184. A 42-year-old woman with recurring episodes of hypoglycemia comes to the physician for a follow-up examination. She says that the episodes occur regardless of how much or how little she has eaten. The patient is on medical leave from her job as a licensed practical nurse. She recently underwent an exploratory laparotomy to confirm the diagnosis of insulinoma, but no abnormalities were found. She is 173 cm (5 ft 8 in) tall and weighs 55 kg (120 lb); BMI is 18 kg/m². She appears mildly anxious. Her 2-hour postprandial serum glucose concentration is 70 mg/dL. Which of the following is the most likely diagnosis? A) Conversion disorder B) Factitious disorder C) Hypoglycemia D) Insulinoma E) Metabolic syndrome
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- Becky has been admitted to the paediatric ward from the emergency department after being brought to hospital by her parents due to becoming drowsy at home. Becky is being treated for diabetic ketoacidosis via intravenous insulin and fluids, blood glucose was 36 mmol/l and blood ketones were 3.2 mmol/l on admission. Currently, becky is withdrawn and has said she wants to go home, she says will be ok and that she doesn’t want the treatment. When speaking to mom and dad, they have stated that becky should not be told about the severity of her condition as she will worry too much. Patient Details Name: becky Smith Date of Birth: 13/08/2009 - Age 14 Address: Next Of Kin: Parents, James and Donna Religion: None Ethnic origin: White British Presenting Complaint or Reason for visit Diabetic ketoacidosis (DKA) secondary to recently diagnosed type 1 diabetes (T1DM) Past Medical History T1DM Autism Current Medication Lantus – 12 units - one per day in the evening Novorapid – for administration…You are a nurse in an acute care hospital. Your new patient JD is in the hospital for fractures. His chart showed he has type 2 diabetes with HbA1c of 8.0%. JD’s sister came in to visit at lunch and brought him a Big Mac (3 slices of bread) with large fries on the side in addition to a bag of potato chips and a bottle of orange juice. You are concerned about the high carbohydrate content of the meal and discussed this with JD and JD’s sister. JD’s sister said, “I know my brother has diabetes, so I didn’t bring him soda or dessert.” JD said “I really love my carbs, but I know I should avoid all carbs to make my sugar low. Doctor said something about my ‘A1c’. Do you know what that is about?” Both JD and his sister said they would like to learn more about diabetes and diet. Please explain to JD and his sister what the HbA1c test is and how to use A1c level to categorize normal blood sugar, pre-diabetes, and diabetes according to the ADA. Please also describe the target HbA1c level for…Jessica Sagat, 21 years old, is a type 1 diabetic client. She has been ill for the past several days and is unable to control her blood sugar. She has developed elevated blood sugar, nausea, vomiting, rapid and deep respirations, and a fruity odor to her breath. An arterial blood gas (ABG) is taken and the results are pH 7.30, PaCO2 43 mm Hg, Bicarb (HCO3) 19 mEq/L, and PaO2 93 mmHg.(Learning Objective10) 1. What type of acid-base imbalance is this client experiencing? What components of the acid-base balance system are involved in this imbalance? 2. What are the normal ABG values?
- Jessica Sagat, 21 years old, is a type 1 diabetic client. She has been ill for the past several days and unable to control her blood sugar. She has developed elevated blood sugar, nausea, vomiting, rapid and deep respirations, and a fruity odor to her breath. An arterial blood gas (ABG) is taken and the results are: pH 7.30, PaCO2 43 mm Hg, Bicarb (HCO3) 19 mEq/L, and PaO2 93 mmHg. What type of acid–base imbalance is this client experiencing? What components of the acid–base balance system are involved in this imbalance? What are the normal ABG values?A diabetic patient of yours has been prescribed the following: “Give 4 units of Humulin N U-100 subcut, and Humalog U-100 per sliding scale od.” Use the medication order, insulin labels and sliding scale to answer the following questions. Humalog Sliding Scale Blood-glucose (mmol/L) Humalog Dosage (units) < 4.0 0; initiate hypoglycaemia protocol 4.1 – 8 0 8.1 – 10 0 10.1 – 12 0 12.1 – 14 2 14.1 – 16 4 16.1 – 18 6 18.1 – 20 8 > 20.0 8; notify MD a) Your patient’s blood-glucose level is 18.3 mmol/L. How many units of Humalog will you administer? (1 mark) b) Given that you can combine these two medications into one syringe, what is the total dosage of insulin that you will administer? (2 marks)An 8-year-old girl was down with diabetes mellitus during the pneumonia. Diabetes mellitus is compensated by introduction of insulin Actrapid НМ 4 units in the morning, 6 units at dinner time, 4 units before supper, 2 units at о 11.00p.m. After two weeks of treatment, the girl started suffering from hypoglycaemia. A daily dosage of insulin decreased to 8 units. There is retained normoglycemia, glycosuria. What is the mitigated need for insulin associated with?
- You are a nurse in an acute care hospital. Your new patient JD is in the hospital for fractures. His chart showed he has type 2 diabetes with HbA1c of 8.0%. JD’s sister came in to visit at lunch and brought him a Big Mac (3 slices of bread) with large fries on the side in addition to a bag of potato chips and a bottle of orange juice. You are concerned about the high carbohydrate content of the meal and discussed this with JD and JD’s sister. JD’s sister said, “I know my brother has diabetes, so I didn’t bring him soda or dessert.” JD said “I really love my carbs, but I know I should avoid all carbs to make my sugar low. Doctor said something about my ‘A1c’. Do you know what that is about?” Both JD and his sister said they would like to learn more about diabetes and diet. Doctor said something about my ‘A1c’. Do you know what that is about?” ----- Can you Explain in detail what is A1c? Please explain to JD and his sister what the HbA1c test is and how to use A1c level to categorize…“You are a nurse in an acute care hospital. Your new patient JD is in the hospital for fractures. His chart showed he has type 2 diabetes with HbA1c of 8.0%. JD’s sister came in to visit at lunch and brought him a Big Mac (3 slices of bread) with large fries on the side in addition to a bag of potato chips and a bottle of orange juice. You are concerned about the high carbohydrate content of the meal and discussed this with JD and JD’s sister. JD’s sister said, “I know my brother has diabetes, so I didn’t bring him soda or dessert.” JD said “I really love my carbs, but I know I should avoid all carbs to make my sugar low. Doctor said something about my ‘A1c’. Do you know what that is about?” Both JD and his sister said they would like to learn more about diabetes and diet.” Q1. Please explain to JD why he needs carbohydrates and describe the 2 functions of carbohydrate. Please explain to JD and his sister what the HbA1c test is and how to use A1c level to categorize normal blood…A 6-year-old boy is brought to the physician by his mother because of intermittent upper abdominal pain during the past 5 weeks and a rash for 1 week. Vital signs are normal. Physical examination shows yellow nodules over the extensor surfaces of the upper extremities. There's hepatomegaly and tenderness on palpation of the epigastric region. Serum studies show an increased amylase activity, increased chylomicron concentration, and a markedly increased triglyceride concentration. 3 months after beginning a fat-restricted diet, his serum chylomicron and triglyceride concentration decreased significantly, and the skin lesions resolve. A deficiency of which of the following enzymes is the most likely cause of these findings? a. Acetyl-CoA carboxylase b. HMG-CoA lyase c. HMG-CoA reductase d. Hormone-sensitive lipase e. Lipoprotein lipase
- 89. A 32-year-old woman comes to the physician because of a 4-month history of fatigue; she also has had a 9-kg (20-lb) weight gain during this period. Her blood pressure is 160/98 mm Hg; 1 year ago, her blood pressure was 120/85 mm Hg. Physical examination shows moon facies, truncal obesity, and purple striae over the abdomen. Serum studies show an increased adrenocorticotropic hormone concentration, consistent with measurements at her two most recent visits. This patient most likely has which of the following pathologic changes in the adrenal gland? A) Hyperplasia of zona fasciculata B) Hyperplasia of zona glomerulosa C) Hypertrophy of medulla D) Hypertrophy of zona glomerulosa E) Hypertrophy of zona reticularis8) An endocrine case A woman seeks medical advice because she feels tired and listless. She also complains of gaining weight in the past year, although her appetite has decreased. Her friends have also commented that she seems low, or even depressed. When the doctor examines her, she measures a heart rate of 60 beats / minute, which is a little lower than normal, swollen face and dry, brittle hair. During the examination, she gets cold and freezes even if the temperature around is normally warm. The doctor suspects hypothyroidism, but before a final diagnosis she needs some information, including some blood tests. The results show high cholesterol levels, which is usually seen in hypothyroidism, extremely low thyroid hormone levels and high levels of TSH. These results showed that the woman suffered from a problem with the thyroid gland and not from the pituitary gland. Further tests showed that the woman had an autoimmune disease, Hashimoto's disease in which the thyroid follicle…140. A 42-year-old man is brought to the emergency department by his wife because of a 24-hour history of severe abdominal pain. His wife says that he has been drinking excessive amounts of alcohol for the past 3 days. His blood alcohol concentration is 160 mg/dL. Physical examination shows scleral icterus and right upper quadrant tenderness of the abdomen. Microscopic examination of a liver biopsy specimen shows hepatocyte necrosis, bridging portal fibrosis, and macrovesicular steatosis. There are numerous Mallory bodies and neutrophilic infiltrates. Which of the following abnormalities is most likely in this patient? A) Globules of a-antitrypsin OB) Impaired synthesis of fatty acids C) Increased conjugation of bilirubin D) Increased generation of ATP by mitochondria E) Increased NADH/NAD* ratio F) Increased oxidation of fatty acids