Nokea
The following are true about education for insulin therapy EXCEPT:
- A. It can only be done by nurses
- B. Different subjects to be covered at different stages of insulin therapy
- C. Improves adherence to insulin therapy
- D. It takes time
Correct Answer: A
Rationale: Insulin teaching docs, educators join nurses, staged topics boost sticking, time and prep pay off; nurse-only's bunk. Nurses weave this chronic learning web, not solo.
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During artificial ventilation in a patient with chronic obstructive pulmonary disease, air trapping:
- A. Leads to hypotension when venous return is reduced significantly.
- B. Is likely to be present when the capnogram fails to reach a plateau in expiration.
- C. May be reduced by using a low respiratory rate.
- D. Is reduced by decreasing the ratio of inspiratory time to expiratory time.
Correct Answer: A
Rationale: Air trapping in COPD during mechanical ventilation occurs due to incomplete exhalation from airway obstruction, leading to intrinsic positive end-expiratory pressure (auto-PEEP). This increases intrathoracic pressure, compressing the vena cava and reducing venous return, which can cause hypotension a critical complication. A capnogram failing to plateau suggests prolonged exhalation, consistent with air trapping, but it's a diagnostic sign, not a consequence. A low respiratory rate allows more exhalation time, reducing air trapping, while decreasing the inspiratory-to-expiratory time ratio (e.g., shortening inspiration) similarly helps by extending exhalation. Positive end-expiratory pressure (PEEP) can exacerbate air trapping if excessive, but its effect depends on levels used. Hypotension from reduced venous return is a direct physiological result of severe air trapping, making it the most definitive statement in this context.
Which of the following is NOT an example of intermittent fasting?
- A. Alternate day fasting
- B. Mediterranean dieting
- C. Modified fasting regimes such as the 5:2 diet'
- D. Time restricted feeding
Correct Answer: B
Rationale: Fasting flips alternate, 5:2, timed, holy skips; Mediterranean's steady, not starved. Nurses clock this chronic fast gap.
All of the following are potential factors leading to weight gain EXCEPT:
- A. Disrupted circadian rhythm
- B. Use of anti-histamines and sulphonylureas
- C. Changes in gut microbiota
- D. Controlled food portions that are of low energy density
Correct Answer: D
Rationale: Weight gain factors include disrupted circadian rhythm (metabolic dysregulation), antihistamines/sulphonylureas (appetite increase, insulin secretion), and gut microbiota shifts (altered energy harvest). Controlled food portions of low energy density (e.g., vegetables) reduce calorie intake, aiding weight loss, not gain, per obesity research. This exception highlights dietary control's role in managing chronic conditions like diabetes or obesity, guiding physicians in patient counseling for sustainable weight regulation.
A 56 year old lady with Type 2 DM and a BMI of 30 kg/m2 is reviewed by her family doctor due to poor glycaemic control. She is treated with oral gliclazide since she is diagnosed as diabetic and currently she is on 160 mg bid. Her serum creatinine is 110 μmol/L. Which ONE of the following medications should be most appropriately to be added next?
- A. Metformin
- B. Acarbose
- C. Pioglitazone
- D. Insulin
Correct Answer: A
Rationale: Gliclazide maxed, HbA1c off metformin's next, safe at creatinine 110 (eGFR likely 50+), tackling insulin resistance in obesity. Acarbose slows carbs, pioglitazone risks fluid, insulin's later, linagliptin's fine but less foundational. Nurses add this chronic sugar anchor, boosting control without kidney strain.
Renal failure is the second cause of death in patients with diabetes mellitus. Question: What is the end (histological) stage in the development of diabetic nephropathy?
- A. Arteriolar hyalinosis
- B. GBM thickening
- C. Kimmerstiel Wilson lesions
- D. Mesangial matrix expansion
Correct Answer: C
Rationale: Diabetic nephropathy's end Kimmerstiel Wilson nodules scar kidneys, past thickening or expansion. Nurses dread this, a chronic renal doom mark.