Chapter 20 - [additional] Endocrine and Hematologic Emergencies

Question 1

Type 1 diabetes is a condition in which:
A. too much insulin is produced.
B. glucose utilization is impaired.
C. too much glucose enters the cell.
D. the body does not produce glucose.

Answer 1

B. glucose utilization is impaired.

Question 2

A 45-year-old man with type 1 diabetes is found unresponsive. Which of the following questions is MOST important to ask his wife?
A. “Did he take his insulin today?”
B. “How long has he been a diabetic?”
C. “Has he seen his physician recently?”
D. “What kind of insulin does he take?”

Answer 2

“Did he take his insulin today?”

Question 3

A diabetic patient presents with a blood glucose level of 310 mg/dL and severe dehydration. The patient’s dehydration is the result of:
A. excretion of glucose and water from the kidneys.
B. a deficiency of insulin that causes internal fluid loss.
C. an infection that often accompanies hyperglycemia.
D. an inability to produce energy because of insulin depletion.

Answer 3

A. excretion of glucose and water from the kidneys.

Question 4

Which combination of factors would MOST likely cause a hypoglycemic crisis in a diabetic patient?
A. Eating a meal and taking insulin
B. Skipping a meal and taking insulin
C. Eating a meal and not taking insulin
D. Skipping a meal and not taking insulin

Answer 4

B. Skipping a meal and taking insulin

Question 5

A 19-year-old diabetic male was found unresponsive on the couch by his roommate. After confirming that the patient is unresponsive, you should:
A. suction his oropharynx.
B. manually open his airway.
C. administer high-flow oxygen.
D. begin assisting his ventilations.

Answer 5

B. manually open his airway.

Question 6

What breathing pattern would you MOST likely encounter in a patient with diabetic ketoacidosis (DKA)?
A. Slow and shallow
B. Shallow and irregular
C. Rapid and deep
D. Slow and irregular

Answer 6

C. Rapid and deep

Question 7

A woman called EMS because her 12-year-old son, who had been experiencing excessive urination, thirst, and hunger for the past 36 hours, has an altered mental status and is breathing fast. You should be MOST suspicious for:
A. low blood sugar.
B. hypoglycemia.
C. hypoglycemic crisis.
D. hyperglycemic crisis.

Answer 7

D. hyperglycemic crisis.

The child is experiencing a hyperglycemic crisis secondary to severe hyperglycemia. Hyperglycemic crisis is characterized by a slow onset and excessive urination (polyuria), thirst (polydipsia), and hunger (polyphagia). Other signs include rapid, deep breathing with a fruity or acetone breath odor (Kussmaul respirations); a rapid, thready pulse; and an altered mental status.

Question 8

If the cells do not receive glucose, they will begin to metabolize:
A. fat.
B. acid.
C. sugar.
D. ketones.

Answer 8

A. fat

Question 9

In contrast to a hyperglycemic crisis, a hypoglycemic crisis:
A. rarely presents with seizures.
B. presents over a period of hours to days.
C. should not routinely be treated with glucose.
D. usually responds immediately after treatment.

Answer 9

D. usually responds immediately after treatment.

Question 10

Patients with diabetic ketoacidosis experience polydipsia because:
A. they are dehydrated secondary to excessive urination.
B. the cells of the body are starved due to a lack of glucose.
C. fatty acids are being metabolized at the cellular level.
D. hyperglycemia usually causes severe internal water loss.

Answer 10

A. they are dehydrated secondary to excessive urination.
Severe hyperglycemia—which leads to diabetic ketoacidosis—causes the body to excrete large amounts of glucose and water. As a result, the patient becomes severely dehydrated, which leads to excessive thirst (polydipsia).

Question 11

When dealing with hematologic disorders, the EMT must be familiar with the composition of blood. Which of the following is considered a hematologic disease?
A. Sickle cell disease
B. Hemophilia
C. Lou Gehrig’s disease
D. Both A and B

Answer 11

D. Both A and B

Question 12

The assessment of a patient with a hematologic disorder is the same as it is with all other patients an EMT will encounter. In addition to obtaining a SAMPLE history, EMTs should ask which of the following questions?
A. Have you had a crisis before?
B. When was the last time you had a crisis?
C. How did your crisis resolve?
D. All of the above.

Answer 12

D. All of the above.

Question 13

Which one of the following is NOT an appropriate treatment for EMTs to provide to a patient who has a hematologic disorder?
A. Analgesics for pain
B. Support of symptoms
C. High-flow oxygen therapy at 12 to 15 L/min
D. Rapid transport

Answer 13

A. Analgesics for pain

Question 14

Diabetes is MOST accurately defined as a(n):
Select one:
A.
abnormally high blood glucose level.
B.
lack of insulin production in the pancreas.
C.
disorder of glucose metabolism.
D.
mass excretion of glucose by the kidneys.

Answer 14

C.
disorder of glucose metabolism.

Question 15

A 28-year-old female patient is found to be responsive to verbal stimuli only. Her roommate states that she was recently diagnosed with type 1 diabetes and has had difficulty controlling her blood sugar level. She further tells you that the patient has been urinating excessively and has progressively worsened over the last 24 to 36 hours. On the basis of this patient’s clinical presentation, you should suspect that she:
Select one:
A.
has a urinary tract infection.
B.
has a low blood glucose level.
C.
is significantly hyperglycemic.
D.
has overdosed on her insulin.

Answer 15

C.
is significantly hyperglycemic.

Question 16

In general, oral glucose should be given to any patient who:
Select one:
A.
has an altered mental status and a history of diabetes.
B.
has a blood glucose level that is less than 100 mg/dL.
C.
is unresponsive, even in the absence of a history of diabetes.
D.
has documented hypoglycemia and an absent gag reflex.

Answer 16

A.
has an altered mental status and a history of diabetes.

Question 17

Which of the following signs or symptoms would the EMT MOST likely encounter in a patient with new-onset type 1 diabetes?
Select one:
A.
Low blood glucose level
B.
Weight gain and edema
C.
Weight loss and polyuria
D.
Total lack of appetite

Answer 17

C.
Weight loss and polyuria

Question 18

When assessing an unresponsive diabetic patient, the primary visible difference between hyperglycemia and hypoglycemia is the:
Select one:
A.
rate of the patient’s pulse.
B.
rate and depth of breathing.
C.
patient’s mental status.
D.
presence of a medical identification tag.

Answer 18

B.
rate and depth of breathing

Question 19

Patients with uncontrolled diabetes experience polyuria because:
Select one:
A.
they drink excess amounts of water due to dehydration.
B.
high blood sugar levels cause permanent kidney damage.
C.
excess glucose in the blood is excreted by the kidneys.
D.
low blood glucose levels result in cellular dehydration.

Answer 19

C.
excess glucose in the blood is excreted by the kidneys.

Question 20

A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days’ duration. Her blood glucose level reads 320 mg/dL. If this patient’s condition is not promptly treated, she will MOST likely develop:
Select one:
A.
hypoxia and overhydration.
B.
irreversible renal failure.
C.
severe insulin shock.
D.
acidosis and dehydration.

Answer 20

D.
acidosis and dehydration.

Question 21

You respond to a movie theater for a 70-year-old male who is confused. His wife tells you he has type 2 diabetes but refuses to take his pills. Your assessment reveals that the patient is diaphoretic, tachycardic, and tachypneic. Initial management for this patient should include:
Select one:
A.
performing a rapid exam and obtaining vital signs.
B.
assisting the patient with his diabetic medication.
C.
applying a nonrebreathing mask at 15 L/min.
D.
administering one to two tubes of oral glucose

Answer 21

C.
applying a nonrebreathing mask at 15 L/min.

Question 22

During your assessment of a 70-year-old woman, she tells you that she takes blood-thinning medication and has to wear compression stockings around her legs. This information should make you suspect that she has:
Select one:
A.
severe hyperglycemia.
B.
deep vein thrombosis.
C.
sickle-cell disease
D.
hemophilia

Answer 22

B.
deep vein thrombosis.