Clinical Judgment First
A patient with type 1 DM presents with polyuria, polydipsia, nausea, and fruity breath. ABG shows metabolic acidosis.
What is diabetic ketoacidosis (DKA) requiring immediate insulin and IV fluid therapy?
A patient receiving insulin becomes diaphoretic, tremulous, and confused.
What is hypoglycemia, and the priority is to check blood glucose and administer a rapid‑acting carbohydrate?
A newly diagnosed type 2 DM patient asks how exercise lowers glucose levels.
What is increased insulin sensitivity and glucose uptake by skeletal muscle?
Excess cortisol causes hyperglycemia, muscle wasting, and truncal obesity.
What is Cushing syndrome?
This insulin has no peak and provides basal coverage for 24 hours.
What is insulin glargine or detemir?
A patient post‑thyroidectomy suddenly develops perioral tingling and carpopedal spasms.
What is acute hypocalcemia requiring airway assessment and IV calcium gluconate?
A patient with hyperthyroidism is febrile, tachycardic, and agitated post‑surgery.
What is thyroid storm, and the priority is airway, beta‑blockers, and cooling measures?
A patient on basal‑bolus insulin asks why long‑acting insulin is continued when NPO.
What is preventing hepatic glucose output and ketosis even without food intake?
A patient with pituitary adenoma presents with enlarged hands, feet, and cardiomegaly.
What is acromegaly due to excess growth hormone?
A patient on sulfonylureas must be monitored closely for this adverse effect.
What is hypoglycemia due to increased insulin release?
A patient with SIADH has Na⁺ 118 mEq/L, headache, and confusion.
What is the risk for increased intracranial pressure and the need for fluid restriction and hypertonic saline?
A patient with diabetes and gastroparesis has erratic postprandial glucose levels.
What is the need to prioritize timing insulin administration after meals rather than before?
A patient with recurrent hypoglycemia lives alone.
What is the importance of continuous glucose monitoring (CGM) and carrying fast‑acting glucose?
A patient with diabetes insipidus has high serum osmolality and dilute urine.
What is deficiency of ADH requiring desmopressin and close I&O monitoring?
This medication class improves insulin sensitivity but causes fluid retention and weight gain.
What are thiazolidinediones (e.g., pioglitazone)?
A patient with long‑standing type 2 DM reports nocturnal diaphoresis and morning hyperglycemia.
What is the Somogyi effect caused by nocturnal hypoglycemia triggering counter‑regulatory hormone release?
A confused patient with DM found unresponsive has an unknown glucose level.
What is administering glucagon if IV access is unavailable as the safest immediate intervention?
A patient with type 2 DM and CKD asks why metformin was discontinued.
What is risk for lactic acidosis when renal function declines?
A patient with hypothyroidism has bradycardia, hypothermia, and altered mental status.
What is myxedema coma requiring IV levothyroxine and ventilatory support?
A patient with pheochromocytoma is prepared for surgery.
What is the need for alpha‑blockade before beta‑blockers to prevent hypertensive crisis?
A patient with adrenal insufficiency presents with hypotension, hyponatremia, hyperkalemia, and hypoglycemia after abrupt steroid discontinuation.
What is an adrenal crisis requiring immediate IV hydrocortisone and isotonic fluids?
A patient with DKA has K⁺ 5.8 mEq/L prior to insulin therapy.
What is assessing and closely monitoring potassium because insulin administration will shift potassium intracellularly?
A patient states, “I stop insulin when I’m sick because I’m not eating.”
What is incorrect sick‑day management increasing risk for DKA, and insulin should never be stopped?
Chronic hyperglycemia leads to nerve damage through sorbitol accumulation and ischemia.
What is diabetic peripheral neuropathy as a microvascular complication?
A hospitalized patient with DM is on enteral feedings.
What is scheduled basal and correction insulin rather than sliding‑scale insulin alone?