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10. Nutrition — Biochemistry MCQs
KEMU · 28 MCQs with clinical pearls · Prof Jariya
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Sections in this kemu
- Protein Metabolism — 10 MCQs
- Fed and Fasting State — 7 MCQs
- Blood Glucose Regulation — 6 MCQs
- Metabolic Syndrome — 3 MCQs
- Nitrogen Balance — 2 MCQs
Sample MCQs with clinical pearls
A 6-year-old girl presents in comatose state with Kussmaul's respiration, ketonuria, and glucosuria. She is diagnosed with diabetic ketoacidosis. Kussmaul's breathing in this child is a compensatory response to which of the following?
A) Hypocalcaemia
B) Hypoglycaemia
C) Metabolic acidosis ✔
D) Metabolic alkalosis
E) Respiratory alkalosis
Kussmaul respiration with coma in a child indicates DIABETIC KETOACIDOSIS and METABOLIC ACIDOSIS. Deep sighing breathing is respiratory compensation, blowing off carbon dioxide to raise pH. The triad is hyperglycaemia, ketosis and high anion gap acidosis. Treatment is fluids first, then insulin, with potassium added early - and cerebral oedema is the feared complication in children. MEMORY: 'Deep sighing breathing in a child means the body is blowing off acid.'
A 55-year-old man with long-standing uncontrolled type 2 diabetes presents with a 3-month history of increased urination and excessive thirst. His fasting blood glucose is 18 mmol/L. The biochemical basis of his excessive thirst is which of the following?
A) Hypercalcaemia
B) Hyperkalaemia
C) Hypernatraemia
D) Hyperosmolarity ✔
E) Lactic acidosis
HYPEROSMOLARITY dominates HYPERGLYCAEMIC HYPEROSMOLAR STATE - glucose often above 33 mmol/L with osmolality over 320, profound dehydration and altered consciousness, but little or no ketosis. Residual insulin suffices to suppress lipolysis, which is why ketones stay low. It occurs in type 2 diabetes, develops over days, and carries higher mortality than DKA. MEMORY: 'Enough insulin to stop ketones, not enough to stop the glucose.'
A 55-year-old man with uncontrolled type 2 diabetes has blood glucose of 18 mmol/L and passes large volumes of urine. Which of the following best explains osmotic diuresis in this patient?
A) ADH suppression
B) Glucosuria ✔
C) Hypernatraemia
D) Ketonuria
E) Tubular damage
GLUCOSURIA begins once plasma glucose exceeds the RENAL THRESHOLD of about 180 mg/dL (10 mmol/L), when filtered glucose exceeds SGLT2 reabsorptive capacity. The resulting OSMOTIC DIURESIS causes polyuria, and consequent dehydration causes polydipsia - the classic symptoms. SGLT2 inhibitors deliberately lower this threshold to promote glucose loss. MEMORY: 'Above one-eighty the sugar spills, and the water follows it.'
28 MCQs are arranged to the learning outcomes of this kemu.
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