AMLS Endocrine Emergencies 3

Question 1

A patient with type 1 diabetes presents with diaphoresis, tachycardia, and anxiety. Blood glucose is 45 mg/dL. After giving 25 g of D50W IV, glucose rises to 120 mg/dL. What should be done next?

Accepted Answer

Provide a complex carbohydrate snack and monitor for recurrence

Answer

Administer a second D50W bolus immediately

Answer

Start a regular insulin drip

Answer

Discharge the patient once glucose is above 100 mg/dL

Question 2

Which finding on an arterial blood gas (ABG) is most consistent with diabetic ketoacidosis (DKA)?

Accepted Answer

pH 7.22, PaCO2 20 mmHg, HCO3 8 mEq/L

Answer

pH 7.48, PaCO2 50 mmHg, HCO3 34 mEq/L

Answer

pH 7.35, PaCO2 40 mmHg, HCO3 24 mEq/L

Answer

pH 7.50, PaCO2 30 mmHg, HCO3 22 mEq/L

Question 3

A patient on long-term lithium therapy presents with hypothermia, altered mental status, macroglossia, periorbital edema, and bradycardia. What treatment should be initiated?

Accepted Answer

IV thyroid hormone (T4 or T3) replacement and supportive care

Answer

IV methimazole and propranolol

Answer

High-dose corticosteroids only

Answer

Emergent cardioversion for bradycardia

Question 4

Which of the following is the most appropriate initial antihypertensive agent for a hypertensive emergency caused by pheochromocytoma?

Accepted Answer

IV phentolamine or IV nicardipine (alpha-blockade first)

Answer

IV labetalol (beta-blocker first)

Answer

IV furosemide

Answer

IV hydralazine

Question 5

Cushing's syndrome results from chronic excess of which hormone?

Accepted Answer

Cortisol (glucocorticoid excess)

Answer

Thyroid hormone (T4/T3)

Answer

Aldosterone

Answer

Growth hormone

Question 6

An elderly patient with known type 2 diabetes is found unresponsive with a blood glucose of 950 mg/dL, serum osmolality of 365 mOsm/kg, and no significant ketonuria. What is the priority action?

Accepted Answer

IV fluid resuscitation with 0.9% normal saline

Answer

Immediate IV insulin bolus 10 units

Answer

Sodium bicarbonate 1 mEq/kg IV

Answer

Intubation and hyperventilation

Question 7

Which of the following patients is at HIGHEST risk for developing hyperosmolar hyperglycemic state (HHS) rather than DKA?

Accepted Answer

A 70-year-old with poorly controlled type 2 diabetes and a respiratory infection

Answer

A 22-year-old with type 1 diabetes who missed an insulin dose

Answer

A 35-year-old with new-onset type 1 diabetes

Answer

A 16-year-old with type 1 diabetes and vomiting illness