Deck 4: Endocrinology

Question 1

A 36-year-old female is conscious and alert and complaining of palpitations. She denies chest pain, difficulty breathing, or loss of consciousness but becomes "dizzy" with exertion. She states that she has been experiencing agitation, insomnia, intolerance to heat, and weight loss. Physical exam reveals exophthalmos and an enlarged thyroid gland. HR = 142 and regular, BP = 110/70, RR = 14 and regular. Which of the following would be most effective in treating this patient?

A) 250 cc fluid challenge
B) 50 percent dextrose IV
C) Synchronized cardioversion
D) Propranolol

Answer 1

Propranolol

Question 2

A patient presents with a history of frequent urination, signs and symptoms of dehydration, and a blood glucose of 958 mg/dL. There is no acetone odor on his breath. To which of the following can the absence of an acetone odor most likely be attributed?

A) Elimination of ketoacids by the blood buffer system
B) Elimination of ketoacids through Kussmaul's respirations
C) The ability to use enough glucose to meet metabolic needs
D) The ability to convert to the use of amino acids for energy metabolism

Answer 2

The ability to use enough glucose to meet metabolic needs

Question 3

You encounter a patient complaining of polyuria, polyphagia, polydipsia, and abdominal pain. Based on these complaints, which of the following would you also expect to find?

A) Complaint of chest pain and shortness of breath
B) Blood glucose of less than 70 mg/dL
C) Kussmaul's respirations and a fruity breath odor
D) Blood glucose between 80 and 120 mg/dL

Answer 3

Kussmaul's respirations and a fruity breath odor

Question 4

Which of the following best describes the relationship between the hypothalamus and the endocrine system?

A) The hypothalamus produces all of the releasing hormones that act on other endocrine organs.
B) The hypothalamus is the link between the central nervous system and the endocrine system.
C) The hypothalamus regulates most endocrine activities via positive feedback mechanisms.
D) The hypothalamus is also known as the posterior pituitary gland.

Question 5

Prehospital management of an unresponsive patient with hypoglycemia should NOT include:

A) administration of D50 IV.
B) administration of glucagon IM.
C) BVM ventilations with 100 percent O₂ and an OPA.
D) administration of oral glucose.

Question 6

Your patient is a 72-year-old male who is conscious but lethargic and sitting in a chair. His son states that the patient has been a bit slow lately and has been gaining weight. The medical history includes hypothyroidism and myocardial infarction. The patient has been compliant with his Synthroid and has nitroglycerin for use as needed. The patient responds to verbal stimuli, is confused, has a large tongue, and pale, cold, doughy skin. His only complaint is constipation. HR = 60 and regular, BP = 112/80, RR = 10 and shallow, SaO₂ = 92%, temperature = 88°F,blood glucose = 180 mg/dL. Your treatment of this patient should include:

A) infusion of 1 to 2 liters of warm normal saline.
B) atropine 0.5 mg IV.
C) rewarm with heat packs.
D) oxygen, 4 lpm by nasal cannula.

Question 7

Which of the following pathologies would necessitate the use of increased care in the preparation of an IV site because of skin fragility and increased risk of infection?

A) Addison's disease
B) Graves' disease
C) Cushing's syndrome
D) Myxedema

Question 8

Your patient is a 56-year-old male who is conscious and exhibits slurred speech, irritability, and cool, clammy skin. Blood glucose is 54 mg/dL. Proper treatment for this patient could include all of the following EXCEPT:

A) 5 to 10 mg of glucagon IM.
B) consideration of D50 IV if the patient cannot follow simple commands.
C) IV of NS.
D) administration of oral glucose if the patient is able to swallow.

Question 9

A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to:

A) insulin shock.
B) cerebral hypoglycemia.
C) gluconeogenesis.
D) diabetic ketoacidosis.

Question 10

Your patient is a 42-year-old male who is supine on the floor, responsive only to pain. His wife states that he has been extremely depressed recently and talked about suicide yesterday. The patient's skin is hot and dry, pupils are dilated and reactive to light bilaterally, and there is vomit around his mouth. HR = 138 and regular, BP = 82/52, RR = 16 and shallow. Temperature is 105.5°F. The patient has a history of hypothyroidism, for which he takes Synthroid. Your partner suctions the airway and initiates BVM ventilations with 100 percent oxygen and an oropharyngeal airway. In addition to monitoring the cardiac rhythm and starting an IV of normal saline, you should:

A) perform synchronized cardioversion and intubate if the rhythm does not convert.
B) intubate the trachea and request orders for propranolol, IV.
C) intubate the trachea and request orders for diltiazem.
D) administer 25 g of 50 percent dextrose and intubate if the level of responsiveness does not improve.

Question 11

Which of the following is least likely to be a precipitating factor of thyrotoxic crisis?

A) Trauma
B) Cold environment
C) Infection
D) Overdose of thyroid hormone

Question 12

Which of the following is NOT a modifiable risk factor for type II diabetes?

A) Lack of exercise
B) Obesity
C) Heredity
D) Poor diet

Question 13

Acute exacerbation of Addison's disease can lead to ECG changes and cardiovascular collapse as a result of electrolyte imbalance secondary to:

A) increased mineralocorticoid secretion from the adrenal glands.
B) potassium retention and sodium excretion.
C) fluid retention, potassium excretion, and sodium retention.
D) decreased mineralocorticoid secretion with increased sodium and potassium excretion.

Question 14

Which of the following statements about the epidemiology of Graves' disease is TRUE?

A) Graves' disease typically manifests late in adulthood.
B) Heredity does not predispose people to Graves' disease.
C) Obesity and poor dietary habits increase the risk of Graves' disease.
D) Graves' disease is about six times more common in women than in men.

Question 15

A chemical substance that is released into the blood by a gland and that controls or affects processes in other glands or body systems is a(n):

A) enzyme.
B) hormone.
C) leukotriene.
D) neurotransmitter.

Question 16

Immediately after birth, an infant is allowed to suckle at the mother's breast. Palpation of the uterus suggests that the uterus is contracting. This finding can be attributed to:

A) secretion of oxytocin.
B) secretion of estrogen and progesterone.
C) inhibition of estrogen and progesterone.
D) inhibition of oxytocin.

Question 17

Which of the following best explains the process of osmotic diuresis associated with hyperglycemia?

A) Glucose in the urine lowers osmotic pressure inside the kidney tubule, preventing water reabsorption.
B) Glucose in the urine raises osmotic pressure inside the kidney tubule, drawing water into the tubule.
C) Decreased insulin levels result in decreased ADH secretion.
D) Elevated blood glucose levels result in increased ADH secretion.

Question 18

A 63-year-old female with a history of hypothyroidism presents in a stuporous state, responsive only to pain. Physical exam reveals thin hair, a puffy face, an enlarged tongue, and cold, doughy skin. Her heart rate is 70 and regular, RR is 10 and regular, BP is 90/62, blood glucose level is 60 mg/dL, and temperature is 86°F via a tympanic thermometer. Your treatment of this patient should NOT include:

A) active rewarming.
B) endotracheal intubation.
C) 50 percent dextrose, IV.
D) IV fluids at a TKO rate.

Question 19

Hyperglycemia is most likely a result of damage to the pancreatic ________ cells.

A) alpha
B) beta
C) acinar
D) delta

Question 20

A three-year-old male patient has a history of an underdeveloped cell-mediated immune system. Which of the following most likely contribute to this deficiency?

A) Hypoadrenalism
B) HIV infection
C) Type I diabetes mellitus
D) Thymus gland insufficiency and a lack of thymosin secretion

Question 21

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.

Question 22

Your patient is a 39-year-old male with a history of alcoholism. He is unresponsive, with cool, clammy skin and a weak, rapid pulse of 108. BP = 128/92, RR = 12 and regular. Your partner manages the airway and assists ventilations, but you are unable to start an IV after three attempts. Which of the following is most appropriate at this point?

A) Reattempt the IV while en route.
B) Dextrose, 25 g, and thiamine, 100 mg, both IM
C) Glucagon, 1.0 mg, and thiamine, 100 mg, both IM
D) Glucagon 1.0 mg IM

Question 23

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

Question 24

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

Question 25

A patient has a fever of 105°F, irritability, delirium, tachycardia, vomiting, and hypotension. These signs and symptoms are most consistent with:

A) thyrotoxic crisis.
B) myxedema.
C) Graves' disease.
D) hypothyroidism.

Question 26

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

Question 27

Your patient is a 42-year-old male who had surgery four years ago to remove his posterior pituitary gland because of a tumor. He stopped taking replacement hormones because they caused depression. Which of the following is the most likely consequence of the patient's noncompliance with hormone replacement therapy?

A) Hypoglycemia
B) Hypertension
C) Reduced ability to fight infection
D) Dehydration

Question 28

A type I diabetic presents with deep, rapid respirations and a fruity odor on her breath. Which of the following would best help correct the underlying physiologic disturbance?

A) Oxygen
B) Dextrose
C) Insulin
D) Glucagon

Question 29

Your patient is a 72-year-old male patient who is conscious but slow to respond to questions and commands. He has become increasingly lethargic, unemotional, and easily fatigued over the past two months. He has had a decreased appetite and has gained weight over the same period. The patient further states, "I'm constipated and always cold." Which of the following additional signs or symptoms would be consistent with this patient presentation?

A) A "moon-faced" appearance and hyperpigmentation of the skin
B) A puffy face, an enlarged tongue, and pale, doughy skin
C) Hypothermia, tachycardia, and hypertension
D) Goiter, atrial fibrillation, nausea, and vomiting

Question 30

Which of the following explains the profound protein catabolism and gluconeogenesis associated with Cushing's syndrome?

A) Cushing's syndrome affects normal fat deposition.
B) Glucocorticoids cause sodium retention and increased blood volume.
C) Cortisol is an antagonist to insulin.
D) Increased epinephrine and norepinephrine release result in hypermetabolism.

Question 31

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

Question 32

Your patient is a 45-year-old male who has been suffering from hypocalcemia since surgery to remove his thyroid gland six weeks ago. Of the following, which is most likely the cause of the patient's hypocalcemia?

A) Increased function of residual thyroid tissue
B) Loss of parathyroid gland function
C) Loss of thyroid gland function
D) Increase in parathyroid gland function

Question 33

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.

Question 34

Secretion of glucagon from the pancreas results in ________, which causes a(n) ________ in blood glucose levels.

A) glucogenesis, decrease
B) glycogenolysis, decrease
C) glucogenesis, increase
D) glycogenolysis, increase

Question 35

Which of the following hormones has the greatest effect on blood pressure homeostasis?

A) Calcitonin
B) Cortisol
C) Parathyroid hormone
D) Aldosterone

Question 36

A 24-year-old male is supine on the floor and unconscious with snoring respirations. You note a weak, rapid pulse and cool, diaphoretic skin. HR = 124 and regular, BP = 136/88, RR = 12 and regular. Blood glucose is 24 mg/dL. After manually opening the airway and providing oxygen, which of the following should be performed next?

A) Start an IV and administer 25 gm dextrose, IV.
B) Start an IV and administer 0.3 mg glucagon, IV.
C) Intubate the trachea, start an IV, and administer 25 gm dextrose.
D) Administer glucagon, 1 mg IM.

Question 37

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

Question 38

Which of the following is associated with a greater predisposition for hypoglycemia due to decreased gluconeogenesis?

A) Pancreatitis
B) Cholecystitis
C) Cardiac failure
D) Renal failure

Question 39

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

Question 40

A 34-year-old female, conscious, alert, and oriented, is complaining of a three-week history of increased appetite, weight loss, weakness, insomnia, and inability to tolerate heat. She has recently been frequently agitated and prone to mood swings. Based on these signs and symptoms, which of the following best describes the additional findings you could expect?

A) Hyperpigmentation of the skin and hirsutism
B) Heart block and hypotension
C) Enlarged tongue and cool, puffy skin
D) Exophthalmos and goiter

Question 41

The thyroid releases TSH to:

A) promote shivering.
B) protect the vascular system.
C) increase metabolism.
D) decrease insulin.

Question 42

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."

Question 43

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.

Question 44

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.

Question 45

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.

Question 46

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.

Question 47

Cushing's syndrome is a disorder of the:

A) posterior pituitary gland.
B) adrenal glands.
C) thyroid gland.
D) ovaries.

Question 48

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."

Question 49

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."

Question 50

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.

Question 51

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

Question 52

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.

Question 53

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.

Question 54

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.

Question 55

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

Question 56

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.

Question 57

The posterior pituitary produces which two hormones?

A) Insulin and glucagon
B) Epinephrine and norepinephrine
C) Growth hormone and gonadotropin
D) ADH and oxytocin

Question 58

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.

Question 59

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.

Question 60

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.

Question 61

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.

Question 62

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.

Question 63

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.