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I-HUMAN CASES GERIATRICS EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
i-Human Cases Exam: Geriatrics
70 Questions with Detailed Rationales
Based on Common i-Human Virtual Simulation Scenarios
CASE 1: 82-Year-Old Male with Confusion and Polyuria – Diabetes and
Hyperglycemia (Questions 1-12)
Question 1
An 82-year-old male with a history of type 2 diabetes presents with confusion,
polyuria, and polydipsia over the past 2 days. His blood glucose is 450 mg/dL. What
is the most likely diagnosis?
A) Diabetic ketoacidosis (DKA)
B) Hyperosmolar hyperglycemic state (HHS)
C) Hypoglycemia
D) Urinary tract infection
Answer: B
Rationale: HHS is a life-threatening complication of diabetes, more common in older
adults. It is characterized by severe hyperglycemia (>600 mg/dL), hyperosmolality, and
dehydration without significant ketosis. Symptoms include confusion, polyuria, and
polydipsia.
Question 2
What is the most important initial intervention for a patient with HHS?
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A) Insulin therapy
B) Intravenous fluid resuscitation
C) Antibiotics
D) Sodium bicarbonate
Answer: B
Rationale: The priority in HHS is fluid resuscitation with isotonic saline (0.9% NaCl) to
correct dehydration and improve perfusion. Insulin therapy is also important but should
be initiated after fluid resuscitation. Hypokalemia must be corrected before insulin
administration.
Question 3
What is the most important complication of HHS?
A) Cerebral edema
B) Thromboembolism
C) Cardiac arrhythmias
D) Acute kidney injury
Answer: B
Rationale: Thromboembolism (e.g., DVT, PE, stroke) is a major complication of HHS
due to severe dehydration and hyperviscosity. Prophylactic anticoagulation is often
indicated. Other complications include acute kidney injury, cardiac arrhythmias, and
coma.
Question 4
The patient's serum osmolality is 340 mOsm/kg. What is the significance of this
finding?
A) Normal osmolality
B) Severe hyperosmolality
C) Mild hyperosmolality
D) Hypoosmolality
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Answer: B
Rationale: Serum osmolality >320 mOsm/kg indicates hyperosmolality. This is a key
diagnostic feature of HHS. Elevated osmolality contributes to confusion and other
neurological symptoms.
Question 5
What is the most appropriate insulin regimen for HHS?
A) Regular insulin IV infusion
B) Long-acting insulin SC
C) Short-acting insulin SC
D) No insulin needed
Answer: A
Rationale: Regular insulin IV infusion is the preferred insulin regimen for HHS. It allows
for rapid and precise glucose control. Insulin should be initiated after fluid resuscitation
and correction of hypokalemia. The goal is to lower glucose by 50-75 mg/dL per hour.
Question 6
What is the most important electrolyte to monitor in HHS?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
Answer: B
Rationale: Potassium levels should be closely monitored in HHS. Insulin therapy can
cause hypokalemia by shifting potassium into cells. Hypokalemia can lead to cardiac
arrhythmias. Potassium should be replaced as needed to maintain levels >3.3 mEq/L.
Question 7
The patient has a history of dementia and lives alone. What is the most important
I-HUMAN CASES GERIATRICS EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
i-Human Cases Exam: Geriatrics
70 Questions with Detailed Rationales
Based on Common i-Human Virtual Simulation Scenarios
CASE 1: 82-Year-Old Male with Confusion and Polyuria – Diabetes and
Hyperglycemia (Questions 1-12)
Question 1
An 82-year-old male with a history of type 2 diabetes presents with confusion,
polyuria, and polydipsia over the past 2 days. His blood glucose is 450 mg/dL. What
is the most likely diagnosis?
A) Diabetic ketoacidosis (DKA)
B) Hyperosmolar hyperglycemic state (HHS)
C) Hypoglycemia
D) Urinary tract infection
Answer: B
Rationale: HHS is a life-threatening complication of diabetes, more common in older
adults. It is characterized by severe hyperglycemia (>600 mg/dL), hyperosmolality, and
dehydration without significant ketosis. Symptoms include confusion, polyuria, and
polydipsia.
Question 2
What is the most important initial intervention for a patient with HHS?
, Page 2 of 29
A) Insulin therapy
B) Intravenous fluid resuscitation
C) Antibiotics
D) Sodium bicarbonate
Answer: B
Rationale: The priority in HHS is fluid resuscitation with isotonic saline (0.9% NaCl) to
correct dehydration and improve perfusion. Insulin therapy is also important but should
be initiated after fluid resuscitation. Hypokalemia must be corrected before insulin
administration.
Question 3
What is the most important complication of HHS?
A) Cerebral edema
B) Thromboembolism
C) Cardiac arrhythmias
D) Acute kidney injury
Answer: B
Rationale: Thromboembolism (e.g., DVT, PE, stroke) is a major complication of HHS
due to severe dehydration and hyperviscosity. Prophylactic anticoagulation is often
indicated. Other complications include acute kidney injury, cardiac arrhythmias, and
coma.
Question 4
The patient's serum osmolality is 340 mOsm/kg. What is the significance of this
finding?
A) Normal osmolality
B) Severe hyperosmolality
C) Mild hyperosmolality
D) Hypoosmolality
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Answer: B
Rationale: Serum osmolality >320 mOsm/kg indicates hyperosmolality. This is a key
diagnostic feature of HHS. Elevated osmolality contributes to confusion and other
neurological symptoms.
Question 5
What is the most appropriate insulin regimen for HHS?
A) Regular insulin IV infusion
B) Long-acting insulin SC
C) Short-acting insulin SC
D) No insulin needed
Answer: A
Rationale: Regular insulin IV infusion is the preferred insulin regimen for HHS. It allows
for rapid and precise glucose control. Insulin should be initiated after fluid resuscitation
and correction of hypokalemia. The goal is to lower glucose by 50-75 mg/dL per hour.
Question 6
What is the most important electrolyte to monitor in HHS?
A) Sodium
B) Potassium
C) Calcium
D) Magnesium
Answer: B
Rationale: Potassium levels should be closely monitored in HHS. Insulin therapy can
cause hypokalemia by shifting potassium into cells. Hypokalemia can lead to cardiac
arrhythmias. Potassium should be replaced as needed to maintain levels >3.3 mEq/L.
Question 7
The patient has a history of dementia and lives alone. What is the most important
