--- title: Question Report - Dyspnea secondary to metabolic acidosis / DKA Path description: "Question Report we want your feedback - Dyspnea secondary to metabolic acidosis / DKA Path: Emergency Medicine," image: https://challengercme.com/hubfs/Screenshot%202023-07-17%20121331.jpg --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/question-report-dyspnea-secondary-to-metabolic-acidosis-/-dka-path-emergency-medicine#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) # Question Report - Dyspnea secondary to metabolic acidosis / DKA Path Question Report we want your feedback - Dyspnea secondary to metabolic acidosis / DKA Path: Emergency Medicine, [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Jul 17, 2023 ### < [All Posts](https://challengercme.com/blog) Try Med-Challenger Start a free trial today and save! 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[BROWSE COURSES](https://fuse.challengercme.com/store) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/question-report-dyspnea-secondary-to-metabolic-acidosis-/-dka-path-emergency-medicine&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/question-report-dyspnea-secondary-to-metabolic-acidosis-/-dka-path-emergency-medicine&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/question-report-dyspnea-secondary-to-metabolic-acidosis-/-dka-path-emergency-medicine&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/question-report-dyspnea-secondary-to-metabolic-acidosis-/-dka-path-emergency-medicine&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![Dyspnea secondary to metabolic acidosis / DKA Path](https://challengercme.com/hubfs/Screenshot%202023-07-17%20121331.jpg) Challenger's 'Report Question' button allows people using a course to comment on questions, ask for clarification, or tell us about inaccuracies or issues with a question.  These are sent to an AI model, and to human clinical editors to determine if the question needs to be changed. Comments can be as simple as a question being overly complicated for the level of test preparation or CME intended, or point out conflicting guidelines and publications.  We are publishing most of these reports on our blog, to see what other clinicians think. | Question | Dyspnea secondary to metabolic acidosis / DKA Path: Emergency Medicine | | --- | --- | | Question Stem | A 56-year-old surgical nurse presents to you with a history of shortness of breath while at work in the operating room. He reports a 2- to 3-day history of gradually worsening shortness of breath, which he describes as difficulty catching his breath. He says he was tachypneic while at work in the operating room. He denies fever, cough, chest pain, or palpitations. His past medical history is unremarkable. His family history is remarkable for diabetes mellitus, including an adult brother with insulin-dependent diabetes mellitus. Vital signs are: temperature 99°F, heart rate 120 beats/minute, respiratory rate 26 breaths/minute, blood pressure 120/80 mm Hg, and oxygen saturation 99% on room air. Cardiac examination is remarkable only for tachycardia. Lungs are clear to auscultation. You observe that the patient is taking deep frequent breaths that interrupt his speech. Abdomen is soft and nontender. The physical examination is remarkable for a severe gangrenous wound with partial loss of the right great toe. Which of the following tests or imaging modalities is most likely to reveal the etiology of this patient’s dyspnea? | | Answer 1 | complete blood count | | Answer 2 | electrocardiography | | Answer 3 | chest x-ray | | Answer 4 | complete metabolic panel (correct answer) | | Answer 5 | cardiac markers | | Incorrect Answer Remediation | This patient is demonstrating the deep rapid pattern of Kussmaul breathing. Kussmaul breathing represents respiratory compensation for severe metabolic acidosis, and it is most commonly associated with diabetic ketoacidosis. A complete blood count, electrocardiography, chest x-ray, and cardiac markers are all helpful in the evaluation of dyspnea but are not likely to reveal this patient’s primary pathology. The metabolic panel is most likely to reveal the etiology of the patient’s dyspnea and support the diagnosis of diabetic ketoacidosis, including a blood glucose level above 250 mg/dL, anion gap greater than 10, and a bicarbonate level below 15 mEq/L. An arterial blood gas level revealing pH less than 7.3 and positive serum ketones would further confirm the diagnosis. | | References | Chansky ME, Lubkin CL. Diabetic ketoacidosis. In: Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed., 2011:1432-1438. Sarko J, Stapczynski JS. Respiratory distress. In: Tintinalli JE, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed., 2011:465-473. | Question has been reported with the following comment: *This would be much more believable if the patient was in his twenties.* | Challenger's AI Responded | It appears the user is questioning the plausibility of the clinical scenario given the patient's age. While it's true that diabetic ketoacidosis (DKA) is more common in younger people, especially those with type 1 diabetes, it's important to note that DKA can occur at any age and in any type of diabetes when glucose regulation is significantly disrupted. In the scenario presented, the patient has a family history of diabetes mellitus, and also presents with a severe gangrenous wound on his toe, which could be a sign of undiagnosed or poorly controlled diabetes mellitus, potentially leading to a situation of uncontrolled hyperglycemia and DKA. The signs of DKA, such as the Kussmaul breathing described, can occur in any individual with severe metabolic acidosis, irrespective of their age. Therefore, while the scenario might be less typical (given the patient's age and absence of known diabetes), it is still medically plausible. This question might have been designed to challenge the learner's ability to recognize DKA even in less typical presentations. Nonetheless, feedback like this is valuable for improving the real-world applicability of the learning materials. | | --- | --- | | Clinical Editor Response | While the case is plausible, this is an exam preparation course, and the learning objective of the question was to recognize Kussmaul breathing as a DKA sign in absence of other indicators, not specifically to show that DKA can occur at any age.  Given the learning objective, the scenario should be rewritten. If we're going to do atypical presentations, it should go into the confounding signs and symptoms section. | What do you think? ``` ```       ## Similar posts internal medicine ### [23-year-old with type 1 diabetes presenting with large rash](https://challengercme.com/blog/23-year-old-with-type-1-diabetes-presenting-with-large-rash) It's Quiz Time with Med-Challenger! Med-Challenger Oct 30, 2024 family medicine ### [24-year-old woman with type 1 diabetes mellitus and poor compliance is admitted to the ICU](https://challengercme.com/blog/24-year-old-woman-with-type-1-diabetes-mellitus-and-poor-compliance-is-admitted-to-the-icu) It's Diabetes Mellitus Quiz Time with Med-Challenger! Med-Challenger Dec 15, 2024 emergency medicine ### [80 year old man with a history of diabetes mellitus](https://challengercme.com/blog/80-year-old-man-with-a-history-of-diabetes-mellitus) It's Emergency Medicine Quiz Time with Med-Challenger! 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "BlogPosting", "about" : [ "diabetic ketoacidosis (DKA)", "Kussmaul breathing", "metabolic acidosis", "complete metabolic panel", "arterial blood gas", "anion gap", "bicarbonate", "serum ketones", "exam preparation", "medical education", "question reporting / feedback" ], "articleSection" : "Emergency Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2023-07-17T18:18:57.759Z", "datePublished" : "2023-07-17T18:18:57.000Z", "description" : "Question Report we want your feedback - Dyspnea secondary to metabolic acidosis / DKA Path: Emergency Medicine", "headline" : "Question Report - Dyspnea secondary to metabolic acidosis / DKA Path: Emergency Medicine", "image" : [ { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation (site/branding image used on the article).", "name" : "Med-Challenger Medical Education, a Division of Challenger Corporation" } ], "inLanguage" : "en-US", "keywords" : [ "diabetic ketoacidosis", "DKA", "Kussmaul breathing", "metabolic acidosis", "complete metabolic panel", "arterial blood gas", "anion gap", "bicarbonate", "emergency medicine", "exam preparation", "medical education", "question report" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/question-report-dyspnea-secondary-to-metabolic-acidosis-/-dka-path-emergency-medicine", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Complete metabolic panel. The patient demonstrates Kussmaul breathing — a deep rapid pattern representing respiratory compensation for severe metabolic acidosis, most commonly seen in diabetic ketoacidosis. A metabolic panel is most likely to show findings that support DKA (blood glucose > 250 mg/dL, anion gap > 10, bicarbonate < 15 mEq/L). An arterial blood gas with pH < 7.3 and positive serum ketones would further confirm the diagnosis." }, "name" : "Which test is most likely to reveal the etiology of this patient’s dyspnea?", "text" : "A 56-year-old surgical nurse presents with 2–3 days of gradually worsening shortness of breath, tachypnea (RR 26), tachycardia, clear lungs, oxygen saturation 99% on room air, and deep frequent breaths interrupting speech. Physical exam shows a severe gangrenous wound of the right great toe. Which of the following tests or imaging modalities is most likely to reveal the etiology of this patient’s dyspnea? (choices: complete blood count; electrocardiography; chest x-ray; complete metabolic panel; cardiac markers)" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Complete metabolic panel — Kussmaul breathing indicates respiratory compensation for metabolic acidosis, commonly due to DKA. CMP can demonstrate hyperglycemia (>250 mg/dL), an elevated anion gap (>10), and low bicarbonate (<15 mEq/L); ABG with pH < 7.3 and positive serum ketones would further confirm DKA." }, "name" : "Which test is most likely to reveal the etiology of this patient’s dyspnea?" }, "position" : 1 } ], "name" : "Practice Questions", "numberOfItems" : 1 } ```