10 free EMT practice questions: Endocrine Disorders

Panic attack: A panic attack causes rapid breathing, often with tingling around the mouth and in the fingers. Panic builds over minutes and has nothing to do with 3 days of thirst and frequent urination. A panic attack does not make ketones, so there is no fruity odor. Calling this panic leaves an acidotic, dehydrated diabetic sitting at a construction site.

Heat exhaustion: fits a worker in the heat who becomes weak and lightheaded with cool, pale, moist skin and cramping. This patient's skin is warm and dry. The thirst and bathroom trips started 3 days ago, not during today's shift. Heat exposure also does not explain the fruity odor, which only ketones cause.

Hypoglycemia: the most important condition to check for in any diabetic with a change in mental status, because you can fix it in minutes. Low blood sugar fits a patient who gets worse over minutes with confusion, tremor, and cool, clammy skin. A falling sugar sets off adrenaline, which makes the skin pale, cool, and sweaty. This patient's skin is warm and dry. Low sugar also does not cause deep, rapid breathing or a fruity odor. These symptoms built over 3 days.

Viral gastroenteritis with dehydration: Viral gastroenteritis is the most common cause of dehydration in a school-age child. Gastroenteritis can cause a fast pulse, tiredness, and dry skin. A child dehydrated from vomiting and diarrhea makes less urine, not more. This child is drinking more and urinating more, and no vomiting or diarrhea is reported. Gastroenteritis also does not explain the fruity breath.

Asthma exacerbation: An asthma exacerbation causes fast breathing with wheezing, a long exhale, and accessory muscle use. There is usually a known history and a trigger. Kussmaul breathing is deep and fast, but the air moves freely. This child is breathing hard on purpose to fix an acid problem, not fighting to get air out. Asthma does not cause a week of thirst, weight loss, and acetone on the breath.

Anxiety related to a change in routine: Anxiety about a change in routine can cause hyperventilation. Anxious breathing is rapid and shallow, not deep. Anxiety does not cause a week of weight loss, constant thirst, and frequent urination. Calling this anxiety leaves the DKA untreated, and DKA can progress to coma.

The patient has a history of type 1 diabetes: A history of type 1 diabetes explains why this patient can have low blood sugar from insulin. Type 1 diabetes tells you nothing about the airway right now. Whether oral glucose is safe depends on the patient being conscious and able to swallow, never on the type of diabetes.

The patient's skin is pale and diaphoretic: Pale, diaphoretic skin is the body's sympathetic response to low blood sugar. The patient sweats, and the blood vessels tighten. Pale, diaphoretic skin confirms the hypoglycemia. Skin signs say nothing about whether the patient can swallow or protect the airway, so they do not stop you from giving oral glucose.

The patient's blood glucose is 40 mg/dL: A blood glucose of 40 mg/dL confirms the hypoglycemia you are treating. A low blood glucose is the reason to give glucose, not a reason to hold it back.

Withhold glucose and transport; signs are not classic for hypoglycemia: Sweating and trembling are the classic signs of low blood sugar, and this patient has neither. The glucose of 52 mg/dL is measured, and the measured number proves the sugar is low even without those signs. Withholding glucose leaves a brain that is already short on fuel without the sugar it needs.

Administer high-flow oxygen and transport without glucose administration: Oxygen makes sense for a confused patient who is hypoxic. This patient's SpO2 is 97% on room air, so low oxygen is not the problem. Oxygen does nothing to raise the blood sugar that is causing the weakness and slurred speech.

Treat the patient for stroke using aspirin and rapid transport: Sudden confusion and slurred speech in an 81-year-old can look like a stroke. Low blood sugar causes the same deficits, and a normal glucose is what lets a stroke impression stand. This patient's glucose is 52 mg/dL, and the low sugar explains every finding. Aspirin is never part of EMT stroke care. You cannot rule out a bleeding stroke in the field, and aspirin thins the blood.

The glucometer reads below 70 mg/dL: A reading below 70 with symptoms makes hypoglycemia the working diagnosis. When you have a reading, the reading tells you glucose is the right treatment. The reading cannot tell you whether the patient can safely swallow the glucose. An unresponsive patient with a glucose of 38 needs sugar even more and still cannot take anything by mouth.

The patient has a documented history of type 1 diabetes mellitus: A history of diabetes raises your suspicion. A known insulin-dependent diabetic with an altered mental status should make you think hypoglycemia right away. History still does not decide whether glucose is safe to give. Patients with type 2 diabetes on sulfonylureas go low as well. People with no diabetes at all can go low from alcohol, sepsis, or long fasting.

The skin is warm and dry rather than cool and diaphoretic: Warm, dry skin points the other way, toward hyperglycemia. In hyperglycemia the patient is dehydrated and is not sweating. The classic skin with hypoglycemia is cool and diaphoretic. A finding that argues against low sugar cannot be a requirement for treating low sugar. The swallow and protect rule applies no matter what the skin looks like.

Use a tongue depressor to open the patient's mouth and administer the oral glucose gel: Prying the mouth open with a tool belongs to airway emergencies where getting in is life-saving. Even then, prying is not how oral glucose is given. The clenched jaw tells you this patient cannot safely take anything by mouth. Forcing a tongue depressor past clenched teeth can injure the teeth and soft tissue. Any gel that follows still carries the same aspiration risk.

Apply the oral glucose gel under the tongue, where it can be absorbed without the patient swallowing: Under the tongue is a real route, and it is how nitroglycerin is absorbed. Oral glucose gel is a sugar that has to be swallowed, not a drug absorbed under the tongue. The gel still goes into a mouth the patient cannot control, so the aspiration risk is the same. Placing the gel also wastes time before the ALS request that actually fixes the problem.

Delay transport and periodically retry oral glucose until the patient cooperates: Retrying later only works if the patient becomes able to cooperate. The confusion comes from the low glucose, and the glucose is falling. With time, this patient gets less able to cooperate, not more. Every retry spends minutes the brain is going without fuel. Hypoglycemia does not fix itself while you wait.

The liver producing glucagon: The liver is the organ that stores sugar as glycogen and releases sugar into the blood. Glucagon is made by the pancreas, not the liver. Diabetes is the pancreas not making enough insulin, or the body not responding to insulin.

The adrenal glands producing epinephrine: The adrenal glands make epinephrine, also called adrenaline, as part of the stress response. The adrenal glands and epinephrine do not regulate blood sugar the way the pancreas and insulin do in diabetes.

The thyroid producing thyroxine: The thyroid makes thyroxine and sets the body's metabolic rate. Thyroxine does not control blood sugar, and the thyroid is not the gland that fails in diabetes.

Low blood glucose directly damages the myelin sheath surrounding peripheral nerves: Nerve damage in diabetes is peripheral neuropathy. Peripheral neuropathy is a slow, long-term problem from blood glucose that runs high over time. One low reading does not damage the nerves this way, and nerve damage does not explain sudden confusion.

Low blood glucose causes the brain's blood vessels to constrict, reducing perfusion: Narrowed blood vessels cutting down blood flow to the brain fits a stroke. Low blood glucose is a fuel problem for the brain cells, not a blood vessel problem. No vessels are constricting here.

Low blood glucose triggers a release of excess insulin, worsening the glucose deficit: Too much insulin is a cause of low blood glucose. Option D has the cause and effect backward. Low blood glucose does not trigger a release of extra insulin.

Place oral glucose gel between the cheek and gum: Gel between the cheek and gum is how you give oral glucose to a patient who can swallow and protect the airway. This patient does not respond to pain at all. A patient that unresponsive cannot keep the gel out of the airway.

Administer oral glucose and then reassess in 5 minutes: Reassessing in 5 minutes still means you give a contraindicated treatment first. The risk of aspiration starts as soon as the glucose goes in. A recheck later does not undo that risk.

Dissolve an oral glucose tablet in water and pour it into the mouth: Pouring a dissolved tablet into the mouth is even more dangerous than the gel. A liquid poured into the mouth of an unresponsive patient is very likely to be aspirated.

Administer oral glucose gel between the cheek and gum: A glucose of 34 with an altered mental status would normally call for oral glucose. This patient cannot manage the saliva already in the mouth. Glucose gel on top of that saliva is likely to be aspirated.

Administer oral glucose because the patient's eyes open to voice: Opening the eyes to a loud voice shows the patient can be aroused. Being arousable is not the same as protecting the airway. This patient makes only incomprehensible sounds, does not follow commands, and lets saliva pool without swallowing. Those findings show the swallow and gag reflexes are gone.

Withhold oral glucose until the blood glucose level drops below 30 mg/dL: No blood glucose number, such as 30, decides when oral glucose is safe. Airway protection decides that. At 34 with saliva pooling in the mouth, the airway problem already rules out anything by mouth.