Student MCQs – Peds Diabetes

Which of the following is a common medication used in the treatment of Type 1 Diabetes Mellitus (T1DM) in pediatrics?**

  - A. Metformin

  - B. Insulin

  - C. Sulfonylureas

  - D. DPP-4 inhibitors

Correct answer: B

Explanation:

1.     Correct

1.     B: Insulin can be used in treatment of both Type 1 and Type 2

2.     Incorrect

1.     A: Metformin is only used as  treatment of Type 2 diabetes in children.

2.     C: Sulfonylureas are not approved for use in children.

3.     D: DPP-4 inhibitors  are not approved for use in children.

2. What is a primary treatment goal for managing Type 2 Diabetes Mellitus (T2DM) in pediatric patients?**

  - A. Achieving normal blood pressure

  - B. Stabilizing blood glucose levels

  - C. Reducing cholesterol levels

  - D. Preventing osteoporosis

 

Correct answer: B

Explanation:

1.     Correct

1.     A: Achieving normal blood pressure helps prevent progression of long-term macrovascular and microvascular complications.

2.     B: Maintaining daily ranges of blood glucose is one of the primary goals of diabetes treatment.

3.     C: Reducing cholesterol levels can also help prevent progression of long-term macrovascular and microvascular complications.

2.     Incorrect

D: Bone density is not directly affected by the lack of insulin or insulin response

1.     Which of the following is a biochemical criterion for diagnosing diabetic ketoacidosis (DKA) in pediatrics?

§  A) Blood glucose level < 200 mg/dL

§  B) Blood pH > 7.3

§  C) Serum bicarbonate < 15 mEq/L

§  D) Serum potassium > 5.5 mEq/L

A is incorrect - DKA is diagnosed by blood glucose > 200.

B is incorrect - DKA is diagnosed by pH < 7.3

C is correct

D is incorrect - the remaining criteria are ketones in urine/serum and B-hydroxybutyrate > 3. Potassium is often elevated in DKA but it is not a biochemical criterion.

What is a clinical sign of diabetic ketoacidosis (DKA) in pediatrics?

§  A) Bradycardia

§  B) Kussmaul breathing

§  C) Hypothermia

§  D) Hypertension

 

A is incorrect - tachycardia is a sign of DKA

B is correct - rapid, fast breathing (Kussmaul) occurs as an attempt to compensate for low pH by blowing off acid (CO2)

C is incorrect - could not find any information on hypothermia (or fever, for that matter)

D is incorrect - while class slides state that patients normally maintain their blood pressure in DKA and UpToDate says that > 10% will develop or present with hypertension, I do not think hypertension is a ‘clinical sign’ of DKA

What is the primary goal for A1C levels in children with Type 1 Diabetes Mellitus (T1DM)?

A. < 6.5%
B. < 7.0%
C. < 7.5%
D. < 8.0%

 

Correct Answer: C. < 7.5%
Incorrect Answers: 

A is incorrect because it is too intense of a goal for T1DM in children.

B is incorrect because this is the A1C goal for T2DM in children, not T1DM.

D is incorrect because it is not as intensive as recommended for the A1C goal in T1DM in pediatrics.

Which medication is FDA-approved for use in children with Type 2 Diabetes Mellitus (T2DM) only and is administered as a subcutaneous injection?

A.     Metformin

B.     Insulin

C.    Liraglutide

D.    Empagliflozin

 

Correct Answer: C. Liraglutide is correct because it's a FDA approved subcutaneous injection for T2DM in children but not T1DM.
Incorrect Answers: 

A is incorrect because it is an oral medication.

B is incorrect because it is also approved for T1DM in children.

D is incorrect because is is an oral medication.

Which medication is commonly used to manage T1DM in pediatric patients?

A. Metformin

B. Glimepiride

C. Insulin

D. Glyburide

 

Correct Answer: C insulin 

C is the correct answer because insulin is the main treatment option for T1DM. While insulin can be used for T2DM as well, the other medications are ONLY used for T2DM. 

A, B, and D are incorrect answers because they are used to treat T2DM, which focuses on insulin resistance rather than the lack of insulin production 

 

Which of the following is a common goal for both T1DM and T2DM management in pediatric patients?

A. Reducing blood pressure

B. Achieving glycemic control

C. Enhancing immune function

D. Increasing insulin secretion

 

 

Correct Answer: B achieving glycemic control 

Glycemic control is correct because this is the biggest side effect when it comes to T1 and T2 DM. Depending on treatment regimens, a patient can experience hypo or hyperglycemia, so it is very important to make sure patients with diabetes are monitoring their blood glucose levels frequently throughout the day. 

A is incorrect because high blood pressure is not a typical symptom of diabetes. While it is important to monitor, it is not something that typically results from having diabetes. C is incorrect because immune function is only a factor in T1DM due to antibodies attacking the beta cells that produce insulin. T2DM patients do not have this autoimmune disorder. D is incorrect because increasing insulin secretion is something that is only focused on in T2DM due to a resistance to insulin. T1DM patients are unable to produce insulin, so they do not focus on increasing secretion, it is a focus on adding insulin to the body.

Which life-threatening complication is most frequently associated with diabetic ketoacidosis (DKA) in pediatric patients?

a. Cardiac arrhythmia

b. Cerebral edema

c. Liver failure

d. Acute kidney injury

 

explanation:

a. Cardiac arrhythmia - Incorrect, this is not a common complication of DKA 

b. Cerebral edema - Correct, 60-90% of mortality from pediatric DKA is secondary to cerebral edema

c. Liver failure - Incorrect, this is not a common complication of DKA

d. Acute kidney injury - Incorrect, this is not very common complication of DKA

 

 

2. Which complication is often linked to poor glycemic control in pediatric Type 2 Diabetes Mellitus (T2DM)?

a. Thyroid dysfunction

b. Retinopathy

c. Celiac disease

d. Cerebral palsy

a. Thyroid dysfunction - Incorrect, this complication is more seen in T1DM

b. Retinopathy - Correct, this is a common complication for uncontrolled hyperglycemia in T2DM

c. Celiac disease - Incorrect, this complication is more seen in T1DM

d. Cerebral palsy - Incorrect, this complication is not seen in diabetes

1.     Which medication is primarily used to correct hyperglycemia in diabetic ketoacidosis (DKA)?

o   A) Metformin

o   B) Glucagon

o   C) Insulin 

o   D) Sulfonylureas

 

  

Correct Answer: C) Insulin

Confirmation: C) Insulin is the correct answer as it is the first line agent that works immediately for hyperglycemia. A) Metformin and D) Sulfonylureas may have an effect for hyperglycemia, but not fast enough for what is necessary for DKA. B) Glucagon would actually increase blood glucose instead of decreasing it. 

What is the purpose of fluid replacement therapy in the treatment of DKA?

 

o   A) To reduce insulin resistance

o   B) To prevent hypoglycemia 

o   C) To increase blood glucose levels

o   D) To correct dehydration

 

 

Correct Answer: D) To correct dehydration

Confirmation: D) To correct dehydration is the correct answer as fluids is for dehydration that is very commonly seen with DKA as the body tries to filter out the extra glucose. Fluids to correct dehydration is an appropriate response to DKA. A) To reduce insulin resistance does not make any sense as fluids would not reduce insulin resistance. B) To prevent hypoglycemia also does not make snes in this circumstance as fluids would not prevent hypoglycemia, and hypoglycemia would not happen without insulin treatment. C) To increase blood glucose levels also do not make sense as fluids do not increase blood glucose levels and would not be ideal in a situation of DKA. 

Which of the following best describes the role of insulin in the treatment of Diabetic Ketoacidosis (DKA)?

Options: 

1.     Insulin is administered to increase blood glucose levels and reduce acidosis. 

2.     Insulin is administered to decrease blood glucose levels and correct metabolic acidosis. 

3.     Insulin is administered to increase ketone production and promote ketosis. 

4.     Insulin is administered to decrease ketone production and increase protein synthesis.

 

Answer: B. Insulin is administered to decrease blood glucose levels and correct metabolic acidosis.

Confirmation: This option is correct because insulin therapy is essential in the treatment of DKA as it helps lower blood glucose levels and correct metabolic acidosis by reducing ketone production.

Explanation:

A: Insulin is not used to increase blood glucose levels; it is used to decrease them.

C: Insulin helps reduce ketone production, not increase it.

D: While insulin can promote protein synthesis, the primary goal in DKA treatment is to lower glucose levels and correct acidosis.

Which of the following best describes the role of intravenous fluids in the treatment of Diabetic Ketoacidosis (DKA)?

Options: 

1.     Intravenous fluids are administered to decrease blood glucose levels and increase ketone production.

2.     Intravenous fluids are administered to rehydrate the patient, restore electrolyte balance, and improve tissue perfusion.

3.     Intravenous fluids are administered to increase blood pressure and reduce the need for insulin therapy. 

4.     Intravenous fluids are administered to cause diuresis and promote dehydration.

 

 

Answer: B. Intravenous fluids are administered to rehydrate the patient, restore electrolyte balance, and improve tissue perfusion.

Confirmation: This option is correct because intravenous fluids are crucial in the treatment of DKA to rehydrate the patient, restore electrolyte balance, and improve tissue perfusion, which are essential for overall recovery.

Explanation:

A: Intravenous fluids do not directly decrease blood glucose levels or increase ketone production.

C: While fluids can support blood pressure, they do not reduce the need for insulin therapy.

D: Intravenous fluids aim to rehydrate the patient, not promote dehydration.

Which of the following is a potential complication of diabetic ketoacidosis (DKA) in pediatric patients? 

 

A) Hyperthyroidism 

B) Cerebral edema 

C) Hypotension 

D) Appendicitis

 

Option B is correct because it is a potential complication of DKA and 60-90% of mortality is secondary to cerebral edema in DKA patients

 

Option A is incorrect because it is not a complication of DKA, option C is incorrect because most patients do not get hypotension as a result of DKA, some patients may experience hypertension with DKA, option D is incorrect because it is not a complication of DKA.

What is a common long-term difficulty faced by pediatric patients with Type 1 Diabetes Mellitus (T1DM)? 

 

A) Increased risk of autoimmune conditions 

B) Reduced appetite 

C) Persistent weight gain 

D) Resistance to antibiotics

 

 

Option A is correct because T1DM is an autoimmune condition and having one autoimmune condition makes you more likely to develop another.

 

Option B is incorrect because it is not a result of T1DM, increased appetite can actually be a symptom of undiagnosed T1DM, option C is incorrect because T1DM can cause weight loss or lean BMI while T2DM may be a result of obese BMI, option D is incorrect because resistance to antibiotics is not a difficulty faced by patients with T1DM.

Which of the following is a characteristic feature of type 1 diabetes mellitus (T1DM) in pediatrics?

o   A) Insulin resistance

o   B) Autoimmune destruction of beta cells

o   C) Obesity

o   D) Hyperinsulinemia

 

 

Explanation: Type 1 diabetes is characterized by the inability to produce and release insulin, due to the destruction of beta cells by the patient’s own immune system. Insulin resistance, obesity, and hyperinsulinemia would be features of type 2 diabetes.

2.     Which diagnostic test is commonly used to differentiate between T1DM and T2DM in pediatrics?

o   A) Fasting Blood Glucose

o   B) C-Peptide Test

o   C) Oral Glucose Tolerance Test

o   D) Hemoglobin A1c

Explanation: Fasting blood glucose will not differentiate between type 1 and type 2 because both will yield high glucose if not treated. Similarly with A1c, both type 1 and type 2 will show elevated results if not well controlled. An oral glucose tolerance test is use to diagnose type 2 diabetes, but will not adequately differentiate the two types. A C-peptide test is commonly used to differentiate between type 1 and type 2 diabetes because it reflects the amount of insulin secreted from the pancreas. An elevated level will rule out type 1, and a low level will rule out type 2.

Which of the following is a distinguishing characteristic of the pathophysiology of type 1 diabetes mellitus (T1DM) in pediatrics?

A) Insulin resistance

B) Autoimmune destruction of beta cells

C) Elevated triglycerides

D) Obesity

B is correct because T1DM is an autoimmune disorder that destroys beta cells, halting their ability to make insulin. A is incorrect because insulin resistance is the underlying pathophysiology of T2DM. C and D are incorrect because elevated triglycerides and obesity are more associated with T2DM.

 

:  In the comparison of clinical presentation between type 1 and type 2 diabetes mellitus in pediatric patients, which symptom is most commonly associated with type 1 diabetes?

A) Weight gain

B) Frequent infections

C) Rapid onset of symptoms

D) Hypertension

C is correct because beta cells will lose their functionality over time but then quickly lose all function, causing a rapid onset of symptoms. A is incorrect because sudden weight loss is more common with T1DM. B is incorrect because frequency of infections is not associated with diabetes. D is incorrect because hypertension us not a symptom of diabetes

1.     Which medication is primarily used to lower blood glucose levels in the treatment of DKA?

   - A) Insulin

   - B) Metformin

   - C) Glucagon

   - D) Sulfonylureas

 

Correct Answer: A) Insulin

Confirmation: option A is correct because insulin is used until fasting and postprandial glycemia have been restored to normal.

Explanation: 

·       option B is incorrect because although metformin can help lower blood glucose in those with T2DM, it is not recommended for DKA treatment due to the risk of lactic acidosis.

·       option C is incorrect because Glucagon increases blood glucose levels and is used in emergency settings when a patient is experiencing hypoglycemic situations. This is the opposite of what DKA is, which is too much blood glucose.

·       option D is incorrect because although sulfonylureas can help lower blood glucose levels, it is not used in the setting of DKA.

2.     Which medication is used to correct electrolyte imbalances in patients with DKA?

   - A) Insulin

   - B) Potassium chloride

   - C) Sodium bicarbonate

   - D) Calcium gluconate

 

Correct Answer: B) Potassium chloride

Confirmation: option B is correct because it can correct low levels of potassium

Explanation: 

·       option A is incorrect because insulin corrects hyperglycemia and could also cause hypokalemia.

·       option C is incorrect because sodium bicarbonate is used to correct acidosis but could cause significant consequences such as hypokalemia.

·       option D is incorrect because calcium gluconate is not directly used for electrolyte imbalances but for stabilizing cardiac membrane.

Which of the following is the leading cause of mortality in pediatric patients with diabetic ketoacidosis (DKA)?

1.     A) Hyperkalemia
B) Cerebral edema
C) Hypoglycemia
D) Hyperchloremic metabolic acidosis

Correct Answer: B) Cerebral edema

Cerebral edema accounts for majority of DKA-related mortality in pediatric patients

Why the Incorrect Options Are Wrong:

A) Hyperkalemia

Potassium imbalances are common in DKA, but they are manageable with electrolyte monitoring and appropriate replacement. They do not cause the majority of DKA-related deaths, unlike cerebral edema​.

C) Hypoglycemia

Hypoglycemia can occur if insulin therapy is continued without appropriate dextrose supplementation, but it is not the primary cause of death in DKA.

D) Hyperchloremic metabolic acidosis

This occurs due to the administration of large volumes of isotonic fluids, but it is not life-threatening.

What is a major challenge in distinguishing between type 1 and type 2 diabetes in pediatric patients at initial diagnosis?

1.     A) T1DM and T2DM always have distinct clinical presentations
B) C-peptide is not a reliable test for differentiation
C) Antibody testing is not useful in differentiating between T1DM and T2DM
D) Rising obesity rates have made clinical differentiation difficult

Correct Answer: D) Rising obesity rates have made clinical differentiation difficult

Obesity rates in children have increased, leading to more cases of T2DM that resemble T1DM. Many children with obesity and insulin resistance initially appear to have T2DM but are later diagnosed with T1DM based on autoantibody testing​. C-peptide and autoantibody testing are often necessary to confirm the diagnosis​.

Why the Incorrect Options Are Wrong:

A) T1DM and T2DM always have distinct clinical presentations

Many children with T2DM present with DKA, which was traditionally seen only in T1DM​. Some T1DM patients may have a gradual onset of hyperglycemia, resembling T2DM​.

B) C-peptide is not a reliable test for differentiation

C-peptide is a key diagnostic marker. Low C-peptide = T1DM (low insulin production), High C-peptide = T2DM (high insulin resistance)​.

C) Antibody testing is not useful in differentiating between T1DM and T2DM

Autoantibody testing is crucial. T1DM is associated with autoimmune markers, whereas T2DM is not​.

Which of the following biochemical criteria is indicative of diabetic ketoacidosis (DKA) in pediatrics?

        a) Blood glucose level ≥ 200 mg/dL 

        b) Serum bicarbonate < 15 mEq/L

        c) Blood pH < 7.3

        d) All of the above

 

D is correct as all of these are required for the diagnosis of DKA.

The rest of the answers are incorrect as they do not constitute DKA separately, you must have all of these features present.

Which of the following criteria is used to determine the resolution of DKA in pediatrics?

        a) Normalization of serum bicarbonate (≥ 18 mEq/L)

        b) Blood glucose level < 200 mg/dL

        c) Absence of ketonuria

        d) Normalization of anion gap

 

D is the correct answer as it signifies the resolution of the metabolic acidosis caused by DKA

B is incorrect as, while the hyperglycemia is hopefully corrected, blood glucose is not the true issue of DKA. Acidosis is. A is incorrect as sodium bicarbonate, while important to metabolic pH, is not what is gauged to determine resolution of DKA. C is incorrect as this is a piece of the resolution, and hopefully helped by the intervention, the full picture of resolution is in the normalization of the metabolic acidosis/anion gap.