A 48-year-old woman with a 3-day history of nausea and vomiting has deep sighing respiration and her breath smells sweet. The receiving physician's clinical diagnosis is diabetic ketoacidosis (DKA). Further investigations revealed: plasma glucose is very high (often>40 mmol/L), along with

48. A 58-year-old woman comes to the office because of a 1-month history of fatigue, fever, shortness of breath, and joint pain; she also has had a 3.2-kg (7-lb) weight loss during this period. Her temperature is 37.6°C (99.7°F), and respirations are 34/min. Physical examination shows tenderness to palpation over the maxillary sinus, nasal ulcerations, and a bulging, red left tympanic membrane. Laboratory studies show: Erythrocyte sedimentation rate Serum C-reactive protein 65 mm/h 8.2 mg/L (N=0.08-3.1) 2+ 2+ Urine Blood Protein Histologic examination of a biopsy specimen of affected lung tissue shows granulomata and vasculitis. An autoantibody is most likely directly binding which of the following cell types in this patient? OA) Basophils B) Endothelial cells C) Fibroblasts D) Neutrophils E) Plasma cells

158. A 3-year-old girl is brought to the physician because of a 4-day history of irritability, vomiting, decreased urinary frequency and volume, and diarrhea. She visited a local petting zoo with her family 1 week ago. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 30/min, and blood pressure is 130/100 mm Hg. Physical examination shows pallor, petechiae over the chest, and mild abdominal tenderness. Laboratory studies show: A) Elastin B) Fibrin Hemoglobin Hematocrit C) Hemosiderin D) IgA E) IgE F) IgG Erythrocyte count Leukocyte count Reticulocyte count Platelet count Serum Urea nitrogen Creatinine Bilirubin, total Direct Indirect Lactate dehydrogenase 5.9 g/dL (N=11-15) 31% (N=28% -45%) 3.1 million/mm³ (N=3.9-5.31) 18,000/mm³ (N=6000-17,500) 4.5% (N=0.5% -1.5%) 52,000/mm³ (N=150,000-400,000) Direct antiglobulin (Coombs) test result is negative. A photomicrograph of a peripheral blood smear is shown. Acetaminophen, amlodipine, and fluid and nutritional support…

An unresponsive client who has diabetes is brought to the emergency department with rapid, deep respirations. Additional findings include: blood glucose 24.9 mmol/L, arterial pH 7.2 and urinalysis showing presence of ketones and glucose. Which of the following statements best describes the underlying cause of this patient’s presentation? Question 64 options: a)  Relative insulin deficiency, causing hyperglycemia, oxidative stress, renal dysfunction and acidosis b)  Nocturnal elevation of growth hormone resulting in hyperglycemia in the morning c)  Absolute insulin deficiency, increased counter-regulatory hormone, lipolysis and free fatty acid release d)  Hypoglycemia causes release of glucagon, resulting in glycogenolysis and hyperglycemia