Chapter 23- Endocrine Emergencies

1. The endocrine system comprises a network of ___________ that produce and secrete chemical messengers called ____________. A) glands, hormones B) nodes, catecholamines C) vessels, leukotrienes D) synapses, neurotransmitters

Ans: A

15. The release of glucagon into the bloodstream stimulates: A) the liver to convert glycogen to glucose. B) the liver to take in and store more glucose. C) the cells to uptake sugar from the bloodstream. D) the vessels to constrict, thus increasing blood pressure.

Ans: A

21. Type 1 diabetes that is secondary to an autoimmune disorder occurs when: A) the body builds up antibodies that destroy the islets of Langerhans. B) insufficient white blood cells predispose the pancreas to infection. C) glucagon and insulin are destroyed by phagocytic white blood cells. D) the patient experiences an allergic reaction to his or her own glucose.

Ans: A

27. Which of the following would NOT cause hypoglycemia in the patient with type 1 diabetes? A) Insulin underdose B) Too much insulin C) Too little food D) Strenuous exertion

Ans: A

32. Hyperglycemia is characterized by: A) a gradual onset and warm, dry skin. B) shallow respirations and bradycardia. C) a rapid onset and cool, clammy skin. D) a blood glucose level above 110 mg/dL.

Ans: A

38. Which of the following interventions would the paramedic LEAST likely perform on a patient with diabetic ketoacidosis? A) Insulin administration B) Endotracheal intubation C) Sodium bicarbonate administration D) Infusion of 1 to 2 L of normal saline

Ans: A

39. Patients with hyperosmolar hyperglycemic nonketotic coma: A) present with severe dehydration and neurologic deficits. B) experience more severe acidosis than patients with diabetic ketoacidosis. C) typically require prehospital sodium bicarbonate therapy. D) most commonly have a history of type 1 diabetes mellitus.

Ans: A

4. Molecules that bind to a cell's receptor and trigger a response, resulting in some kind of action or biologic effect, are called: A) agonists. B) mediators. C) antagonists. D) neurotransmitters.

Ans: A

44. Which of the following statements regarding Addison disease is MOST correct? A) Addison disease most often occurs when the immune system creates antibodies that attack and destroy the adrenal cortex. B) Addison disease is also known as secondary adrenal insufficiency and is most often the result of a viral infection. C) The signs and symptoms of Addison disease are a direct result of the overproduction of cortisol and aldosterone. D) Hallmark signs of Addison disease are hypertension and fluid retention that result from excess sodium reabsorption.

Ans: A

47. The chief clinical manifestation of Addisonian crisis is: A) shock. B) dehydration. C) lower back pain. D) an elevated temperature.

Ans: A

53. You are dispatched to the residence of a 60-year-old woman who was found unresponsive by her husband. As you are assessing the patient, her husband tells you that she is a diabetic and has recently experienced several "small strokes." In addition to properly managing her airway, you should: A) perform a field glucose test to rule out hypoglycemia. B) start an IV line and give her 50 mL of 50% dextrose. C) avoid giving her glucose because of her small strokes. D) start an IV line and give her a 20-mL/kg fluid bolus.

Ans: A

59. A 68-year-old obese woman presents with a markedly decreased level of consciousness. She was found in bed by her husband. Your primary assessment reveals that her respirations are slow and shallow, her pulse is slow and weak, and her skin is cold and dry. According to the patient's husband, she has had a recent infection, but he cannot remember what the doctor called it. You should be MOST suspicious that this patient is experiencing: A) myxedema coma. B) Addisonian crisis. C) diabetic ketoacidosis. D) acute hypothyroidism.

Ans: A

60. Which of the following clinical presentations is MOST consistent with thyrotoxicosis? A) Severe tachycardia, fever, nausea and vomiting, and confusion B) Profound bradycardia, hypothermia, and respiratory depression C) Apathy, hypoglycemia, abdominal pain, and an irregular pulse D) Obesity, cool skin, severe hypotension, and respiratory distress

Ans: A

9. When the body's metabolic rate decreases: A) the thyroid gland secretes thyroxine. B) oxygen demand increases accordingly. C) the kidneys excrete more sodium and water. D) thyroid-stimulating hormone secretion is reduced.

Ans: A

10. Secretion of the parathyroid hormone is regulated by blood levels of: A) sodium. B) calcium. C) potassium. D) phosphorus.

Ans: B

14. The endocrine component of the pancreas: A) comprises the pancreatic duct. B) comprises the islets of Langerhans. C) releases epinephrine and norepinephrine. D) secretes digestive enzymes into the duodenum.

Ans: B

17. What is the function of estrogen? A) It stimulates the release of progesterone from the pituitary gland. B) It signals the anterior pituitary gland to secrete luteinizing hormone. C) It releases androgens that are responsible for pubic and armpit hair. D) It signals the posterior pituitary gland to secrete gonadotropic hormones.

Ans: B

19. When the pancreas does not produce enough insulin or the cells do not respond to the effects of the insulin that is produced: A) the cells will metabolize oxygen and function normally. B) glucose levels in the blood and urine will be elevated. C) serum glucose levels will fall and brain damage may occur. D) the body will stop making glucose as a protective mechanism.

Ans: B

20. Microvascular complications of diabetes include all of the following, EXCEPT: A) retinopathy. B) hypertension. C) nephropathy. D) neuropathy.

Ans: B

25. Diabetic patients would MOST likely present with atypical signs and symptoms of: A) bacterial pneumonia. B) acute coronary syndrome. C) an acute ischemic stroke. D) viral or fungal meningitis.

Ans: B

26. Common symptoms of type 2 diabetes include all of the following, EXCEPT: A) thirst. B) dysuria. C) fatigue. D) blurred vision.

Ans: B

3. Unlike exocrine glands, endocrine glands: A) do not affect the rate of cellular metabolism. B) release chemicals directly into the bloodstream. C) have ducts that carry their secretions into a body cavity. D) produce chemicals that work faster than the nervous system.

Ans: B

30. Thirty minutes of hypoglycemia in a patient: A) will generally not result in permanent neurologic damage. B) is more dangerous than an equivalent period of hyperglycemia. C) is only life threatening if the blood glucose is less than 40 mg/dL. D) is less dangerous than an equivalent period of hyperglycemia.

Ans: B

31. Prior to administering 50% dextrose (D50) via IV push, it is MOST important to: A) protect the airway with an endotracheal tube. B) ensure that the IV line is patent and freely flowing. C) confirm a blood glucose reading of less than 40 mg/dL. D) draw blood for later analysis in the emergency department.

Ans: B

37. A patient with diabetic ketoacidosis experiences polydipsia as a result of: A) hyperglycemia. B) dehydration. C) metabolic acidosis. D) inefficient nutrient utilization.

Ans: B

42. A decrease in adrenal hormone production will result in all of the following, EXCEPT: A) weakness. B) hypertension. C) dehydration. D) inability to respond to stress.

Ans: B

43. The primary role of cortisol is to: A) maintain an adequate blood pressure. B) assist with the body's response to stress. C) regulate the metabolism of carbohydrates. D) decrease the body's inflammatory response.

Ans: B

48. Which of the following would MOST likely cause Cushing syndrome? A) Abrupt termination of steroids such as prednisone and hydrocortisone B) Administration of large amounts of methylprednisolone to an asthma patient C) An acute decrease in cortisol secretion secondary to an infection or malignancy D) Underuse of corticosteroids for illnesses such as rheumatoid arthritis and asthma

Ans: B

49. A patient with Cushing syndrome would MOST likely present with: A) ketoacidosis. B) hypoglycemia. C) decreased urination. D) acute hyperactivity.

Ans: B

5. If there is a physiologic level of antidiuretic hormone in the bloodstream, then: A) blood pressure decreases secondary to dilation of the vessels. B) the renal tubules are stimulated to reabsorb sodium and water. C) potassium, phosphorus, and magnesium are lost through diuresis. D) the kidneys excrete excessive sodium and water from the body.

Ans: B

52. A 29-year-old man presents with bizarre behavior and profuse sweating. His wife tells you that he has type 1 diabetes and that he took his insulin today. During your assessment, you will MOST likely find that the patient is: A) dehydrated. B) tachypneic. C) hyperglycemic. D) breathing deeply.

Ans: B

54. You receive a call to the county jail for a male inmate who is unresponsive. According to the jailor, the patient was arrested for being "drunk." Your assessment reveals that the patient is profusely diaphoretic, and his respirations are rapid and shallow. His blood glucose level reads 30 mg/dL. As your partner assists the patient's ventilations, you start an IV and administer 50% dextrose. Reassessment reveals that the patient is responsive to pain only and his blood glucose level is 46 mg/dL. You should: A) intubate his trachea to prevent aspiration and transport him immediately. B) administer a second dose of dextrose and prepare for immediate transport. C) give him 1 mg of glucagon IM and reassess his blood glucose. D) conclude that he will require immediate definitive care and begin transport.

Ans: B

56. A 51-year-old man with type 2 diabetes presents with confusion, blurred vision, and signs of significant dehydration. According to the man's wife, he has had a fever and flu-like symptoms for the past few days. She further tells you that he has "stuck to his diet" as advised by his physician. His blood pressure is 90/50 mm Hg, pulse is 120 beats/min and weak, and respirations are rapid and shallow. You assess his blood glucose level, which reads "high." This patient is MOST likely: A) producing ketones due to fat metabolism. B) experiencing hyperosmolar nonketotic coma. C) significantly acidotic and requires bicarbonate. D) hyperglycemic secondary to being dehydrated.

Ans: B

8. The posterior lobe of the pituitary gland secretes: A) thyroxine and growth hormone. B) antidiuretic hormone and oxytocin. C) three gonadotropic hormones and oxytocin. D) growth hormone and thyroid-stimulating hormone.

Ans: B

12. If the body experiences a drop in volume or blood pressure: A) aldosterone stimulates the sweat glands, resulting in diaphoretic skin. B) adrenocorticotropic hormone causes a reduction in the secretion of cortisol. C) aldosterone secretion stimulates the kidneys to reabsorb sodium from the urine. D) catecholamine release inhibits the conversion of glycogen to glucose in the liver.

Ans: C

13. The adrenal medulla secretes norepinephrine following stimulation from the: A) brainstem. B) diencephalon. C) hypothalamus. D) pituitary gland.

Ans: C

18. Diabetes is MOST accurately defined as: A) inadequate insulin secretion, which leads to increased circulating blood glucose levels. B) a decrease in circulating insulin levels, which results in a drop in serum blood sugar levels. C) a metabolic disorder in which the body's ability to metabolize simple carbohydrates is impaired. D) an endocrine disorder in which the liver is unable to produce and store adequate amounts of glycogen.

Ans: C

24. Insulin resistance occurs when: A) autoantibodies break down insulin before it can be utilized by the body. B) the release of epinephrine and norepinephrine renders insulin less effective. C) the pancreas produces enough insulin, but the body cannot utilize it effectively. D) the body produces excessive insulin, which causes a profound drop in blood glucose.

Ans: C

29. The clinical presentation of a hypoglycemic patient would MOST likely resemble that of a patient with: A) classic heatstroke. B) an opiate overdose. C) alcohol intoxication. D) a hemorrhagic stroke.

Ans: C

34. Diabetic ketoacidosis occurs when: A) blood glucose levels rise above 250 mg/dL. B) the renal system begins to excrete ketones. C) the cells metabolize fat and produce ketones. D) insulin production exceeds glucagon production.

Ans: C

35. Severe dehydration that commonly accompanies diabetic ketoacidosis is caused by: A) prolonged compensatory hyperventilation. B) decreased fluid intake secondary to hyperglycemia. C) hyperglycemia-induced osmotic diuresis and vomiting. D) the loss of key electrolytes such as sodium and potassium.

Ans: C

41. Adrenal insufficiency is characterized by decreased function of the ______________ and consequent underproduction of ______________. A) adrenal glands, catecholamines B) adrenal medulla, norepinephrine C) adrenal cortex, cortisol and aldosterone D) adrenal glands, epinephrine and norepinephrine

Ans: C

46. The MOST common cause of Addisonian crisis is: A) overwhelming stress. B) a severe acute infectious process. C) abrupt termination of corticosteroid use. D) acute failure of one or both of the adrenal glands.

Ans: C

51. Unlike hypothyroidism, hyperthyroidism: A) results in a decreased cardiac output. B) causes a decrease in the metabolic rate. C) causes an increase in oxygen demand. D) often results in acute myxedema coma.

Ans: C

58. You are dispatched to a residence for an elderly woman who is "sick." When you arrive and assess her, you note that she is responsive to pain only and has hot, moist skin and rapid, shallow respirations. You find prednisone, Paxil, and multivitamins on her nightstand. Further assessment of this patient will MOST likely reveal: A) a normal blood glucose level and a "moon face" appearance. B) severe hypertension, flattened T waves, and asymmetric pupils. C) hypoglycemia, hypotension, and ECG evidence of hyperkalemia. D) a blood glucose reading above 400 mg/dL and a fruity breath odor.

Ans: C

6. The primary anatomic link between the endocrine system and the nervous system is/are the: A) pancreas. B) adrenal glands. C) hypothalamus. D) adrenal cortex.

Ans: C

11. The adrenal cortex produces hormones called _______________, which: A) catecholamines, increase the blood pressure. B) glucocorticoids, stimulate energy production. C) gonadotropin, regulate testosterone production. D) corticosteroids, regulate the body's metabolism.

Ans: D

16. Which of the following statements regarding insulin is correct? A) Insulin stimulates the conversion of glycogen to glucose. B) An increase in insulin levels causes an increase in blood glucose. C) Insulin is a pancreatic hormone that performs exocrine functions. D) Insulin is the only hormone that decreases blood glucose levels.

Ans: D

2. Which of the following is/are NOT an exocrine gland? A) Liver B) Sweat glands C) Salivary glands D) Adrenal glands

Ans: D

22. A person with type 1 diabetes: A) is often an older person whose pancreas does not produce adequate insulin. B) can often control his or her diabetes with a proper diet and regular exercise. C) is not as likely to experience hypoglycemia as a person with type 2 diabetes. D) generally does not produce any insulin and requires daily insulin injections.

Ans: D

23. Excessive alcohol consumption can lead to low blood glucose levels because: A) alcohol destroys any insulin that is produced. B) alcohol antagonizes the pancreatic beta cells. C) alcohol blocks the pancreatic release of insulin. D) alcohol depletes glycogen stores in the liver.

Ans: D

28. The tissues of the central nervous system: A) can metabolize fat and proteins to make energy. B) are able to store glucose and use just what is needed. C) can only survive for about an hour without glucose. D) depend entirely on glucose as their source of energy.

Ans: D

33. An illness or infection would MOST likely cause: A) diabetic ketoacidosis. B) acute hyperglycemia. C) blood glucose above 500 mg/dL. D) a slow onset of hyperglycemia.

Ans: D

36. Unlike the patient with hypoglycemia, the patient with severe hyperglycemia: A) usually does not vomit. B) has a normal breath odor. C) rapidly improves with treatment. D) is tachypneic and hyperpneic.

Ans: D

40. Prehospital treatment for patients with hyperosmolar hyperglycemic nonketotic coma focuses on: A) intubation and insulin administration. B) correction of electrolyte abnormalities. C) high-flow oxygen and IV or IM glucagon. D) airway management and fluid rehydration.

Ans: D

45. In contrast to primary adrenal insufficiency, secondary adrenal insufficiency is caused by: A) idiopathic atrophy of both of the adrenal glands that results in a deficiency of all the steroid hormones they secrete. B) adrenal gland destruction caused by tuberculosis; viral, bacterial, or fungal infections; or cancer of the adrenal gland. C) acute hypertension and overhydration due to excess sodium reabsorption. D) decreased cortisol secretion secondary to a lack of adrenocorticotropic hormone secretion from the pituitary gland.

Ans: D

50. Signs and symptoms of hypothyroidism include: A) tachycardia and hypertension. B) hot, flushed skin and restlessness. C) diarrhea and emotional lability. D) bradycardia and sluggish reflexes.

Ans: D

55. A 30-year-old woman presents with 3 days of generalized weakness, dizziness, and excessive urination. She is conscious but restless, and she tells you that she is extremely thirsty. Her blood pressure is 96/66 mm Hg, her pulse is 110 beats/min and full, and her respirations are increased and somewhat deep. On the basis of this patient's clinical presentation, she will MOST likely require oxygen and: A) 25 g of 50% dextrose. B) in-hospital antibiotics. C) 0.5 to 1 mg of glucagon. D) crystalloid fluid hydration.

Ans: D

57. You are assessing a 70-year-old man with a blood glucose reading of 400 mg/dL and note the presence of sharply peaked T waves on the cardiac monitor. Which of the following medications would this patient MOST likely receive in the prehospital setting? A) Insulin B) Glucagon C) Potassium D) Bicarbonate

Ans: D

7. Which of the following is an example of endocrine regulation via a negative feedback mechanism? A) As blood glucose levels fall, glucagon is secreted and stimulates the liver to convert glycogen to glucose. B) A stress response stimulates the sympathetic nervous system to release epinephrine into the bloodstream. C) When circulating volume is decreased, the pituitary gland secretes antidiuretic hormone into the bloodstream. D) The neural regulating mechanism decreases its signals to the adrenal medulla, decreasing epinephrine release.

Ans: D