A 16-year-old boy suffering from type I diabetes is seen in the emergency
room with the chief complain of severe right-sided chest pain. Two hours
earlier he felt feverish and experienced a teeth-chattering chill. The
diabetes of the patient is presently well controlled on 2 daily doses of
insulin. The patient also is very compliant with his prescribed diet. After
physical examination and laboratory tests a diagnosis of atypical
pneumonia is made. Which of the following should be included in an
appropriate treatment plan for this patient?
A) To increase the daily insulin dosage
B) To start a course of ampicillin therapy
C) To add a daily administration of chlorpropamide
D) To start a course of vancomycin therapy
E) To add a daily administration of metformin
A 15-year-old girl was admitted to the emergency room following a motor
vehicle accident. She was obtunded and responded only to pain. Medical
history obtained from her mother was unremarkable. Physical examination
showed a patient with contusions on face and arms, but no signs of cranial
trauma. Vital sings were: temperature 97 F, respirations 22/min, pulse 124
bpm, blood pressure 90/70 mm Hg. Pertinent blood values were:
bicarbonate 6 mEq/L, glucose 847 mg/dL, creatinine 1.1 mg/dL. Urinalysis
showed the following : specific gravity 1.036, glucose 4+,ketones 4+.
Which of the following statements correctly pairs the most likely disorder
of the patient with the appropriate emergency treatment?
A) Diabetic hyperosmolar coma - IV regular insulin
B) Acute renal failure - furosemide
C) Diabetic ketoacidosis - IV regular insulin
D) Respiratory acidosis - bicarbonate, by IV infusion
E) Diabetic ketoacidosis - SC lente insulin
A 24-year-old woman with type I diabetes was brought unconscious to the
emergency room. Her blood glucose level was 395 mg/dL. An intravenous
infusion of insulin was started and the patient’s blood glucose decrease to
a normal level after 6 hours. Which of the following molecular actions most
likely contributed to the therapeutic effect of the drug in this patient?
A) Inhibition of glucose transporters in pancreas cell membranes
B) Phosphorylation of tyrosine kinase receptor
C) Activation of ATP-sensitive K+ channels in target cells
D) Stimulation of hormone sensitive lipase
E) Inhibition of liver glucokinase
A 22-year-old man with type I diabetes mellitus noticed symptoms of
tachycardia, sweating, nausea, headache and dizziness following his
participation in a game of football. The man has been maintained with twice
daily“split-mixed “ injections of regular insulin and lente insulin. Which of
the following would be the most appropriate treatment for this patient?
A) SC regular insulin
B) Oral propranolol
C) SC glucagon
D) Oral sugar
E) Oral metformin
F) Oral glyburide
A 7-year-old boy was brought to the emergency room by his parents
because of nausea, vomiting and persistent abdominal pain secondary to
the flu. Pertinent lab values on admission were: blood glucose 300 m/dL,
glycosuria 3+. Which of the following drugs would be appropriate for this
patient?
A) Miglitol
B) Metformin
C) Pioglitazone
D) Repaglinide
E) Regular insulin
F) Glyburide
A 65-year-old obese man was found to have a fasting blood glucose levels
of 170 mg/dL during a routine visit. Subsequent lab exams revealed
decreased glucose tolerance and fasting hyperglycemia. An appropriate
treatment was started but a week later the man complained of flatulence,
bleaching, diarrhea and abdominal pain. Which of the following drugs was
he most likely taking?
A) Regular insulin
B) Glyburide
C) Miglitol
D) Metformin
E) Repaglinide
F) Pioglitazone
A 72-year-old woman with type 2 diabetes mellitus was hospitalized
because of malaise, respiratory distress, nausea and vomiting and
lethargy. On admission vital signs were: blood pressure 134/90, pulse 80
bpm, respiration 32 breath/min. Laboratory data showed an anion gap of 24
mmol/L, plasma lactate of 6 mmol/L (normal 0.5- 1.5), creatinine 3.2 mg/dL,
arterial blood pH 7.24. The patient was most likely receiving which of the
following drugs?
A) Glucagon
B) Metformin
C) Repaglinide
D) Insulin
E) Glyburide
F) Pioglitazone