MCQ Questions on Diabetic Ketoacidosis (DKA)

- What is the primary metabolic complication of Type 1 Diabetes (T1D) leading to Diabetic Ketoacidosis
(DKA)?

a) Hyperglycemia

b) Hypoglycemia

c) Hyperlipidemia

d) Hyperinsulinemia

- Besides the failure to take insulin, what other factors can precipitate DKA?

a) Low dietary fat intake

b) Sedentary lifestyle

c) Elevated insulin levels

d) High protein intake

- What is the characteristic breathing pattern seen in DKA, known as?

a) Cheyne-Stokes breathing

b) Bradypnea

c) Kussmaul breathing

d) Tachypnea

- In the context of DKA, what is the role of beta-hydroxybutyrate in blood ketone levels?

a) It is not present in DKA.

b) It is a precursor of acetoacetate.

c) It primarily accounts for ketone concentration.

d) It reflects glycogen breakdown.

- What is the primary goal of fluid replacement in DKA?

a) Correct metabolic alkalosis

b) Increase insulin secretion

c) Prevent hyperglycemia

d) Counteract dehydration and dilute ketones

- Why is urine ketone testing considered limited for diagnosing DKA?

a) It provides immediate results.

b) Measures beta-hydroxybutyrate accurately.

c) May result in false negatives.

d) Reflects blood ketone levels perfectly.

- What is the purpose of administering 5% dextrose with 0.45% sodium chloride when serum glucose is
less than 200 mg/dL?

a) To prevent hypoglycemia

b) To correct hypernatremia

c) To enhance ketone body formation

d) To promote glucose uptake by cells

- What criterion is NOT a part of the DKA hallmark Tetrad?

a) Ketonemia

b) Bicarbonate (less than or equal to 15 mEq/L)

c) Blood glucose greater than 250 mg/dL

d) Arterial pH less than or equal to 7.3

- What symptom is indicative of the persistence of the ketotic state in DKA?

a) Increased appetite

b) Normal breathing pattern

c) Severe abdominal pain

d) Deep, labored breathing

- What happens to hormone-sensitive lipase in DKA due to insulin deficiency?

a) Activates lipase

b) Inhibits lipase

c) Has no impact on lipase activity

d) Converts lipase to glucagon

- At what serum glucose level is the infusion of 5% dextrose with 0.45% sodium chloride recommended
in DKA treatment?

a) Less than 100 mg/dL

b) Less than 150 mg/dL

c) Less than 200 mg/dL

d) Greater than 250 mg/dL

- When is potassium supplementation held in DKA treatment?

a) If baseline serum potassium is less than 3.3 mEq/L

b) If baseline serum potassium is greater than 3.3 but less than 5.3 mEq/L

c) If baseline serum potassium is 5.3 mEq/L or greater initially

d) If baseline serum potassium is within the normal range

- What is the clinical manifestation that indicates the persistence of the ketotic state in DKA?

a) Normal breathing pattern

b) Increased appetite

c) Deep, labored breathing d) Fruity odor

- Why might urine ketone testing have limitations in diagnosing DKA?

a) It provides immediate and accurate reflection of DKA severity.

b) Measures beta-hydroxybutyrate, the most clinically relevant ketone body.

c) Ketones may appear in urine before reaching significant levels in the blood.

d) It accurately reflects the severity of DKA better than blood ketone testing.

- What is the primary purpose of fluid replacement in DKA management?

a) To increase blood pressure.

b) To dilute ketones in the blood.

c) To correct metabolic acidosis.

d) To induce diuresis.

-What is the role of bicarbonate levels in the diagnostic criteria for DKA?

a) Marker of hyperglycemia.

b) Indicator of ketone body production.

c) Measurement of acid-base balance.

d) Assessment of insulin sensitivity.

- What is the significance of Kussmaul breathing in DKA?

a) Indicates respiratory alkalosis.

b) Suggests a normal breathing pattern.

c) Reflects metabolic acidosis.

d) Occurs during deep sleep.

- Why is corrected sodium calculated in DKA management?

a) To assess fluid balance.

b) To account for the impact of high blood glucose on sodium levels.

c) To determine the need for potassium supplementation.

d) To monitor the response to insulin therapy.

- What blood pH level is considered a hallmark diagnostic criterion for DKA?

a) Greater than 7.5.

b) Less than 6.8.

c) Between 7.3 and 7.4.

d) Greater than 7.3.

- What is the purpose of intravenous infusion of insulin in DKA treatment?

a) To induce ketosis.

b) To promote glucose uptake by peripheral tissues.

c) To decrease glucagon secretion.

d) To increase ketone body formation.

- What clinical manifestations indicate the persistence of the ketotic state in DKA?

a) Normal breathing pattern.

b) Tachycardia.

c) Depressed consciousness.

d) Increased appetite.

- Why is 5% dextrose with 0.45% sodium chloride recommended when serum glucose is less than 200
mg/dL in DKA treatment?

a) To prevent hypoglycemia.

b) To correct hypernatremia.

c) To enhance insulin effectiveness.

d) To promote ketone body formation.

- What action is taken if baseline serum potassium is less than 3.3 mEq/L in DKA treatment?

a) Administer potassium 20–30 mEq/hour.

b) Hold potassium administration.

c) Monitor and replace potassium as needed. d) Interrupt insulin treatment.

- What criteria indicate that DKA is resolved and can be converted to subcutaneous insulin?

a) Blood glucose less than 100 mg/dL.

b) Venous pH greater than 7.3, serum bicarbonate of 15 mEq/L or greater, and calculated anion gap of 12
mEq/L or less.

c) Ketonuria disappearance.

d) Normalization of heart rate.

- What factor is believed to contribute to the lower frequency of ketoacidosis in Type 2 Diabetes (T2D)?

a) Higher portal vein insulin levels.

b) Lower glucagon secretion.

c) Reduced epinephrine release.

d) Enhanced peripheral glucose utilization.

- How does beta-hydroxybutyrate contribute to the diagnostic thresholds in DKA?

a) It is a precursor of insulin.

b) It is a marker of metabolic alkalosis.

c) Its levels indicate the severity of DKA.

d) It is the primary ketone body in urine.

- Why is there a need to change fluid composition to 5% dextrose with 0.45% sodium chloride when
serum glucose is less than 200 mg/dL?

a) To prevent hyperglycemia.

b) To avoid hypernatremia.

c) To provide additional calories.

d) To continue correction of metabolic acidosis.

28. Potassium Management:

- What action is taken if baseline serum potassium is less than 3.3 mEq/L in DKA treatment?

a) Administer potassium 20–30 mEq/hour.

b) Hold potassium administration.

c) Monitor and replace potassium as needed.

d) Interrupt insulin treatment.

- Why is the administration of insulin crucial in DKA?

a) To induce ketogenesis.

b) To decrease glucagon secretion.

c) To increase blood glucose levels.

d) To promote glucose uptake by cells.

- What is the significance of Kussmaul breathing in DKA?

a) Indicates respiratory alkalosis.

b) Suggests normal breathing pattern.

c) Reflects metabolic acidosis.

d) Occurs during deep sleep

- What is the most frequent precipitating factor for Diabetic Ketoacidosis (DKA)?

a) Excessive sugar intake

b) Failure to take insulin

c) Sedentary lifestyle

d) High protein diet

- What roles do catecholamines, especially epinephrine, play in the pathophysiology of DKA?

a) Stimulate insulin secretion

b) Block residual insulin action and stimulate glucagon secretion

c) Decrease gluconeogenesis

d) Induce peripheral glucose utilization

 - What is a characteristic clinical manifestation of DKA that is described as deep, labored breathing?

a) Tachypnea

b) Bradypnea

c) Hyperventilation

d) Cheyne-Stokes breathing

- Which of the following is a hallmark diagnostic criterion for DKA?

a) Blood glucose level less than 200 mg/dL

b) Bicarbonate greater than 20 mEq/L

c) Ketonuria

d) Arterial pH less than or equal to 7.3

- What is the most clinically relevant ketone body in DKA, especially when measuring blood ketone
levels?

a) Acetoacetate

b) Beta-hydroxybutyrate

c) Acetone

d) Lactic acid

- Why is fluid replacement necessary in the treatment of DKA?

a) To increase blood pressure

b) To dilute ketones in the blood

c) To correct metabolic acidosis

d) To induce diuresis

- What formula is typically used to calculate corrected sodium in DKA patients?

a) Add 1.6 mEq/L for every 100 mg/dL of glucose above 100 mg/dL

b) Subtract 1.6 mEq/L for every 100 mg/dL of glucose above 100 mg/dL

c) Multiply serum sodium by blood glucose level

 d) Divide serum sodium by blood glucose level

- At what serum glucose level is the infusion of 5% dextrose with 0.45% sodium chloride recommended
in DKA treatment?

a) Less than 100 mg/dL

b) Less than 150 mg/dL

c) Less than 200 mg/dL

d) Greater than 250 mg/dL

- What condition is required for DKA to be considered resolved and converted to subcutaneous insulin?

a) Venous pH less than 7.3

b) Serum bicarbonate less than 15 mEq/L

c) Calculated anion gap greater than 12 mEq/L

d) Serum glucose less than 200 mg/dL and specific criteria met

- In DKA treatment, when is insulin treatment interrupted concerning baseline serum potassium levels?

a) If baseline serum potassium is less than 3.3 mEq/L

b) If baseline serum potassium is greater than 3.3 but less than 5.3 mEq/L

c) If baseline serum potassium is 5.3 mEq/L or greater

d) If baseline serum potassium is within the normal range

- What is the recommended action for potassium levels in DKA when baseline serum potassium is 5.3
mEq/L or greater initially?

a) Administer potassium 20–30 mEq/hour

b) Hold potassium administration

c) Monitor and replace potassium as needed

d) Interrupt insulin treatment

- Why might urine ketone testing have limitations in diagnosing DKA?

a) It provides immediate and accurate reflection of DKA severity

b) Measures beta-hydroxybutyrate, the most clinically relevant ketone body

c) Ketones may appear in urine before reaching significant levels in the blood

d) It accurately reflects the severity of DKA better than blood ketone testing

- What effect does insulin deficiency have on hormone-sensitive lipase in DKA?

a) Stimulates lipase activity

b) Inhibits lipase activity

c) Has no impact on lipase activity

d) Converts lipase to glucagon

- What is the characteristic fruity odor associated with DKA attributed to?

a) High blood glucose levels

b) Elevated ketone bodies

c) Respiratory alkalosis

d) Metabolic acidosis

- In DKA diagnosis, what is the role of bicarbonate levels?

a) Hyperglycemia marker

b) Indicator of ketone body production

c) Measurement of acid-base balance

d) Assessment of insulin sensitivity

- What triggers the release of the catecholamine epinephrine in DKA?

a) Elevated insulin levels

b) Stressors such as infections and trauma

c) Increased glucagon secretion

d) High blood glucose levels

- Which symptom indicates the persistence of the ketotic state in DKA?

a) Normal breathing pattern

b) Tachycardia

c) Depressed consciousness

d) Increased appetite

- Why is the correction of metabolic acidosis crucial in DKA treatment?

a) To induce diuresis

b) To decrease blood glucose levels

c) To prevent potassium depletion

d) To reverse ketonemia

- What blood pH level is considered a hallmark diagnostic criterion for DKA?

a) Greater than 7.5

b) Less than 6.8

c) Between 7.3 and 7.4

d) less than 7.3

- What is the purpose of intravenous infusion of insulin in DKA treatment?

a) To induce ketosis

b) To promote glucose uptake by peripheral tissues

c) To decrease glucagon secretion

d) To increase ketone body formation

- Which of the following is NOT a clinical manifestation of DKA?

a) Severe abdominal pain

b) Fruity odor

c) Bradypnea

d) Nausea and vomiting

 - Why is 5% dextrose with 0.45% sodium chloride recommended when serum glucose is less than 200
mg/dL in DKA treatment?

a) To prevent hypoglycemia

b) To correct hypernatremia

c) To enhance insulin effectiveness

d) To promote ketone body formation

- When is potassium supplementation held in DKA treatment?

a) If baseline serum potassium is less than 3.3 mEq/L

b) If baseline serum potassium is greater than 3.3 but less than 5.3 mEq/L

c) If baseline serum potassium is 5.3 mEq/L or greater

d) If baseline serum potassium is within the normal range

- What criteria indicate that DKA is resolved and can be converted to subcutaneous insulin?

a) Blood glucose less than 100 mg/dL

b) Venous pH greater than 7.3, serum bicarbonate of 15 mEq/L or greater, and calculated anion gap of
12 mEq/L or less

c) Ketonuria disappearance

d) Normalization of heart rate

- What factor is believed to contribute to the lower frequency of ketoacidosis in Type 2 Diabetes (T2D)?

a) Higher portal vein insulin levels

b) Lower glucagon secretion

c) Reduced epinephrine release

d) Enhanced peripheral glucose utilization

- Why is urine ketone testing limited in diagnosing DKA?

a) It measures beta-hydroxybutyrate levels.

b) It provides immediate results.

 c) It may result in false negatives.

d) It correlates well with blood ketone levels.

- Why is there a need to change fluid composition to 5% dextrose with 0.45% sodium chloride when
serum glucose is less than 200 mg/dL?

a) To prevent hyperglycemia

b) To avoid hypernatremia

c) To provide additional calories

d) To continue correction of metabolic acidosis

- What action is taken if baseline serum potassium is less than 3.3 mEq/L in DKA treatment?

a) Administer potassium 20–30 mEq/hour

b) Hold potassium administration

c) Monitor and replace potassium as needed

d) Interrupt insulin treatment

- Why is the administration of insulin crucial in DKA?

a) To induce ketogenesis

b) To decrease glucagon secretion

c) To increase blood glucose levels

d) To promote glucose uptake by cells

- What is the significance of Kussmaul breathing in DKA?

a) Indicates respiratory alkalosis

b) Suggests normal breathing pattern

c) Reflects metabolic acidosis

d) Occurs during deep sleep

 - What triggers the release of epinephrine in Diabetic Ketoacidosis (DKA)?

a) Elevated insulin levels

b) Stressors such as infections and trauma

c) Increased glucagon secretion

d) High blood glucose levels

- How does insulin deficiency contribute to the formation of ketone bodies in DKA?

a) Stimulates lipase activity

b) Inhibits lipase activity

c) Converts lipase to glucagon

d) Activates ketone synthesis

- What is the characteristic fruity odor associated with DKA attributed to?

a) High blood glucose levels

b) Elevated ketone bodies

c) Respiratory alkalosis

d) Metabolic acidosis

- What criteria define the hallmark Tetrad for DKA diagnosis?

a) Hyperglycemia, ketonemia, bicarbonate less than 15 mEq/L, arterial pH less than or equal to 7.3

b) Hypoglycemia, ketonuria, bicarbonate greater than 20 mEq/L, arterial pH greater than 7.5

c) Normoglycemia, acetoacetate levels, serum bicarbonate normal, arterial pH within the

physiological range

d) Hyperglycemia, lactate levels, bicarbonate greater than 25 mEq/L, arterial pH greater than 7.4

- What is the primary purpose of fluid replacement in DKA management?

a) To increase blood pressure

b) To dilute ketones in the blood

c) To correct metabolic acidosis d) To induce diuresis

 - Why might urine ketone testing have limitations in diagnosing DKA?

a) It provides immediate and accurate reflection of DKA severity

b) Measures beta-hydroxybutyrate, the most clinically relevant ketone body

c) Ketones may appear in urine before reaching significant levels in the blood

d) It accurately reflects the severity of DKA better than blood ketone testing

- In DKA treatment, when is insulin treatment interrupted concerning baseline serum potassium levels?

a) If baseline serum potassium is less than 3.3 mEq/L

b) If baseline serum potassium is greater than 3.3 but less than 5.3 mEq/L

c) If baseline serum potassium is 5.3 mEq/L or greater

d) If baseline serum potassium is within the normal range

- What is the recommended action for potassium levels in DKA when baseline serum potassium is 5.3
mEq/L or greater initially?

a) Administer potassium 20–30 mEq/hour

b) Hold potassium administration

c) Monitor and replace potassium as needed

d) Interrupt insulin treatment

- What clinical manifestations indicate the persistence of the ketotic state in DKA?

a) Normal breathing pattern

b) Tachycardia

c) Depressed consciousness

d) Increased appetite

- How does insulin deficiency contribute to the formation of ketone bodies in DKA?

a) Stimulates lipase activity

b) Inhibits lipase activity

c) Converts lipase to glucagon d) Activates ketone synthesis

- What is the characteristic fruity odor associated with DKA attributed to?

a) High blood glucose levels

b) Elevated ketone bodies

c) Respiratory alkalosis

d) Metabolic acidosis

- What criteria define the hallmark Tetrad for DKA diagnosis?

a) Hyperglycemia, ketonemia, bicarbonate less than 15 mEq/L, arterial pH less than or equal to 7.3

b) Hypoglycemia, ketonuria, bicarbonate greater than 20 mEq/L, arterial pH greater than 7.5

c) Normoglycemia, acetoacetate levels, serum bicarbonate normal, arterial pH within the physiological
range

d) Hyperglycemia, lactate levels, bicarbonate greater than 25 mEq/L, arterial pH greater than 7.4

- What is the primary purpose of fluid replacement in DKA management?

a) To increase blood pressure

b) To dilute ketones in the blood

c) To correct metabolic acidosis

d) To induce diuresis

- Why might urine ketone testing have limitations in diagnosing DKA?

a) It provides immediate and accurate reflection of DKA severity

b) Measures beta-hydroxybutyrate, the most clinically relevant ketone body

c) Ketones may appear in urine before reaching significant levels in the blood

d) It accurately reflects the severity of DKA better than blood ketone testing

- In DKA treatment, when is insulin treatment interrupted concerning baseline serum potassium levels?

a) If baseline serum potassium is less than 3.3 mEq/L

b) If baseline serum potassium is greater than 3.3 but less than 5.3 mEq/L

c) If baseline serum potassium is 5.3 mEq/L or greater

d) If baseline serum potassium is within the normal range

- What is the recommended action for potassium levels in DKA when baseline serum potassium is 5.3
mEq/L or greater initially?

a) Administer potassium 20–30 mEq/hour

b) Hold potassium administration

c) Monitor and replace potassium as needed

d) Interrupt insulin treatment

- What clinical manifestations indicate the persistence of the ketotic state in DKA?

a) Normal breathing pattern

b) Tachycardia

c) Depressed consciousness

d) Increased appetite

- What is the purpose of intravenous infusion of insulin in DKA treatment?

a) To induce ketosis

b) To promote glucose uptake by peripheral tissues

c) To decrease glucagon secretion

d) To increase ketone body formation

- What is the significance of Kussmaul breathing in DKA?

a) Indicates respiratory alkalosis

b) Suggests a normal breathing pattern

c) Reflects metabolic acidosis d) Occurs during deep sleep

- What action is taken if baseline serum potassium is less than 3.3 mEq/L in DKA treatment?

a) Administer potassium 20–30 mEq/hour

b) Hold potassium administration

c) Monitor and replace potassium as needed

d) Interrupt insulin treatment

- Why is urine ketone testing limited in diagnosing DKA?

a) It measures beta-hydroxybutyrate levels.

b) It provides immediate results.

c) It may result in false negatives.

d) It correlates well with blood ketone levels.

- Why is there a need to change fluid composition to 5% dextrose with 0.45% sodium chloride when
serum glucose is less than 200 mg/dL?

a) To prevent hyperglycemia

b) To avoid hypernatremia

c) To provide additional calories

d) To continue the correction of metabolic acidosis

- What criteria indicate that DKA is resolved and can be converted to subcutaneous insulin?

a) Blood glucose less than 100 mg/dL

b) Venous pH greater than 7.3, serum bicarbonate of 15 mEq/L or greater, and calculated anion gap of 12
mEq/L or less

c) Ketonuria disappearance

d) Normalization of heart rate

- What factor is believed to contribute to the lower frequency of ketoacidosis in Type 2 Diabetes (T2D)?

a) Higher portal vein insulin levels

b) Lower glucagon secretion

c) Reduced epinephrine release

d) Enhanced peripheral glucose utilization

- How does beta-hydroxybutyrate contribute to the diagnostic thresholds in DKA?

a) It is a precursor of insulin

b) It is a marker of metabolic alkalosis

c) Its levels indicate the severity of DKA

d) It is the primary ketone body in urine

- Why is corrected sodium calculated in DKA management?

a) To assess fluid balance

b) To account for the impact of high blood glucose on sodium levels

c) To determine the need for potassium supplementation

d) To monitor response to insulin therapy

- What clinical manifestation indicates the persistence of the ketotic state in DKA?

a) Normal breathing pattern

b) Increased appetite

c) Depressed consciousness

d) Fruity odor

- Why is the correction of metabolic acidosis crucial in DKA treatment?

a) To induce diuresis

b) To decrease blood glucose levels

c) To prevent potassium depletion

d) To reverse ketonemia

- How do stressors like infections and trauma contribute to DKA?

a) By promoting insulin secretion

b) By decreasing glucagon levels

c) By stimulating the release of epinephrine

d) By inhibiting lipase activity

- What is the primary purpose of fluid replacement in DKA management?

a) To increase blood pressure

b) To dilute ketones in the blood

c) To correct metabolic acidosis

d) To induce diuresis

- What is the role of bicarbonate levels in the diagnostic criteria for DKA?

a) Marker of hyperglycemia

b) Indicator of ketone body production

c) Measurement of acid-base balance

d) Assessment of insulin sensitivity

- What is the purpose of intravenous infusion of insulin in DKA treatment?

a) To induce ketosis

b) To promote glucose uptake by peripheral tissues

c) To decrease glucagon secretion

d) To increase ketone body formation