Welcome to your 4. 🩸 Diabetes Mellitus, Insulin Therapy & Acute Diabetic Emergencies Arena — 40 Integrated MCQs
1.
A 64-year-old patient taking metformin develops septic shock and acute renal impairment. He becomes drowsy and has a high-anion-gap metabolic acidosis with markedly elevated lactate. Which management approach best addresses the underlying problem?
2.
A fasting patient with diabetes becomes unconscious from severe hypoglycemia. Intravenous access is delayed and glucagon is administered, but the glycemic response is poor. Which factor best explains the reduced effectiveness?
3.
A 22-year-old man with Type 1 diabetes is switched from regular insulin to insulin lispro before meals. Which property best explains the faster onset of the new preparation?
4.
A 2-year-old child has become irritable and lethargic over several days. The parents report unusually heavy wet nappies, persistent thirst and poor weight gain. Which initial assessment is most appropriate to detect diabetes and determine whether metabolic decompensation has begun?
5.
A junior doctor suggests routine intravenous bicarbonate for a patient with diabetic ketoacidosis. Which explanation best supports withholding bicarbonate in most cases?
6.
A 58-year-old man with Type 2 diabetes develops a severe acute infection with marked symptomatic hyperglycemia despite his usual non-insulin treatment. Which therapeutic principle is most appropriate?
7.
A 74-year-old woman with Type 2 diabetes presents after several days of increasing thirst, weakness and confusion. She is profoundly dehydrated, with extreme hyperglycemia and marked hyperosmolality but little ketosis. Which intervention deserves greatest initial emphasis?
8.
A 34-year-old lean man presents with recent weight loss, polyuria and hyperglycaemia. The clinical type of diabetes is uncertain. Which combination would most strongly support autoimmune insulin deficiency?
9.
A public-health review reports a rising burden of type 2 diabetes in urban populations both globally and in Pakistan. Increasing central obesity, sedentary behaviour and population ageing are also observed. Which explanation best accounts for this trend?
10.
A patient with chronic haemolytic anaemia has symptoms of hyperglycaemia and repeatedly elevated plasma glucose, but HbA1c is unexpectedly low. Which explanation is most appropriate?
11.
A 66-year-old patient taking the same insulin regimen for several months develops recurrent episodes of sweating and confusion after deterioration in renal function. Which factor most likely contributes to these episodes?
12.
A patient with Type 2 diabetes taking an SGLT2 inhibitor presents with nausea, abdominal discomfort and rapid breathing. Blood glucose is only moderately elevated. Which finding would most strongly support diabetic ketoacidosis?
13.
A patient with type 2 diabetes has acceptable fasting glucose but marked post-meal excursions. The clinician wants a short-acting drug that directly stimulates β-cell insulin release in relation to meals. Which drug is most appropriate?
14.
A 72-year-old man with type 2 diabetes develops severe dehydration and confusion during a chest infection. Plasma glucose is markedly elevated, serum osmolality is high, but significant ketonaemia is absent. Which mechanism best explains the limited ketone formation?
15.
A 38-year-old woman with central obesity has acanthosis nigricans and a high fasting insulin concentration despite near-normal plasma glucose. Which sequence best explains these findings?
16.
An elderly patient taking glibenclamide develops recurrent prolonged episodes of low blood glucose after renal function deteriorates. Which factor most likely contributed to this complication?
17.
A 10-year-old child with known Type 1 diabetes develops fever, vomiting and poor oral intake. His parents plan to stop his basal insulin because he is not eating. Which explanation best supports continuing appropriate insulin during the illness?
18.
A 62-year-old man with long-standing diabetes develops a painless plantar ulcer. Examination shows reduced vibration sensation and weak pedal pulses. Which combination most directly explains his increased risk of tissue breakdown?
19.
A patient receiving a stable insulin regimen develops recurrent hypoglycaemia after substantial deterioration in renal function. No change has occurred in diet or insulin dose. Which pharmacokinetic change is most relevant?
20.
A patient starts pioglitazone for type 2 diabetes. Improvement in insulin sensitivity develops gradually over the following weeks rather than immediately. Which property best explains the delayed response?
21.
An elderly man living alone develops hyperosmolar hyperglycemic state during an acute infection. He had become increasingly confused and was unable to obtain sufficient drinking water. Which mechanism best explains his profound dehydration?
22.
A patient using a fixed premixed insulin regimen has acceptable glucose control on routine days but develops frequent glucose fluctuations when meal timing changes. Which feature of the regimen best explains this problem?
23.
A patient using mealtime insulin is given pramlintide. Postprandial glucose improves, and the patient reports greater fullness after meals. Which additional action contributes to this therapeutic effect?
24.
A patient taking metformin has an irregular meal schedule but does not develop symptomatic hypoglycaemia when meals are delayed. Which pharmacological property best explains this advantage?
25.
A 21-year-old woman with Type 1 diabetes develops pneumonia and subsequently presents with diabetic ketoacidosis despite previously satisfactory glucose control. Which change most directly increases her insulin requirement during the infection?
26.
A patient started on acarbose develops troublesome flatulence and abdominal discomfort after carbohydrate-rich meals. Which mechanism best explains these adverse effects?
27.
A laboratory study demonstrates that insulin binding to its cell-surface receptor causes receptor autophosphorylation followed by intracellular signalling. Which receptor type mediates this action?
28.
A patient developing type 2 diabetes has normal fasting glucose but repeatedly elevated glucose after meals. Which early β-cell abnormality best explains this pattern?
29.
A patient with severe hyperglycemia has profound dehydration and markedly increased osmolality. Blood testing also demonstrates significant ketonemia and metabolic acidosis. Which interpretation is most appropriate?
30.
A young adult presents with diabetic ketoacidosis and requires insulin by the intravenous route during acute management. Which insulin preparation is suitable for this purpose?
31.
A patient receiving intravenous insulin for a hyperglycemic emergency develops progressive muscle weakness. Repeat testing shows a substantial fall in serum potassium. Which action of insulin best explains this change?
32.
An obese patient with type 2 diabetes begins treatment with exenatide and subsequently reports earlier fullness during meals and modest weight loss. Which pharmacological effect best explains this response?
33.
A patient with diabetic ketoacidosis is found to have marked potassium depletion before insulin therapy is started. Why must potassium be corrected before continuing aggressive insulin treatment?
34.
Fundus examination of a patient with long-standing diabetes shows areas of retinal capillary closure followed by formation of fragile new vessels. Which process most directly drives the new vessel formation?
35.
A district health programme identifies adults at increased risk of type 2 diabetes and offers biochemical testing before symptoms develop. Individuals with abnormal results are referred for further assessment and early care. Which level of prevention is primarily represented?
36.
A patient with diabetic ketoacidosis receives fluids and intravenous insulin. Several hours later, blood glucose has fallen substantially, but ketones and metabolic acidosis remain present. What is the most appropriate management principle?
37.
A patient with type 2 diabetes is treated with sitagliptin and has little tendency to develop hypoglycaemia when the drug is used without an insulin secretagogue. Which feature best explains this finding?
38.
A patient being treated for diabetic ketoacidosis shows clinical improvement. The physician chooses serial blood ketone measurements rather than relying only on urinary ketones. What is the main reason for this choice?
39.
A patient with established diabetic neuropathy and peripheral arterial disease develops a chronic foot ulcer. A multidisciplinary programme provides wound care, preservation of mobility and rehabilitation to reduce long-term disability. Which level of prevention is represented?
40.
A historical animal-derived insulin preparation is associated with a greater tendency to produce anti-insulin antibodies than porcine insulin. Which preparation is most likely responsible?
