Chapter 4 Endocrinology Part 2

32) Your patient is a 68-year-old female who has been in a rehabilitation hospital for one week following hip replacement surgery. According to the staff, the patient is a type II diabetic and is being treated for a postoperative infection. The patient was lethargic yesterday and was found unresponsive this morning, just before your arrival. Physical exam reveals an accumulation of secretions in her airway, lung sounds clear and equal bilaterally, and skin and mucous membranes warm and dry. HR = 119, BP = 86/58, RR = 16, blood glucose = 864 mg/dL. In addition to initiating basic airway management measures and gaining IV access, which of the following is the best treatment for this patient? A) Intubate, 1 to 2 L NS bolus, 25 g dextrose IV B) Oxygen by nonrebreather mask, NS at a KVO rate, 50 mEq sodium bicarbonate IV C) BVM ventilations with supplemental oxygen, NS at a KVO rate D) Intubate, 1 to 2 L NS bolus Answer: D Diff: 3 Page Ref: 250-252 Standard: Medicine (Endocrine Disorders) Objective: 4, 5, 6 33) Which of the following is least likely to result in hypoglycemia in a type I diabetic patient? A) Increased exercise level B) Taking insulin as usual but missing a meal C) Eating foods high in sugar D) Inadvertently administering too much insulin Answer: C Diff: 2 Page Ref: 250, 254-255 Standard: Medicine (Endocrine Disorders) Objective: 3, 6 34) Your patient is a 32-year-old female who is alert and sitting at her kitchen table complaining of dizziness and near-syncope with exertion. She describes a four-day history of a 104°F fever, nausea, vomiting, and diarrhea unrelieved with over-the-counter medications. Physical examination reveals dry skin and mucous membranes, lung sounds clear and equal bilaterally. HR = 131 and regular, BP = 84/60, RR = 20 and regular, SaO2 = 98%, blood glucose = 58 mg/dL. She has a history of colitis, for which she often takes prednisone, but she has been noncompliant with her prednisone therapy for the past five days because she cannot afford to refill her prescription. The treatment for this patient should include: A) a one-liter NS bolus IV. B) an IV of NS, 25 g dextrose IV, and 100 mg thiamine IV. C) a one-liter NS bolus, IV, and 25 g dextrose IV. D) 15 lpm oxygen by nonrebreather, IV of NS, 25 g dextrose. Answer: C Diff: 3 Page Ref: 258 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 88 35) A 16-year-old female with a history of diabetes is found unconscious in a high school bathroom following volleyball practice. She is tachycardic; has cool, clammy skin; is lethargic; is slightly combative; and is very confused. She is most likely experiencing: A) hypoglycemia. B) diabetic ketoacidosis. C) hyperglycemia. D) diabetic coma. Answer: A Diff: 2 Page Ref: 254, 255 Standard: Medicine (Endocrine Disorders) Objective: 4 36) If a patient being treated for hypoparathyroidism stopped taking the medications prescribed for his condition, which of the following would be most likely to occur? A) Hypercalcemia B) Hyperkalemia C) Hypocalcemia D) Hypokalemia Answer: C Diff: 2 Page Ref: 244 Standard: Medicine (Endocrine Disorders) Objective: 3 37) Which of the following would you expect to see immediately after the ingestion of a large meal? A) Increase of blood glucagon levels and a decrease of blood glucose levels B) Increase of blood glucose and blood insulin levels C) Decrease of blood glucose levels followed by an increase of blood insulin levels D) Increase of blood glucagon and blood glucose levels Answer: B Diff: 2 Page Ref: 245 Standard: Medicine (Endocrine Disorders) Objective: 2 38) You have administered glucagon to a diabetic patient. Which of the following should occur? A) Stimulation of the pancreatic alpha cells, resulting in lipolysis B) Stimulation of the pancreatic beta cells, resulting in a decreased blood glucose level C) Glycogenesis, resulting in a decreased blood glucose level D) Glycogenolysis, resulting in an increased blood glucose level Answer: D Diff: 2 Page Ref: 245 Standard: Medicine (Endocrine Disorders) Objective: 3, 6 89 39) Your patient has a hormone-secreting tumor of the adrenal medulla. What hormone is most likely to be secreted by this tumor? A) Cortisol B) Dopamine C) Epinephrine D) ACTH Answer: C Diff: 2 Page Ref: 242 Standard: Medicine (Endocrine Disorders) Objective: 2, 3 40) Which of the following hormones has the greatest effect on blood pressure homeostasis? A) Calcitonin B) Cortisol C) Parathyroid hormone D) Aldosterone Answer: D Diff: 3 Page Ref: 246 Standard: Medicine (Endocrine Disorders) Objective: 2 41) Your diabetic patient asks you why he "passes out" when his blood sugar gets too low. Which of the following responses is most accurate? A) "When the blood sugar is low, the brain does not get enough oxygen." B) "Brain cells need a constant supply of glucose, or sugar, to function. Without sugar the brain cells cannot work to maintain consciousness." C) "When the blood sugar is low, the blood vessels relax and the blood pressure drops, causing you to faint." D) "The cells of the heart can only use glucose, or sugar, for energy. Without sugar the heart cannot effectively pump blood to the brain." Answer: B Diff: 3 Page Ref: 254, 255 Standard: Medicine (Endocrine Disorders) Objective: 2, 3 42) Your diabetic patient asks you why diabetics need to take insulin. Which of the following answers is most accurate? A) "Insulin helps glucose enter the cells of the body so it can be used for energy." B) "Insulin helps the body eliminate excess glucose through the kidneys." C) "Insulin breaks down glucose into proteins so it can be used by the cells for energy." D) "Without insulin glucose is converted to ketone bodies, which are toxic in large quantities." Answer: A Diff: 3 Page Ref: 247 Standard: Medicine (Endocrine Disorders) Objective: 3 90 43) Which of the following most accurately represents the pathophysiological sequence of untreated type I diabetes? A) Oversecretion of insulin results in hypoglycemia; cells convert to the use of fats for energy resulting in the production of ketone bodies. B) Glucose is not absorbed through the gastrointestinal tract, resulting in hyposecretion of insulin and hypoglycemia. Lack of glucose results in anaerobic metabolism and acidosis. C) Hyposecretion of insulin prevents glucose from being broken down in the gastrointestinal tract; too much glucose is absorbed from the gastrointestinal tract resulting in hyperglycemia and ketoacidosis. D) Hyposecretion of insulin results in inability of glucose to enter cells; blood glucose levels rise, and cells convert to the use of fats for energy, resulting in the production of ketone bodies. Answer: D Diff: 2 Page Ref: 249 Standard: Medicine (Endocrine Disorders) Objective: 3 44) Which of the following is the most direct cause of polyuria in untreated diabetes? A) Hyperglycemia B) Hypoglycemia C) Too much insulin D) Too little insulin Answer: A Diff: 3 Page Ref: 249 Standard: Medicine (Endocrine Disorders) Objective: 3 45) Which of the following most accurately describes the rationale for monitoring the cardiac rhythm in the hyperglycemic patient? A) The increased viscosity of the blood makes myocardial ischemia very likely. B) Polyuria can lead to electrolyte disturbances, resulting in cardiac dysrhythmias. C) Hyperglycemia causes ventricular irritability and increases the risk of ventricular fibrillation. D) All ALS patients must be monitored. Answer: B Diff: 3 Page Ref: 248-249 Standard: Medicine (Endocrine Disorders) Objective: 3, 4 46) Which of the following statements would be most typical of an undiagnosed diabetic? A) "I am so thirsty I have to keep a glass of water by my bed at night." B) "I have gained ten pounds over the past two weeks." C) "It seems like I am dehydrated because I hardly urinate at all." D) "I haven't had much of an appetite. I am not hungry at all." Answer: A Diff: 3 Page Ref: 249 Standard: Medicine (Endocrine Disorders) Objective: 3 91 47) Which of the following statements about hyperglycemic hyperosmolar nonketotic coma (HHNK) is TRUE? A) Unlike diabetic ketoacidosis, HHNK is not life-threatening. B) Prehospital treatment of HHNK includes correcting metabolic acidosis. C) Aside from managing the ABCs, prehospital management is primarily aimed at correcting dehydration. D) Paradoxically, the definitive management of HHNK includes the administration of 50 percent dextrose. Answer: C Diff: 2 Page Ref: 252, 254 Standard: Medicine (Endocrine Disorders) Objective: 1, 6 48) An emergency department physician tells you that the hyperglycemic diabetic you brought in earlier has a pH of 7.40. What is the likeliest explanation of this statement? A) The patient is a type II diabetic who was no longer secreting enough insulin to prevent the use of fats for energy. B) The patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy. C) The patient is a type I diabetic who did not take his insulin and is therefore unable to use glucose for energy. D) The patient is a type I diabetic who took his insulin and did not eat, resulting in the breakdown of proteins for energy. Answer: B Diff: 3 Page Ref: 252 Standard: Medicine (Endocrine Disorders) Objective: 3, 5 49) Which of the following is the most reliable way to differentiate between a hyperglycemic emergency and a hypoglycemic emergency? A) Determine whether or not the patient took his insulin or oral antihyperglycemic medicines. B) Determine whether the patient is a type I or type II diabetic. C) Follow the conventional wisdom, "Pale, cool, wet: low; red, hot, dry: high." D) Assess the blood glucose level. Answer: D Diff: 1 Page Ref: 248-249 Standard: Medicine (Endocrine Disorders) Objective: 4 92 50) You have administered 25 g of 50 percent dextrose to a patient who was initially unresponsive with a blood glucose level of 23 mg/dL. Which of the following is the best indication that the patient's condition is improving? A) The heart rate decreases from 112 to 96 per minute. B) The patient seems less diaphoretic. C) The patient opens his eyes but is confused. D) The respiratory rate decreases from 24 to 16 per minute. Answer: C Diff: 2 Page Ref: 255 Standard: Medicine (Endocrine Disorders) Objective: 4, 6 51) You are assessing an unresponsive patient with a MedicAlert tag that indicates he is a diabetic. The patient's airway is patent, respirations are 20 per minute and adequate, radial pulse is rapid and weak, and the skin is warm and moist. You attempt to get a blood glucose reading, but your blood glucose monitor malfunctions. Which of the following is the best course of action? A) Administer 25 g of 50 percent dextrose. B) Administer a 1 to 2 liter bolus of NS. C) Request another unit to respond to the scene with a blood glucose monitor. D) Request an order for 20 units of regular insulin. Answer: A Diff: 3 Page Ref: 255 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 52) Your patient is a 24-year-old male with a history of type I diabetes. You were called to his place of employment because he was behaving bizarrely. On your arrival he is confused and combative with a blood glucose level of 41 mg/dL. Due to poor vasculature and the patient's combativeness, you have not been able to start an IV. Which of the following is the best course of action? A) Administer 1 mg glucagon, IM. B) Administer 5 mg Valium, IM, and attempt the IV again when the patient is less agitated. C) Administer half an amp (12.5 g) of 50 percent dextrose, IM. D) Use four-point restraints to restrain the patient and transport. Attempt the IV again if the patient becomes unresponsive. Answer: A Diff: 3 Page Ref: 254-255 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 93 53) Cushing's syndrome is a disorder of the: A) posterior pituitary gland. B) adrenal glands. C) thyroid gland. D) ovaries. Answer: B Diff: 1 Page Ref: 257 Standard: Medicine (Endocrine Disorders) Objective: 1, 3 54) Which of the following findings would be atypical in a patient with a history of Cushing's syndrome? A) Blood glucose level of 190 mg/dL B) Blood pressure of 154/86 mmHg C) Bruising of the extremities D) Temperature of 101°F Answer: D Diff: 2 Page Ref: 257 Standard: Medicine (Endocrine Disorders) Objective: 4 55) A finding of exophthalmos and goiter should increase your suspicion for a problem with the: A) anterior pituitary gland. B) posterior pituitary gland. C) thyroid gland. D) parathyroid gland. Answer: C Diff: 2 Page Ref: 256 Standard: Medicine (Endocrine Disorders) Objective: 3, 4 56) The endocrine system differs from the nervous system in that it: A) controls the body without nerve impulses. B) controls the body with specialized chemical messengers. C) doesn't regulate anything in the body. D) directly regulates the brain. Answer: B Diff: 1 Page Ref: 239 Standard: Medicine (Endocrine Disorders) Objective: 2 94 57) Homeostasis refers to: A) the tendency of the body to maintain an appropriate internal environment. B) the body's ability to regulate the external environment. C) intrinsic environmental regulatory factors. D) extrinsic environmental regulatory factors. Answer: A Diff: 1 Page Ref: 239 Standard: Medicine (Endocrine Disorders) Objective: 1 58) The posterior pituitary produces which two hormones? A) Insulin and glucagon B) Epinephrine and norepinephrine C) Growth hormone and gonadotropin D) ADH and oxytocin Answer: D Diff: 1 Page Ref: 243 Standard: Medicine (Endocrine Disorders) Objective: 2 59) The thyroid releases TSH to: A) promote shivering. B) protect the vascular system. C) increase metabolism. D) decrease insulin. Answer: C Diff: 1 Page Ref: 244 Standard: Medicine (Endocrine Disorders) Objective: 2 60) In response to an increase in blood sugar, the pancreas will release insulin to: A) produce more glucose. B) allow the glucose to permeate the cell membrane. C) allow glucose to be wasted in the urine. D) allow glucose to cross the blood-brain barrier. Answer: B Diff: 1 Page Ref: 245 Standard: Medicine (Endocrine Disorders) Objective: 2, 3 95 61) You respond to an ill patient. Upon your arrival, the patient states that she has had an increase in urination, thirst, and general malaise. The patient's finger stick blood glucose reading is 550 mg/dL; her blood pressure is 110/80 mmHg; pulse, 100; respiratory rate 26; ETCO2 29; and you note an acetone odor. You suspect: A) HHNK. B) DKA. C) DNK. D) TNK. Answer: B Diff: 2 Page Ref: 250-252 Standard: Medicine (Endocrine Disorders) Objective: 4, 6 62) You respond to an ill type 2 diabetic patient. Upon your arrival, the patient complains of not feeling well for a few days, and increasing blood glucose levels. You suspect: A) DKA. B) HHNK. C) TNK. D) TPA. Answer: B Diff: 2 Page Ref: 252, 254 Standard: Medicine (Endocrine Disorders) Objective: 4, 6 63) You respond to an unresponsive patient. Upon exam, you get a finger stick blood glucose reading of "Lo." Treatment should include administration of: A) insulin. B) epinephrine. C) dextrose. D) ASA. Answer: C Diff: 2 Page Ref: 255 Standard: Medicine (Endocrine Disorders) Objective: 5, 6 96