Endocrinology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology

Sample item

A 19-year-old with type 1 diabetes presents with vomiting, deep rapid breathing, fruity breath and a glucose of 450 mg/dL. After airway and monitoring, what is the most important first step?

AIntravenous sodium bicarbonate bolusBIntravenous 0.9% salineCSubcutaneous long-acting insulinDIntravenous potassium chloride bolus

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous 0.9% saline

DKA treatment starts with isotonic fluid resuscitation. Insulin infusion follows once serum potassium is confirmed above about 3.3 mmol/L, and potassium is replaced as needed. Bicarbonate is not routine.

Option by option

A. Intravenous sodium bicarbonate bolus
Bicarbonate is reserved for very severe acidosis and is not routine.
B. Intravenous 0.9% saline (correct)
Correct. Volume first.
C. Subcutaneous long-acting insulin
Subcutaneous long-acting insulin is not used to treat DKA.
D. Intravenous potassium chloride bolus
A potassium bolus would be dangerous; potassium is added to fluids according to levels.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Intravenous 0.9% saline. DKA treatment starts with isotonic fluid resuscitation.

Why is "Intravenous sodium bicarbonate bolus" not the answer?

Bicarbonate is reserved for very severe acidosis and is not routine.

Why is "Subcutaneous long-acting insulin" not the answer?

Subcutaneous long-acting insulin is not used to treat DKA.

Why is "Intravenous potassium chloride bolus" not the answer?

A potassium bolus would be dangerous; potassium is added to fluids according to levels.

What concept does this question test?

It tests Endocrinology in General Medicine. Insulin infusion follows once serum potassium is confirmed above about 3.3 mmol/L, and potassium is replaced as needed. Bicarbonate is not routine.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.