Hyperosmolar Hyperglycemic State and Diabetic Complications Practice Questions

25 multiple-choice questions on Hyperosmolar hyperglycemic state and diabetic complications for paramedic and EMT students, from Chapter 24 (Endocrine Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. HHS is increasingly seen in which group besides older adults?

   1. A. Youth with type 2 diabetes
   2. B. Infants with colic
   3. C. Adults with no diabetes risk
   4. D. Pregnant women with no diabetes
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   Answer: A. Youth with type 2 diabetes

   With rising obesity, type 2 diabetes and HHS (often mixed with DKA) now occur in adolescents and young adults, sometimes as the first sign of diabetes, with high mortality.

2. Ketones stay low in HHS mainly because:

   1. A. The liver cannot make any ketones
   2. B. Ketones are lost in the sweat
   3. C. Glucose blocks the ketone test strip reaction
   4. D. Some insulin still blocks fat breakdown
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   Answer: D. Some insulin still blocks fat breakdown

   In HHS, enough insulin remains to suppress breakdown of fat into ketones, but not enough to control glucose, so severe hyperglycemia and dehydration develop without much acidosis.

3. HHS develops over:

   1. A. Several minutes
   2. B. About one hour
   3. C. Days to weeks
   4. D. A few seconds
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   Answer: C. Days to weeks

   Slow onset allows extreme glucose and fluid loss. DKA usually develops over hours to a day.

4. An 82-year-old nursing home resident has confusion, very dry mucous membranes, and a glucose of 'HI.' He is breathing normally. You suspect:

   1. A. DKA
   2. B. HHS
   3. C. Hypoglycemia
   4. D. Thyroid storm
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   Answer: B. HHS

   Severe dehydration and confusion with very high glucose and no Kussmaul breathing fit HHS.

5. The most prominent problem in HHS is:

   1. A. Severe acidosis
   2. B. Low blood glucose
   3. C. Severe hypertension
   4. D. Severe dehydration
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   Answer: D. Severe dehydration

   Fluid deficits can be 8 to 10 liters. Restoring volume is the main treatment.

6. HHS patients may present with neurologic findings such as:

   1. A. Hyperactive reflexes in the legs
   2. B. Seizures or focal deficits
   3. C. Sudden hearing loss in one ear
   4. D. Loss of taste and smell
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   Answer: B. Seizures or focal deficits

   High osmolality affects the brain, causing confusion, seizures (often focal), coma, and stroke-like deficits that can improve as the HHS is treated. Check glucose before assuming stroke.

7. Why is mortality higher in HHS than in DKA?

   1. A. Older patients, more illness
   2. B. It always occurs in children
   3. C. It causes more acidosis
   4. D. It responds faster to insulin
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   Answer: A. Older patients, more illness

   HHS patients are often elderly with heart and kidney disease, and the condition is often found late.

8. Fluid resuscitation in an elderly HHS patient should be:

   1. A. Withheld to prevent edema
   2. B. Given only orally
   3. C. Steady with lung reassessment
   4. D. Given as fast as possible without monitoring
   Show answer

   Answer: C. Steady with lung reassessment

   These patients need large volumes but may have heart failure. Reassess lung sounds and vitals after each bolus.

9. Which medication can help trigger HHS in an older adult with type 2 diabetes?

   1. A. An ACE inhibitor for BP
   2. B. Daily low-dose aspirin for the heart
   3. C. A steroid or thiazide diuretic
   4. D. Acetaminophen for arthritis
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   Answer: C. A steroid or thiazide diuretic

   Steroids raise glucose and thiazides cause fluid loss and impair insulin release, so both can tip a patient into HHS, as can some antipsychotics. Infection remains the most common trigger. ACE inhibitors, low-dose aspirin, and acetaminophen do not meaningfully raise glucose.

10. A nursing home resident with dementia develops HHS. Her dehydration became severe partly because she:

    1. A. Drank too much juice
    2. B. Could not get water herself
    3. C. Took too much insulin
    4. D. Ate too much salt with meals
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    Answer: B. Could not get water herself

    Patients who depend on others for fluids, because of dementia, stroke, or immobility, cannot respond to thirst, so osmotic diuresis quickly leads to profound dehydration.

11. Because of thick, concentrated blood, patients in HHS are at increased risk of:

    1. A. Bleeding from thin blood
    2. B. A very slow heart rate
    3. C. Low pressure in the lungs
    4. D. Blood clots
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    Answer: D. Blood clots

    Dehydration and high osmolality thicken the blood and activate clotting, raising the risk of stroke, MI, and DVT. Hospitals often give clot prevention.

12. A diabetic in DKA has facial swelling, a black crust in the nose, and fever. You should suspect:

    1. A. A fungal sinus infection
    2. B. A simple nosebleed
    3. C. Seasonal allergies
    4. D. A dental abscess in the jaw
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    Answer: A. A fungal sinus infection

    Mucormycosis is an aggressive fungal infection that thrives in ketoacidosis and can spread from the sinuses to the eye and brain. Black necrotic tissue is a warning sign and needs emergency surgery.

13. Diabetic autonomic neuropathy can cause:

    1. A. A bladder that empties poorly
    2. B. Faster wound healing
    3. C. Better hypoglycemia warning
    4. D. Higher heart rate variability
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    Answer: A. A bladder that empties poorly

    Autonomic neuropathy can damage bladder nerves, causing retention and recurrent UTIs, as well as gastroparesis, orthostatic hypotension, and loss of hypoglycemia warning signs.

14. A diabetic has a resting heart rate of 105 that does not change when he stands. This most likely reflects:

    1. A. Normal fitness training
    2. B. Too much thyroid hormone
    3. C. Dehydration from hard exercise
    4. D. Loss of vagal heart control
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    Answer: D. Loss of vagal heart control

    Cardiac autonomic neuropathy causes a fixed resting tachycardia with little variation, and it is linked to silent ischemia and sudden death.

15. Why can gastroparesis make a diabetic's glucose hard to control?

    1. A. It makes the pancreas work faster
    2. B. Food is absorbed at irregular times
    3. C. It blocks insulin from the liver
    4. D. It causes high potassium in the blood
    Show answer

    Answer: B. Food is absorbed at irregular times

    With delayed stomach emptying, mealtime insulin may act before food is absorbed, causing lows, followed by highs later. This mismatch is common in long-standing diabetes.

16. A diabetic foot ulcer with crepitus and foul odor suggests:

    1. A. Normal wound healing tissue
    2. B. A simple callus
    3. C. Necrotizing infection
    4. D. Dry, cracked skin
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    Answer: C. Necrotizing infection

    Gas in tissue suggests a severe necrotizing infection that needs emergency surgery.

17. Charcot foot in diabetics is:

    1. A. A fungal nail infection
    2. B. Neuropathic joint collapse
    3. C. An acute gout attack in the toe
    4. D. A sprained ankle ligament
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    Answer: B. Neuropathic joint collapse

    Loss of sensation allows repeated injury, leading to collapse of foot joints.

18. Diabetics with peripheral vascular disease are at risk for:

    1. A. Improved collateral circulation
    2. B. Faster wound healing
    3. C. Poor healing, amputation
    4. D. Lower infection risk
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    Answer: C. Poor healing, amputation

    Narrowed arteries reduce blood flow to the legs, slowing healing.

19. Autonomic neuropathy may cause which finding when the patient stands?

    1. A. Bradycardia only on rising
    2. B. Hypertension
    3. C. Increased sweating at rest
    4. D. Orthostatic hypotension
    Show answer

    Answer: D. Orthostatic hypotension

    Damaged nerves fail to tighten blood vessels when standing, causing dizziness or fainting.

20. Which glucose level is typical in HHS?

    1. A. Above 600 mg/dL
    2. B. Below 70 mg/dL
    3. C. About 100 mg/dL
    4. D. About 200 mg/dL
    Show answer

    Answer: A. Above 600 mg/dL

    HHS involves extreme hyperglycemia, often above 600 to 1,000 mg/dL.

21. The total fluid deficit in a typical adult with HHS is about:

    1. A. 8 to 10 liters
    2. B. 200 to 300 mL
    3. C. 1 to 2 liters
    4. D. 25 to 30 liters
    Show answer

    Answer: A. 8 to 10 liters

    Prolonged osmotic diuresis in HHS causes a large water deficit, often around 9 liters in adults, which is why fluids are replaced steadily over 24 to 48 hours.

22. In the hospital, glucose in HHS is lowered gradually rather than very quickly to avoid:

    1. A. Kidney stones
    2. B. Brain swelling
    3. C. High blood pressure
    4. D. Allergic reactions
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    Answer: B. Brain swelling

    A rapid fall in glucose and osmolality can shift water into brain cells and cause cerebral edema. Guidelines aim for gradual correction.

23. A patient with newly found, very high glucose has blurry vision. This is usually caused by:

    1. A. A detached retina
    2. B. A brain tumor
    3. C. Glaucoma from high pressure
    4. D. Lens swelling from glucose
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    Answer: D. Lens swelling from glucose

    High glucose draws fluid into the lens, changing its shape and causing temporary blurred vision that improves as glucose normalizes. Sudden painful vision loss would need other evaluation.

24. An older patient found on the floor in HHS should also be assessed for:

    1. A. Seasonal allergies
    2. B. A recent tooth infection
    3. C. Pressure injury and muscle damage
    4. D. Hearing loss from loud noise exposure
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    Answer: C. Pressure injury and muscle damage

    Patients with HHS often lie on the floor for hours, risking pressure injury and rhabdomyolysis, which worsens kidney injury. Check skin, extremities, and urine color.

25. Which finding is most typical of severe dehydration in HHS?

    1. A. Dry mouth and tachycardia
    2. B. Moist skin and bradycardia
    3. C. Crackles and pitting edema
    4. D. Hypertension and flushing
    Show answer

    Answer: A. Dry mouth and tachycardia

    Dehydration reduces blood volume, causing a fast pulse and dry mucous membranes.