Pathology Notes

Practice questions answers Pathology of endocrine pancreas II © Jun Wang, MD, PhD 1. E. Dizziness and sweating are commonly seen in patient with hypoglycemia , the most common acute complication in patient with diabetes . It can be confirmed with abnormally low blood glucose. Diabetic ketoacidosis has lower arterial pH and elevated ketone in urine, as well as hyperglycemia. Diabetic nephropathy has proteinuria and is more likely a chronic process without sudden onset of neurological symptoms, and does not cause hypoglycemia . Diabetic neuropathy is a chronic process involving both motor and sensory functions, but does not cause hypoglycemia . Hyperosmolar hyperosmotic syndrome has a blood glucose > 600 mg/dl. 2. D. The most common causes of hypoglycemia in patients with diabetes include skipping meals, excessive exercise, excess insulin administration, etc. Excess fatty acid metabolism is seen in diabetic ketoacidosis . Glucagonoma causes hyperglycemia, not hypo

Practice questions Pathology of endocrine pancreas II © Jun Wang, MD, PhD 1. Use this case for the next two questions . A 59-year-old man presents with dizziness and sweating for 2 hours. He was diagnosed with type 2 diabetes two months ago, and has been compliant with his medication. In addition, he started an aggressive diet plan to reduce weight. He skipped his breakfast and hiked 3 miles before he felt dizzy. His past medical history include hypertension and obesity. He does not drink alcohol or smoke cigarette. Physical examination reveals a BMI at 35 (normal 18-25). He appears to be slightly confused and his skin is moist. His heart rate is 135 bpm. No other abnormalities are noted. Laboratory test reveal a glucose at 52 mg/dl (normal 70-100 mg/dl) and HbA1C at 8.0% (normal 4-5.6%). Other laboratory test results are within normal range. What is the diagnosis? A. Diabetic ketoacidosis B. Diabetic nephropathy C. Diabetic neuropathy D. Hyperosmolar hyperosmotic syn

Practice questions answers Pathology of endocrine pancreas I © Jun Wang, MD, PhD 1. D. The patient has typical presentation of diabetes (polydipsia, polyuria and weight loss), high blood glucose and low C peptide. In a young patient, this is most compatible with type I diabetes . Graves disease usually does not have hyperglycemia, but should have other presentations of thyrotoxicosis . Diabetic ketoacidosis has lower arterial pH. One of the diagnostic criteria for hyperosmolar hyperosmotic syndrome is blood glucose > 600 mg/dl. In addition, hyperosmolar hyperosmotic syndrome is more commonly seen in older population with type II diabetes . Type II diabetes usually has normal or elevated level of insulin and C peptide. 2. C. The key pathological process for type I diabetes is autoimmune injury of b eta cells. Alpha cell proliferation is seen in patients with elevated level of glucagon and usually has elevated levels of insulin. Amyloid deposit and damage of isle

Practice questions Pathology of endocrine pancreas I © Jun Wang, MD, PhD 1. Use this case for the next three questions . An 11-year-old girl presents with extreme thirst and polyuria for a week. She has lost 10 lb recently, even with increased appetite. Her past medical history is unremarkable. Physical examination reveals a BMI at normal range. No significant abnormalities are noted. Laboratory tests reveals a glucose at 450 mg/dl (normal 70-180 mg/dl), A1C at 15% (normal <8%), C-peptide at 0.1 ng/ml (0.5-2.0 ng/ml). Her arterial blood gas tests are within normal range. Urinalysis reveals trace amount of ketone. What is the diagnosis? A. Graves disease B. Diabetic ketoacidosis C. Hyperosmolar hyperosmotic syndrome D. Type 1 diabetes E. Type 2 diabetes 2. An 11-year-old girl presents with extreme thirst and polyuria for a week. She has lost 10 lb recently, even with increased appetite. Her past medical history is unremarkable. Physical examination reveals a