Diabetes Emergencies Quiz

Diabetes Emergencies Quiz

Diabetes Emergencies Quiz

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1. Question
What are the two most common precipitants of diabetic ketoacidosis (DKA)?
- A. Omission of insulin and infection
- B. Corticosteroids and drug abuse
- C. Hypothyroidism and myocardial infarction
- D. Pancreatitis and stroke
Correct
Incorrect
Insulin plays a significant role in managing DKA, and infection is a frequently observed factor.
2. Question
Which medication is associated with euglycemic DKA (glucose level < 250mg/dL)?
- A. Beta-blockers
- B. Diuretics
- C. Corticosteroids
- D. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors
Correct
Incorrect
This medication class affects carbohydrate metabolism and volume status.
3. Question
What is the primary cause of hyperglycemia in DKA?
- A. Increased lipolysis
- B. Accelerated gluconeogenesis, glycogenolysis, and decreased glucose utilization
- C. Dehydration
- D. Peripheral insulin resistance
Correct
Incorrect
Insulin deficiency plays a major role in the development of hyperglycemia in DKA.
4. Question
What are the common symptoms present in patients with DKA?
- A. Polyuria, polydipsia, weight loss, vomiting, and abdominal pain
- B. Hypertension, bradycardia, and headache
- C. Edema, chest pain, and shortness of breath
- D. Fever, chills, and night sweats
Correct
Incorrect
The symptoms of DKA are related to increased urination, thirst, and gastrointestinal issues.
5. Question
Which laboratory finding is typically used to rule out metabolic acidosis?
- A. HCO3 level of 18-20 meq/L
- B. Serum creatinine level
- C. Anion gap <10
- D. Glucose level >200 mg/dL
Correct
Incorrect
This lab finding is related to bicarbonate levels in the blood.
6. Question
What complication of DKA is associated with a high mortality rate and manifests as headache, lethargy, papillary changes, or seizures?
- A. Hypoglycemia
- B. Non-anion gap hyperchloremic acidosis
- C. Cerebral edema
- D. Pulmonary edema
Correct
Incorrect
This complication affects the brain and can be life-threatening.
7. Question
Which of the following steps should be followed in the early stages of DKA management?
- A. Initiate insulin therapy immediately
- B. Start IV fluids after a blood sample for biochemistry is sent to the laboratory
- C. Replace fluid deficit within 48-72 hours
- D. Supplement potassium intravenously only after insulin therapy has been initiated
Correct
Incorrect
This step is essential for the initial assessment and management of the patient's condition.
8. Question
When should a patient with DKA be transitioned from intravenous to subcutaneous insulin?
- A. When plasma glucose levels reach <200-250 mg/dL
- B. After fluid therapy has been initiated
- C. Two hours after long-acting insulin administration
- D. Two hours before discontinuing IV insulin
Correct
Incorrect
Timing is crucial to ensure a smooth transition between insulin administration methods.
9. Question
Which of the following medications can potentially precipitate DKA by affecting carbohydrate metabolism and volume status?
- A. Diuretics
- B. Beta-blockers
- C. Corticosteroids
- D. All of the above
Correct
Incorrect
Consider medications that can impact carbohydrate metabolism and fluid balance in the body.
10. Question
What is euglycemic DKA, and which medication has been associated with it?
- A. DKA with glucose level >250 mg/dL, associated with corticosteroids
- B. DKA with glucose level <250 mg/dL, associated with SGLT-2 inhibitors
- C. DKA without ketosis, associated with diuretics
- D. DKA with normal electrolyte levels, associated with beta-blockers
Correct
Incorrect
This form of DKA presents with a glucose level that is not as high as typically expected.
11. Question
Which of the following symptoms is NOT typically present in patients with DKA?
- A. Polyuria
- B. Polydipsia
- C. Weight gain
- D. Abdominal pain
Correct
Incorrect
Consider the effects of hyperglycemia and dehydration on the patient's weight.
12. Question
What is the goal of fluid replacement in DKA patients within the first 12 hours of treatment?
- A. 25% volume replacement
- B. 50% volume replacement
- C. 75% volume replacement
- D. 100% volume replacement
Correct
Incorrect
This percentage represents an appropriate balance to address dehydration without causing overhydration.
13. Question
A 45-year-old African-American female with a family history of type 2 diabetes and a sedentary lifestyle presents with polyuria, polydipsia, and blurry vision. Her random blood glucose level is 220 mg/dL. Which diagnostic test would confirm her diagnosis?
- A. Hemoglobin A1C
- B. Oral glucose tolerance test
- C. Fasting blood glucose
- D. Any of the above
Correct
Incorrect
Consider the different tests used to diagnose diabetes.
14. Question
A 50-year-old obese male with type 2 diabetes presents with hyperglycemia, ketonemia, and metabolic acidosis. Which of the following treatments should be initiated in this acute setting?
- A. Metformin
- B. Insulin therapy
- C. Lifestyle modifications
- D. Oral glucose tolerance test
Correct
Incorrect
Think about the immediate treatment needed to manage the patient's acute symptoms.
15. Question
A newly diagnosed type 2 diabetic patient presents with moderate to severe volume depletion. What should be the first therapeutic step in their treatment?
- A. Intravenous saline
- B. Insulin therapy
- C. Metformin
- D. Lifestyle modifications
Correct
Incorrect
Consider the immediate treatment needed to address the patient's volume depletion.
16. Question
A 38-year-old Hispanic woman with a history of gestational diabetes is diagnosed with type 2 diabetes. What is a common pathophysiologic defect seen in type 2 diabetes?
- A. Insulin resistance
- B. Insulin overproduction
- C. Decreased gluconeogenesis
- D. Increased glycogen synthesis
Correct
Incorrect
Think about the main issue with insulin in type 2 diabetes.
17. Question
In an acute presentation of diabetes with hyperglycemic symptoms, which laboratory tests should be included in the basic metabolic panel?
- A. Glucose, electrolytes, blood urea nitrogen, creatinine
- B. Hemoglobin A1C, fasting blood glucose, oral glucose tolerance test
- C. Autoantibody testing, C-peptide levels, insulin levels
- D. Liver function tests, urinalysis, blood ketones
Correct
Incorrect
Consider the tests that assess the patient's current metabolic state.
18. Question
Which of the following conditions is more commonly seen in patients with type 1 diabetes rather than type 2 diabetes?
- A. Diabetic ketoacidosis (DKA)
- B. Hyperglycemic hyperosmolar state (HHS)
- C. Insulin resistance
- D. Obesity
Correct
Incorrect
Consider the acute complications that are more specific to type 1 diabetes.
19. Question
In a type 2 diabetic patient with fasting blood glucose levels consistently above the target range, what adjustment should be made to the bedtime basal insulin dose?
- A. Increase the dose by 1-2 units every 3 days
- B. Decrease the dose by 1-2 units every 3 days
- C. Increase the dose by 10% every 3 days
- D. Decrease the dose by 10% every 3 days
Correct
Incorrect
Consider the adjustments needed to bring fasting blood glucose levels within the target range.
20. Question
A 75-year-old patient with type 2 diabetes presents with severe hyperglycemia, dehydration, and altered consciousness. Which condition is most likely responsible for these symptoms?
- A. Diabetic ketoacidosis (DKA)
- B. Hyperglycemic hyperosmolar state (HHS)
- C. Hypoglycemia
- D. Lactic acidosis
Correct
Incorrect
This condition is more prevalent in type 2 diabetics and typically presents with severe hyperglycemia, profound dehydration, and alteration in consciousness.
21. Question
Which is the leading precipitant of hyperglycemic hyperosmolar state (HHS)?
- A. Poor medication compliance
- B. Alcohol abuse
- C. Infections
- D. Myocardial infarction
Correct
Incorrect
Consider the most common factor that can trigger this condition.
22. Question
In the initial treatment of HHS, what is the primary goal of fluid replacement?
- A. Lower blood glucose levels
- B. Correct electrolyte imbalances
- C. Reestablish volume status and restore renal perfusion
- D. Promote insulin action
Correct
Incorrect
Fluid replacement is crucial in preventing a particular type of collapse in HHS patients.
23. Question
What is the major difference between hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA)?
- A. Degree of hyperglycemia
- B. Presence of ketonemia and acidemia
- C. Prevalence of type 1 diabetes
- D. Rate of dehydration
Correct
Incorrect
24. Question
Which of the following precipitating factors is most commonly associated with hyperglycemic hyperosmolar state (HHS)?
- A. Infections
- B. Trauma
- C. Alcohol abuse
- D. Myocardial infarction
Correct
Incorrect
Consider the most common cause of HHS.
25. Question
What is the primary difference between hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA)?
- A. Severity of hyperglycemia
- B. Presence of acidemia and ketonemia
- C. Type of diabetes
- D. Rate of onset
Correct
Incorrect
Think about the differences in metabolic characteristics between HHS and DKA.
26. Question
Which of the following laboratory findings is characteristic of hyperglycemic hyperosmolar state (HHS)?
- A. Plasma glucose > 600 mg/dL
- B. Serum bicarbonate < 18 mEq/L
- C. Positive plasma and urine ketones
- D. Anion gap > 12
Correct
Incorrect
Consider the diagnostic criteria for HHS.
27. Question
Which of the following is the treatment of choice for correcting hyperglycemia in patients with hyperglycemic hyperosmolar state (HHS)?
- A. Subcutaneous insulin
- B. Intramuscular insulin
- C. Oral hypoglycemic agents
- D. Continuous intravenous insulin infusion
Correct
Incorrect
28. Question
A 65-year-old male with a history of type 2 diabetes and a recent A1c of 7.5% is admitted to the hospital with pneumonia. His glucose levels have been persistently ≥180 mg/dL. What should be the initial approach for his glycemic management?
- A. Initiate insulin therapy and target glucose range of 140-180 mg/dL
- B. Continue oral hypoglycemic agents
- C. Target glucose levels between 110-140 mg/dL
- D. Avoid insulin therapy and focus only on treating pneumonia
Correct
Incorrect
Consider the guidelines for initiating insulin therapy and target glucose range in hospitalized patients with diabetes.
29. Question
A 50-year-old female with type 1 diabetes is admitted for surgery and will be NPO. What is an important consideration for her insulin management?
- A. Discontinue all exogenous insulin
- B. Maintain basal insulin even when the patient is NPO
- C. Increase nutritional insulin while NPO
- D. Switch to oral hypoglycemic agents during hospitalization
Correct
Incorrect
Remember the insulin requirements for patients with type 1 diabetes when they are NPO.
30. Question
Which of the following is NOT an appropriate reason for using oral hypoglycemic agents in a hospitalized patient with hyperglycemia?
- A. Minimally elevated glucose levels
- B. Renal impairment
- C. Patient is on oral agents at home
- D. Low risk of hypoglycemia
Correct
Incorrect
Consider the contraindications for using oral hypoglycemic agents in hospitalized patients.
31. Question
A patient is admitted to the ICU and started on total parenteral nutrition (TPN). What is the preferred method of insulin administration for this patient?
- A. Adding insulin to the TPN
- B. Subcutaneous basal and nutritional insulin
- C. Oral hypoglycemic agents
- D. Only correctional insulin as needed
Correct
Incorrect
Consider the safest method
32. Question
A 68-year-old male with type 2 diabetes is admitted to the hospital due to a severe infection. His A1c level is 7.8%. Which of the following is an appropriate initial management for his hyperglycemia?
- A. Hold all oral hypoglycemic agents and initiate insulin therapy
- B. Continue oral hypoglycemic agents
- C. Start GLP agonists
- D. No intervention needed
Correct
Incorrect
Consider the contraindications for using oral hypoglycemic agents in hospitalized patients.
33. Question
A 55-year-old female with type 1 diabetes is admitted to the hospital for surgery and is currently NPO. What is the appropriate insulin management for this patient?
- A. Discontinue all insulin
- B. Continue only nutritional insulin
- C. Continue only basal insulin
- D. Continue both basal and correctional insulin
Correct
Incorrect
Remember that type 1 diabetes patients always need exogenous basal insulin.
34. Question
In a patient with type 2 diabetes on insulin therapy, the pre-meal blood glucose is consistently above 150 mg/dL. What adjustments can be made to the insulin regimen?
- A. Decrease basal insulin
- B. Increase basal insulin
- C. Decrease nutritional insulin
- D. Increase nutritional insulin
Correct
Incorrect
Consider the target range for pre-meal blood glucose levels in a patient with diabetes.
35. Question
A 75-year-old male with type 2 diabetes and severe comorbidities is admitted to the hospital. The institution has limited resources for frequent glucose monitoring. What target glucose range should be aimed for in this patient?
- A. 110-140 mg/dL
- B. 140-180 mg/dL
- C. 180-250 mg/dL
- D. Strictly below 140 mg/dL
Correct
Incorrect
36. Question
A 60-year-old male with type 2 diabetes presents with symptoms of hypoglycemia. His current medication includes a sulfonylurea. Which of the following is the most appropriate first step to manage his hypoglycemia?
- A. Ingest 15-20 grams of glucose
- B. Administer intravenous dextrose
- C. Discontinue the sulfonylurea
- D. Administer glucagon
Correct
Incorrect
Consider the immediate treatment options for hypoglycemia when the patient is conscious and able to ingest carbohydrates.
37. Question
A 45-year-old female with a history of non-islet cell tumor presents with recurrent episodes of hypoglycemia. Which of the following treatments can alleviate hypoglycemia in this patient?
- A. Surgical resection
- B. Frequent feedings
- C. Diazoxide
- D. Octreotide
Correct
Incorrect
Consider the treatment options that can alleviate hypoglycemia specifically in patients with non-islet cell tumors.
38. Question
A patient with type 1 diabetes presents with hypoglycemia unawareness. Which of the following strategies can help restore hypoglycemia awareness in this patient?
- A. Strict avoidance of hypoglycemia for 2-3 weeks
- B. Increase insulin dosage
- C. Initiate an α-glucosidase inhibitor
- D. Decrease carbohydrate intake
Correct
Incorrect
Consider the treatment strategy that focuses on restoring hypoglycemia awareness.
39. Question
In an adult with type 1 diabetes and a history of serious hypoglycemia, which of the following devices or therapies should be considered to manage their condition?
- A. Personal continuous glucose monitoring device
- B. Sensor-augmented insulin pump therapy
- C. Hybrid closed-loop system
- D. All of the above
Correct
Incorrect
40. Question
Which of the following drugs is NOT commonly associated with causing hypoglycemia?
- A. Insulin
- B. Sulfonylureas
- C. Alcohol
- D. Metformin
Correct
Incorrect
Consider the drugs that are less likely to cause hypoglycemia.
41. Question
During a 72-hour fast for the evaluation of hypoglycemia, when should samples for insulin, c-peptide, and glucose be obtained more frequently?
- A. When the patient experiences symptoms of neuroglucopenia
- B. When plasma glucose falls to <60 mg/dl
- C. When plasma glucose falls to <45 mg/dl
- D. At the beginning of the fast
Correct
Incorrect
Consider the glucose level at which closer monitoring is required during the 72-hour fast.
42. Question
A patient with hypoglycemia is unable to ingest carbohydrates and is not in a healthcare setting. Which of the following should be used to correct their hypoglycemia?
- A. Intravenous dextrose
- B. Glucose gel
- C. Glucagon
- D. Octreotide
Correct
Incorrect
Consider the treatment option for hypoglycemia when the patient is unable to ingest carbohydrates and is not in a healthcare setting.
43. Question
Which of the following symptoms is associated with neuroglycopenic hypoglycemia?
- A. Sweating
- B. Tremor
- C. Confusion
- D. Tachycardia
Correct
Incorrect
Consider the symptoms that are caused by reduced glucose availability to the brain

2 Comments

Collapse Comments

MyEndoConsult (Administrator) July 18, 2023 at 4:29 pm

Thanks for the helpful comment, Jean. It is very much appreciated.

BANGAMWABO Jean Bosco July 18, 2023 at 8:35 am

Excellent tool to use

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