenic amino acids); from breakdown
of lipids (such as triglycerides), they include glycerol (although not fatty acids); and from other steps
in metabolism they include pyruvate and lactate.
Glycogenolysis is the biochemical breakdown of glycogen to glucose whereas
glycogenesis is the opposite, the formation of glycogen from glucose.
Glycogenolysis takes place in the cells of muscle and liver tissues in response to
hormonal and neural signals. In particular, glycogenolysis plays an important role in
the adrenaline-induced fight-or-flight response and the regulation of glucose levels in
the blood. The reverse process, glycogenesis, the formation of glycogen from
glucose, occurs in liver and muscle cells when glucose and ATP are present in
relatively high amounts. In the synthesis of glycogen, one ATP is required for every
glucose unit incorporated into the polymeric branched structure of glycogen. The
glucose (in the form of glucose-6-phosphate) is synthesized directly from glucose or
as the end product of gluconeogenesis.
The polysaccharide structure represents the main storage form of glucose in thebody.
In humans, glycogen is made and stored primarily in the cells of the liver and the muscles,
hydrated with three or four parts of water.
2- A person has been on hunger strike for a week. Which of the following statements will apply to
him?
Please select all that apply.
a) Increased release of fatty acids from adipose tissue.
b) Formation of protein.
c) Elevated plasma glucose.
d) Increased activity of hepatic glycogen synthetase.
e) Increased plasma catecholamine levels.
The First Phase of Starvation
During the first stage of starvation, blood glucose levels are maintained through the
production of glucose from proteins, glycogen and fats.
At first, glycogen is broken down into glucose. Only enough glycogen; however, is stored in
the person's liver to last a few hours. After that period of time, blood glucose levels are
maintained by the breakdown of fats and proteins.
Fats are decomposed into glycerol and fatty acids. Fatty acids can be used as a source of
energy, particularly by skeletal muscle, thereby decreasing the use of glucose by tissues
other than the brain.
Glycerol may be used to make a small amount of glucose, yet most of the glucose is formed
from the amino acids of proteins. Some amino acids might be used directly for energy.
The Second Phase of Starvation
In the second phase, which might last for several weeks, fats are the main energy source.
A person's liver metabolizes fatty acids into ketone bodies that can be used as a source of
energy.
After approximately a week of fasting, a person's brain starts to use ketone bodies, as well
as glucose, for sources of energy. Proteins not essential for survival are used first.
The Third Phase of Starvation
The third phase of starvation starts when a person's fat reserves are depleted and there is a
switch to proteins as the major source of the person's energy. Muscles, the largest source
of protein in the body, are quickly depleted. At the end of this phase, proteins - essential for
cellular functions, are broken down and cell function degenerates. Along with loss of weight,
symptoms of starvation include:
•
Apathy
•
Withdrawal
•
Listlessness
•
Increased susceptibility to disease
Few people die directly from starvation because they usually die of an infectious disease
first.
Additional signs of starvation may include flaky skin, changes in hair color and massive
edema in the lower limbs and abdomen, causing the person's abdomen to seem bloated.
During the process of starvation, the ability of the human body to consume volumes of food
also decreases.
Foods low in protein yet high in bulk often times cannot reverse the process of starvation.
Intervention involves feeding the affected person low-bulk food that provides lots of proteins
and kilo-calories and is fortified with minerals and vitamins.
The process of starvation also results in dehydration and dehydration is an important part of
intervention. Even with intervention, a person might be so affected by weakness or disease
they do not have the ability to make a recovery.
The body has 3 energy sources: carbohydrates (stored as glycogen), protein andfats.
It burns them preferentially in that order because of the energy requirements to both store and
break them down. ... The result is the same, but more profound -muscle loss first then fat loss.
3- Regarding diabetes mellitus, which of the following statements are correct?
Please select all that apply.
a) It may be caused by a reduction in functional insulin receptors
b) It is characterized by a fall in urine output.
c) It is associated with an increase in lipolysis.
d) It leads to hypoglycaemia.
e) It is a common symptom of conns
4- Diabetes often results due to
conversion of glucose to glycogen
inability of pancreas to secrete insulin
less water intake in diet
unhealthy and inactive life styles
5- In a healthy person, excess glucose is
stored inside body
converted to glycogen
excreted in urine
not present in diet
6- Clinical manifestations associated with a diagnosis of type 1 DM include all of the following
except:
Polyphagia
Hypoglycemia
Ketonuria
Hyponatremia
7- A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting
blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of
140/84. Which finding would be of most concern of the nurse?
Respiration
Pulse
Temperature
BP
8- When a client is in diabetic ketoacidosis, the insulin that would be administered is:
Human NPH insulin
Insulin lispro injection
Human regular insulin
Insulin glargine injection
9- Insulin forces which of the following electrolytes out of the plasma and into the cells?
Calcium
Magnesium
Potassium
Phosphorus
10- Which of the following chronic complications is associated with diabetes?
Retinopathy, neuropathy, and coronary artery disease
Leg ulcers, cerebral ischemic events, and pulmonary infarcts
Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmia’s
Dizziness, dyspnea on exertion, and coronary artery disease
11- Rotating injection sites when administering insulin prevents which of the following
complications?
Systemic allergic reactions
Insulin resistance
Insulin lipodystrophy
Insulin edema
12- Insulin causes the blood glucose levels to fall, but glucagon causes those levels to rise. The
relationship between the two hormones would be said to be _____.
expressive
antagonistic
synergistic
permissive
13- The risk factors for type 2 diabetes mellitus include _____.
being overweight
family history
All of the options listed are correct.
being a member of a high-risk population
14- The risk factors for type 1 diabetes mellitus include _____.
inactivity
being overweight
family history
All of the options listed are correct.
15- When a pregnant woman develops diabetes mellitus it is called _____.
Diabetes insipidus
Type 2 diabetes mellitus
Type 1 diabetes mellitus
Gestational diabetes
16- Type 2 diabetes can be prevented or delayed through _____.
Lifestyle interventions
Exercise
Weight loss
All of the options listed are correct.
17- The primary risk factor for type 2 diabetes is _____.
Viral infection
Family history
Obesity
Being a member of a high risk population
18- Physical symptoms of type 1 diabetes include _____.
unexplained weight loss
increased thirst
frequent urination
All of the symptoms listed are correct.
19- After a meal, blood glucose levels increase and stimulate the secretion of which hormone?
glucagon
glycogen
pancreatisome
insulin
20- Midmorning, blood glucose levels fall and stimulate the secretion of which hormone?
insulin
glucagon
glycogen
pancreatisome
21- Type 1 diabetes _____.
occurs only with obesity
lowers cells' sensitivity to insulin
involves the immune system attacking and killing pancreas cells that make insulin
occurs only in adults
22- Long-term complications of diabetes include _____.
increased risk for high blood pressure and atherosclerosis
increased risk for kidney failure
impaired sensation in the hands and feet
All the complications listed are correct.
23- A fasting blood glucose test level of _________________ is considered normal.
4 mmol/L to 7 mmol/L
4 mmol/L to 6 mmol
2.8 mmol/L to 5 mmol/L
8 mmol/L or higher on two separate tests
24- A fasting blood glucose test level of _________________ indicates diabetes.
2.5 mmol/L to 3.5 mmol/L
5 mmol/L to 7mmol/L
6 mmol/L to 7 mmol/L
7 mmol/L or higher on two separate tests
25- A fasting blood glucose test level of _________________ indicates prediabetes.
5 mmol/L to 6 mmol/L
7 mmol/L to 9 mmol/L
6.1 mmol/L to 7 mmol/L
126 mg/dl or higher on two separate tests
26- The pathogenesis of hyperglycemia in diabetic ketoacidosis
includes all the following mechanisms except for:
a. Increased glycogenolysis in the liver and Increased gluconeogenesis in the kidneys
b. Increased lipolysis in the kidney
c. Increased serum glucagon
d. Increased gluconeogenesis in adipose tissue
e. Decreased glucose uptake from the muscles
Gluconeogenesis is a ubiquitous process, present in plants, animals, fungi, bacteria, and other
microorganisms.[2] In vertebrates, gluconeogenesis takes place mainly in the liver and, to a lesser
extent, in the cortex of the kidneys.
Diabetic ketoacidosis arises because of a lack of insulin in the body. The lack of insulin and
corresponding elevation of glucagon leads to increased release of glucose by the liver (a process
that is normally suppressed by insulin) from glycogen via glycogenolysis and also
through gluconeogenesis. High glucose levels spill over into the urine, taking water and solutes
(such as sodium and potassium) along with it in a process known as osmotic diuresis.[2] This leads to
polyuria, dehydration, and compensatory thirst and polydipsia. The absence of insulin also leads to
the release of free fatty acids from adipose tissue (lipolysis), which are converted through a process
called beta oxidation, again in the liver, into ketone bodies (acetoacetate and β-hydroxybutyrate). βHydroxybutyrate can serve as an energy source in the absence of insulin-mediated glucose delivery,
and is a protective mechanism in case of starvation. The ketone bodies, however, have a
low pKa and therefore turn the blood acidic (metabolic acidosis). The body initially buffers the
change with the bicarbonate buffering system, but this system is quickly overwhelmed and other
mechanisms must work to compensate for the acidosis.[2] One such mechanism is hyperventilation to
lower the blood carbon dioxide levels (a form of compensatory respiratory alkalosis). This
hyperventilation, in its extreme form, may be observed as Kussmaul respiration.[7]
In various situations such as infection, insulin demands rise but are not matched by the failing
pancreas. Blood sugars rise, dehydration ensues, and resistance to the normal effects of
insulin increases further by way of a vicious circle.[2][5]
27- Which of the following symptoms/signs are included in the clinical
features of diabetic ketoacidosis?
a. Polyuria and weight loss
b. Tachypnea and tachycardia
c. Abdominal pain and vomiting
d. Cheyne – Stokes respiration
e. All of the above
f. a + b + c
28- What is true concerning potassium in diabetic ketoacidosis?
a. Potassium replacement may not be necessary if its level is
normal at initial management of DKA
b. Potassium defi ciency may cause tall, peaked symmetrical T
waves in the electrocardiogram
c. Potassium replacement is necessary during the whole time
period of IV fl uid administration
d. Potassium defi ciency is the cause of hyponatremia observed
at presentation of DKA
29- Untreated diabetes may result in all of the following except:
a.
Blindness
b.
Cardiovascular disease
c.
Kidney disease
d.
Tinnitus
30- Prediabetes is associated with all of the following except:
a.
Increased risk of developing type 2 diabetes
b.
Impaired glucose tolerance
c.
Increased risk of heart disease and stroke
d.
Increased risk of developing type 1 diabetes
31- Diabetics are at increased risk of heart disease if they also:
a.
Smoke
b.
Have high HDL cholesterol levels
c.
Take aspirin
d.
Consume a high-fiber diet
32- Blood sugar is well controlled when Hemoglobin A1C is:
a.
Below 7%
b.
Between 12%-15%
c.
Less than 180 mg/dL
d.
Between 90 and 130 mg/dL
33- Excessive thirst and volume of very dilute urine may be symptoms of:
a.
Urinary tract infection
b.
Diabetes insipidus
c.
Viral gastroenteritis
d.
Hypoglycemia
34- Among female children and adolescents, the first sign of type 1 diabetes may be:
a.
Rapid weight gain
b.
Constipation
c.
Genital candidiasis
d.
Insomnia
35- Which of the following measures does not help to prevent diabetes complications?
a.
Controlling blood glucose
b.
Controlling blood pressure and blood lipids
c.
Eliminating all carbohydrates from the diet
d.
Prompt detection of diabetic eye and kidney disease