Chapter 20 Endocrine and Hematologic Emergencies

What is a normal glucose level in an adult? 20 mg/dL 80 mg/dL 140 mg/dL 200 mg/dL

80 mg/dL (80-120)

Which of the following conditions is the diabetic patient at an increased risk of developing? A. blindness B. depression C. alcoholism D. hepatitis B

A. blindness

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

A. disorder of glucose metabolism.

When obtaining a SAMPLE history from a patient with diabetes, it would be MOST important to determine: A. if he or she has had any recent illnesses or excessive stress. B. approximately how much water the patient drank that day. C. if there is a family history of diabetes or related conditions. D. the name of the physician who prescribed his or her insulin.

A. if he or she has had any recent illnesses or excessive stress.

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: A. is significantly hyperglycemic. B. has a low blood glucose level. C. has a urinary tract infection. D. has overdosed on her insulin.

A. is significantly hyperglycemic.

Excessive eating caused by cellular "hunger" is called: A. polyphagia. B. polydipsia. C. dysphasia. D. dyspepsia.

A. polyphagia.

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?"

A."Did he take his insulin today?" Rationale: All of these questions are important to ask the spouse of an unconscious diabetic. However, it is critical to ask if the patient took his insulin. This will help you differentiate hypoglycemic crisis from hyperglycemic crisis. For example, if the patient took his insulin and did not eat, or accidentally took too much insulin, you should suspect hypoglycemic crisis. If the patient did not take his insulin, you should suspect hyperglycemic crisis.

14.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

A.Analgesics for pain Rationale: Although analgesics would benefit a patient suffering from a hematologic disorder, the administration of such medications is not in the scope of practice for the EMT. ALS providers would have to be present to provide this emergency care.

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.

A.excretion of glucose and water from the kidneys. Rationale: In severe hyperglycemia, the kidneys excrete excess glucose from the body. This process requires a large amount of water to accomplish; therefore, water is excreted with the glucose, resulting in dehydration.

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

A.fat. Rationale: If the body's cells do not receive glucose, they will begin to metabolize the next most readily available substance—fat. Fat metabolism results in the production of ketoacids, which are released into the bloodstream (hence the term "ketoacidosis").

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.

A.they are dehydrated secondary to excessive urination. Rationale: 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).

The normal blood glucose level, as measured by a glucometer, is between: A. 60 and 80 mg/dL. B. 80 and 120 mg/dL. C. 130 and 150 mg/dL. D. 160 and 200 mg/dL.

B. 80 and 120 mg/dL.

Which of the following statements regarding sickle cell disease is correct? A. Sickle cell disease is an inherited blood disorder that causes the blood to clot too quickly. B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen. C. The red blood cells of patients with sickle cell disease are round and contain hemoglobin A. D. Because of their abnormal shape, red blood cells in patients with sickle cell disease are less apt to lodge in a blood vessel.

B. In sickle cell disease, the red blood cells are abnormally shaped and are less able to carry oxygen.

Classic signs and symptoms of hypoglycemia include: A. warm, dry skin; irritability; bradycardia; and rapid respirations. B. cool, clammy skin; weakness; tachycardia; and rapid respirations. C. warm, dry skin; hunger; abdominal pain; and deep, slow respirations. C. cold, clammy skin; bradycardia; hunger; and deep, rapid respirations.

B. cool, clammy skin; weakness; tachycardia; and rapid respirations.

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

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

Type 1 diabetes: A. is typically treated with medications such as metformin (Glucophage). B. is a condition in which no insulin is produced by the body. C. typically occurs in patients between 50 and 70 years of age. D. is defined as a blood sugar level that is less than 120 mg/dL.

B. is a condition in which no insulin is produced by the body.

Symptomatic hypoglycemia will MOST likely develop if a patient: A. eats a regular meal followed by mild exertion B. takes too much of their prescribed insulin C. misses one or two prescribed insulin injections D. markedly overeats and misses an insulin dose

B. takes too much of their prescribed insulin

Which of the following signs or symptoms would the EMT most likely encounter in a patient with new-onset type 1 diabetes? A. weight gain and edema B. weight loss and polyuria C. total lack of appetite D. low blood glucose level

B. weight loss and polyuria

12.What are the two main components of blood? A.Erythrocytes and hemoglobin B.Cells and plasma C.Leukocytes and white blood cells D.Platelets and neutrophils

B.Cells and plasma Rationale: The blood is made up of two main components: cells and plasma. The cells in the blood include red blood cells (erythrocytes), white blood cells (leukocytes), and platelets. These cells are suspended in a straw-colored fluid called plasma.

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

B.Skipping a meal and taking insulin Rationale: The combination that would most likely cause a hypoglycemic crisis is skipping a meal and taking insulin. The patient will use up all available glucose in the bloodstream and become hypoglycemic. Left untreated, hypoglycemic crisis may cause permanent brain damage or even death.

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.

B.glucose utilization is impaired. Rationale: Type 1 diabetes is a disease in which the pancreas fails to produce enough insulin (or produces none at all). Insulin is a hormone that promotes the uptake of sugar from the bloodstream and into the cells. Without insulin, glucose utilization is impaired because it cannot enter the cell.

Which of the following organs can rapidly sustain permanent damage when the body's glucose level is too low? Brain Heart Kidney Liver

Brain

Patients with diabetes who overexert themselves are prone to rapid: A. drops in their ability to sweat. B. increases in their blood pressure. C. drops in their blood glucose levels. D. increases in their blood glucose levels

C. drops in their blood glucose levels.

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

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

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

C.Rapid and deep Rationale: Kussmaul respirations—a rapid and deep breathing pattern seen in patients with DKA—indicates that the body is attempting to eliminate ketones via the respiratory system. A fruity or acetone breath odor is usually present in patients with Kussmaul respirations.

You are working a detail for the women's state volleyball championship at the local university gym when you are dispatched to the visiting team locker room for a player who is feeling weak and dizzy. You are met at the locker room door by the coach who points to a young woman lying supine on a bench. The coach informs you that the player has a history of diabetes and takes insulin on a regular basis. As you approach the patient, you run through some of the information that you know about diabetes. What other sudden onset signs and symptoms may your patient exhibit? A. A slow, bounding pulse B. Rapid, deep respirations C. Nausea and vomiting D. Pale, moist skin

D. Pale, moist skin

To which of the following diabetic patients should you administer oral glucose? A. an unconscious 33-year-old male with cool, clammy skin B. a conscious 37-year-old female with nausea and vomiting C. a semiconscious 40-year-old female without a gag reflex D. a confused 55-year-old male with tachycardia and pallor

D. a confused 55-year-old male with tachycardia and pallor

Diabetic ketoacidosis occurs when: A. blood glucose levels rapidly fall. B. the cells rapidly metabolize glucose. C. the pancreas produces excess insulin. D. insulin is not available in the body.

D. insulin is not available in the body.

Patients with thrombophilia are at an increased risk for: A. various cancers. B. hemorrhagic stroke. C. acute arterial rupture. D. pulmonary embolism.

D. pulmonary embolism.

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

D. rate and depth of breathing.

Patients with type 2 diabetes usually control their disease with all of the following, EXCEPT: A. diet and exercise. B. tolbutamide (Orinase). C. glyburide (Micronase). D. supplemental insulin.

D. supplemental insulin.

13.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.

D.All of the above.

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.hyperglycemia. B.hypoglycemia. C.hypoglycemic crisis. D.hyperglycemic crisis.

D.hyperglycemic crisis. Rationale: 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.

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.

D.usually responds immediately after treatment. Rationale: Hypoglycemic crisis usually responds immediately following treatment with glucose. Patients with hyperglycemic crisis generally respond to treatment gradually, within 6-12 hours following the appropriate treatment. Seizures can occur with both hyperglycemic crisis and hypoglycemic crisis, but are more common in patients with hypoglycemic crisis.

In _________, there are fewer insulin receptors, so insulin resistance develops. Diabetes mellitus type 1 Diabetes mellitus type 2 HHNS Ketoacidosis

Diabetes mellitus type 2

Dry and warm skin indicates hypoglycemia. True/False

False

Which substance is released when the concentration of glucose drops in the blood? Insulin Epinephrine Glucagon Dopamine

Glucagon Glucagon stimulates liver and skeletal muscles to release glycogen, and it converts glycogen back to glucose for use as cellular fuel.

What is the function of insulin in the body? It prevents glucose from oversaturating cells. It enables glucose in the blood to enter cells. It regulates oxygen flow to the cells. It regulates chemical production in the endocrine glands.

It enables glucose in the blood to enter cells.

Which condition is most likely to create a vasoocclusive crisis in patients? Symptomatic hypoglycemia Sickle cell disease Hemophilia Thrombophilia

Sickle cell disease

You are treating a 36-year-old patient who displays the following signs and symptoms: rapid, shallow respirations; pale, cool, clammy skin; tachycardia; weakness on the left side of the body; and confusion and irritability. What should you suspect? Symptomatic hyperglycemia Symptomatic hypoglycemia Vasoocclusive crisis DKA

Symptomatic hypoglycemia

A patient who is hyperglycemic may have Kussmaul respirations and a sweet, fruity breath. True/False

True

A patient with symptomatic hypoglycemia is more critical and more likely to suffer from permanent problems than a patient with hyperglycemia or diabetic ketoacidosis. True/False

True

The only contraindications to oral glucose are an inability to swallow and unconsciousness. True/False

True

Which of the following is the most common metabolic disease of childhood? Type 1 diabetes Type 2 diabetes Ketoacidosis Hyperosmolar hyperglycemic nonketotic syndrome

Type 1 diabetes

Which of the following is classified as an autoimmune disorder? Type 1 diabetes Type 2 diabetes Sickle cell disease Acidosis

Type 1 diabetes Type 1 diabetes is an autoimmune disorder in which the patient's immune system produces antibodies to the pancreatic beta cells.

The condition in which blood clots as a result of an abnormality of the system of coagulation is called: hemophilia. sickle cell disease. thrombosis. thrombophilia.

thrombophilia.