Endo Exam 3: STUDENT INPATIENT DM

Case: A 24-year-old with T1DM has glucose 420 mg/dL, vomiting, and Kussmaul breathing. Which condition is most likely?
A) HHS in middle-aged adults with T2DM
B) DKA in young adults with T1DM
C) Hypoglycemia
D) Hyperosmolar coma in adults over 65

B

Case: A 52-year-old with T2DM is confused and has glucose 780 mg/dL, no significant ketones, and a UTI. Which diagnosis fits best?
A) DKA
B) Euglycemic DKA
C) HHS
D) Lactic acidosis

C

Case: Which is a common precipitating factor for DKA or HHS?
A) Regular exercise
B) Infection such as UTI or pneumonia
C) Low-carbohydrate diet
D) Adequate insulin use

B

Case: What is the DKA triad?
A) Hypoglycemia, ketosis, alkalosis
B) Hyperglycemia, hyperosmolality, dehydration
C) Hyperkalemia, acidosis, azotemia
D) Hyperglycemia, ketosis, metabolic acidosis

D

Case: A patient on an SGLT-2 inhibitor has DKA with a glucose of 180 mg/dL. What is this called?
A) Euglycemic DKA
B) HHS
C) Mild hypoglycemia
D) Ketosis without acidosis

A

Case: A patient with DKA is alert, with nausea, abdominal pain, fruity breath, and Kussmaul respirations. What is the usual onset?
A) Weeks to months
B) Minutes
C) Hours to days
D) Years

C

Case: An older adult with T2DM has altered mental status after a stroke, with glucose 650 mg/dL and minimal ketones. Which is the usual HHS presentation?
A) Alert, with fruity breath
B) Impaired cognition, often with another acute illness
C) Kussmaul respirations only
D) Normal mental status

B

Case: A patient has features of both DKA and HHS. What should you do?
A) Treat as HHS only
B) Treat as DKA when the picture is unclear
C) Treat as hypoglycemia
D) Observe without treatment

B

Case: Which set defines DKA by glucose and mental status?
A) Glucose 200 mg/dL or higher, or prior diabetes; severe is pH under 7.00, HCO3 under 10, stupor or coma
B) Glucose 300 mg/dL or higher; severe is pH under 7.25
C) Glucose 140 mg/dL or higher; severe is HCO3 under 18
D) Glucose 600 mg/dL or higher; severe is osmolality over 320

A

Case: What is the HHS diagnostic criterion for glucose?
A) 250 mg/dL or higher
B) 300 mg/dL or higher
C) 400 mg/dL or higher
D) 600 mg/dL or higher

D

Case: A patient with DKA has glucose 350 mg/dL and no hypotension. What fluid is recommended first?
A) 0.9% NaCl or a balanced crystalloid such as Lactated Ringer’s or Plasma-Lyte
B) D5W alone
C) Free water by mouth
D) Fluid restriction

A

Case: What is the initial IV fluid rate for DKA, and how fast is the deficit replaced?
A) 100-200 mL/hr; full deficit in 2 hours
B) 500-1,000 mL/hr for 2-4 hours; 50% of deficit in 8-12 hours
C) 50 mL/hr; full deficit in 72 hours
D) 2,000 mL/hr for 1 hour

B

Case: When should dextrose be added to IV fluids?
A) When glucose falls under 250 mg/dL
B) When glucose rises above 400 mg/dL
C) Only after insulin is stopped
D) Never in DKA

A

Case: A patient with moderate to severe DKA needs insulin. What is the regimen?
A) SC rapid-acting 0.1-0.2 units/kg every 1-2 hours
B) IV regular insulin infusion at 0.1 units/kg/hr
C) Oral metformin
D) IV regular insulin at 0.05 units/kg/hr

B

Case: What is the HHS insulin regimen?
A) IV regular infusion at 0.1 units/kg/hr
B) SC rapid-acting 0.1-0.2 units/kg every 1-2 hours
C) IV regular infusion at 0.05 units/kg/hr
D) Oral sulfonylurea

C

Case: When is insulin reduced, and what are the DKA and HHS glucose targets until resolution?
A) Reduce at glucose under 250 mg/dL; DKA 150-200 mg/dL, HHS 200-250 mg/dL
B) Reduce at glucose under 400 mg/dL; DKA 300-400 mg/dL, HHS 400-500 mg/dL
C) Reduce at glucose under 100 mg/dL; DKA 70-100 mg/dL, HHS 100-150 mg/dL
D) Never reduce; target 250-300 mg/dL

A

Case: A patient with DKA has K+ 5.2 mmol/L. What is the potassium plan?
A) Give 20 mmol/hr of K+ now
B) Start insulin and give no K+; recheck every 2 hours
C) Stop insulin until K+ falls
D) Give bicarbonate

B

Case: A patient with DKA has K+ 3.2 mmol/L. What is the potassium plan?
A) Give K+ 10-20 mmol/L/hr until above 3.5, and delay insulin
B) Start insulin immediately with no K+
C) Give 50 mmol of K+ IV push
D) Stop all IV fluids

A

Case: When is sodium bicarbonate indicated in DKA?
A) Routinely for all DKA patients
B) Only if pH is under 7.0
C) Only if pH is above 7.3
D) For glucose above 400 mg/dL

B

Case: When is phosphate replaced in DKA?
A) Always, for all patients
B) Only if phosphate is under 1.0 mmol/L with muscle weakness
C) Only if phosphate is above 4.0 mmol/L
D) Never

B

Case: How often should glucose and K+ be checked during DKA treatment?
A) Glucose every 1-2 hours; K+ every 2 hours initially, then every 4 hours during insulin infusion
B) Glucose once daily; K+ once daily
C) Glucose every 12 hours; K+ every 24 hours
D) Glucose every 6 hours; K+ every 8 hours

A

Case: A patient with DKA has glucose 240 mg/dL, but BHB and bicarbonate remain abnormal. What should you do?
A) Stop insulin at 250 mg/dL
B) Add dextrose-containing IV fluids and continue insulin
C) Start SC insulin only
D) Give sodium bicarbonate

B

Case: Which criteria must all be met for DKA resolution?
A) pH 7.3 or higher OR bicarbonate 18 or higher; plasma BHB under 0.6 mmol/L; glucose under 200 mg/dL
B) Urine ketones negative; glucose under 300 mg/dL
C) Anion gap normal only
D) Glucose under 140 mg/dL only

C

Case: A patient with HHS needs resolution criteria. Which criteria apply?
A) Serum osmolality under 300 mOsm/kg, glucose under 250 mg/dL, urine output over 0.5 mL/kg/hr, improved cognition
B) Glucose under 100 mg/dL and BHB under 3 mmol/L
C) Urine ketones negative and pH above 7.4
D) Anion gap under 12 only

A

Case: What is the weight-based total daily dose estimate for transitioning from IV to SC insulin?
A) 0.5-0.6 units/kg/day, or 0.3 if at risk of hypoglycemia
B) 2 units/kg/day
C) 0.05 units/kg/day
D) 10 units/kg/day

A

Case: A team is switching a patient from an IV drip to SC insulin. How much overlap is recommended?
A) No overlap
B) 1-2 hours per the DKA lecture and ADA algorithm; the inpatient lecture said 2-4 hours, so confirm with your instructor
C) 24 hours
D) 10 minutes

B

Case: About what share of DKA admissions are readmitted within the same calendar year?
A) About 2%
B) About 22%
C) About 50%
D) About 86%

B

Case: Which is required at discharge after DKA?
A) Insulin and supplies, education on injection and glucose monitoring, ADA Sick Day Guide review, and follow-up within 2-4 weeks
B) No insulin, metformin only
C) Discharge without education
D) Follow-up in 6 months

A

Case: MT has DKA with glucose 342 mg/dL, BHB 4.8 mmol/L, HCO3 12, pH 7.18, and is alert. What is the severity?
A) Mild
B) Moderate
C) Severe
D) HHS

B

Case: For MT, which initial treatment is appropriate?
A) IV sodium bicarbonate and fluid restriction
B) SC rapid-acting insulin only
C) IV normal saline and IV regular insulin infusion
D) Oral fluids only

C

Case: MT’s Lantus dose is listed on the slide. What is it, and what is the discrepancy?
A) 20 units qHS; the lecture said 30
B) 24 units qHS on the slide; the lecture transcript said 25 units
C) 10 units qAM; no discrepancy
D) 50 units qHS; the lecture said 40

B

Case: What is the deficit replacement timeline, and what is the discrepancy?
A) 50% in 8-12 hours on the algorithm; 24-48 hours in the text bullet
B) 100% in 1 hour in all sources
C) 72 hours in all sources
D) 2 hours in all sources

A

Case: Which statement about anion gap and urine ketones for DKA resolution is correct?
A) Anion gap is reliable; urine ketones are reliable
B) Anion gap can mislead in hyperchloremic non-anion-gap acidosis, and urine ketones lag behind serum BHB
C) Only urine ketones should be used
D) Neither should be checked

B