Eggena 24-1

Question 1

the immediate threat to the patient was not the ketoacidosis, but the dangerously high level of

Answer 1

plasma potassium (hyperkalemia)

Question 2

To prevent ventricular fibrillation, the patient was given an intravenous injection of

Answer 2

calcium gluconate. It raises the threshold of cardiac muscle and protects the heart form the depolarizing action of hyperkalemia.

Question 3

emergency measures for reducing plasma potassium are aimed at

Answer 3

shifting potassium ions into cells, primarily muscle and liver cells. This can be accomplished with insulin or beta-2-adrenergic agonists that stiumlate sodium-potassium or with sodium bicarbonate that draws hydrogen ions into out of cells on hydreogen/sodium ion antiporters.

Question 4

sodium bicarbonate should be avoided in this situation because

Answer 4

it may cause matabolic alkalosis that could cause seizures and cardiac arrhythmias.

Question 5

the patient was severely dehydrated and volume depleted, which had

Answer 5

decreased cardiac output and renal perfusion, causing an increase in BUN and creatinine and in their ratio.

Question 6

type 2 diabetes is caused by

Answer 6

increased resistance of target cells (muscle and adipose cells) to insulin. The increase in resistance to insulin may be caused by a decrease in the number of functional insulin recceptors at the cell surface.

Question 7

the pancreas does secrete insulin in patients with type II diabetes, but the amount of insulin secreted is

Answer 7

insufficient to overcome the desensitized target cells.

These patients have a relative deficiency of insulin, even though actually measured concentrations may be normal or even high.

Question 8

_ is the most important factor that contributes to hyperglycemia.

Answer 8

obesity

Question 9

counterregulatory hormones, such as excessive _ or excessive _ can induce a diabetes like condition with high plasma glucose by opposing the action of insulin.

Answer 9

growth hormone, cortisol

Question 10

excess secretion of other hormones, _ and _, may sometimes be responsible for raising plasma glucose by inhibiting insulin secretion or interfering with its actions.

Answer 10

glucagon, somatostatin

Question 11

stress from surgery or infections often raises

Answer 11

plasma glucose in diapetic patients; glucose returns to normal when the stress subsites.

Question 12

Drugs such as corticosteroid preparations or diuretics, may

Answer 12

aggravate diabetes and cause hyperglycemia.

Question 13

classical symptoms of diabetes are

Answer 13

polyuria

polydipsia

polyphagia

Question 14

polyuria is caused by

Answer 14

loss of glucose in urine.

Question 15

polyphagia results when cells in the

Answer 15

hypothalamic satiety center sense (incorrectly) plasma glucose to be too low.

The reason for this inappropriate hunger drive is that insulin is required for glucose entry into cells of the satiety center.

Question 16

if glucose cannot enter satiety center neurons because insulin is lacking or ineffective,

Answer 16

hypothalamic feeding centers are released from tonic inhibition by the satiety center, the person feels hungry, seeks food and eats.

Question 17

other typical symptoms the patient has are

Answer 17

blurred vision
fatigue
infection
neurological problems

Question 18

the patient’s vision improved as

Answer 18

blood glucose declined into the normal range.

His blurred vision resulted when glucose diffused into the lens when plasma glucose was high, pulling water with it and distorting the lens.

Question 19

the patient’s fatigue was caused by

Answer 19

insufficient glucose entry into muscle cells and partly by muscle wasting, as proteins were broken down and amino acids converted to glucose in the absence of insulin.

Question 20

peripheral neuropathy and the baroreceptor reflex are symptoms of

Answer 20

diabetes.

Question 21

If fasting blood sugar is greater than _ and confirmed with a second measurement, the patient has diabetes.

Answer 21

140 mg/dl

Question 22

if fasting blood sugar is less than 140 but more than 115, a person

Answer 22

may or may not have diabetes. In this situation, a glucose tolerance test is performed.

Question 23

glucose tolerance test

Answer 23

the test subject eats a high carbohydrate diet for 3 days and on the morning of the test, drinks a solution with 75 g of glucose. blood samples are collected at 30 min intervals for 2 hours and analyzed for glucose.

Question 24

glycosylated hemoglobin

Answer 24

glucose attaches to hemoglobin A, so that hemoglobin is glycosylated.

Question 25

the amount of glycohemoglobin is propotional to the

Answer 25

average glucose level in the preceding 1-2 months.

Question 26

plasma levels of C peptide are about _ times higher than insulin.

Answer 26

8 times.

it is used to evaluate patients with ypoglycemia.