Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Endocrine Disorders--->Pituitary
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Question 1# Print Question

A 42-year-old man is brought to the emergency department by his family after suffering a generalized seizure that lasted for 10 seconds. His past medical history includes depression, schizophrenia, 20 pack-year smoking history, heavy alcohol use, but no documented cirrhosis. His pulse is 94 beats/min, blood pressure 108/62 mm Hg, respiration rate 14 breaths/min, and is afebrile. Physical examination demonstrates normal skin turgor, clear lungs, normal cardiac examination, trace edema, and nonfocal neurologic examination. Head computed tomography (CT) is negative and chest X-ray shows a possible hilar/perihilar mass with mediastinal widening. His labs are:

  • sodium 118 mEq/L
  • potassium 4.2 mEq/L
  • chloride 87 mEq/L
  • bicarbonate 23 mEq/L
  • urea nitrogen 12 mg/dL
  • creatinine 1.2 mg/dL
  • glucose 118 mg/dL
  • Measured serum osmolality is 265 mOsm/kg
  • Urine sodium is 36 mEq/L
  • urine osmolality is 355 mOsm/kg

Alcohol level is 0 and toxicology screen is negative.

What is the most likely etiology of this patient’s symptoms?

A. Syndrome of inappropriate antidiuretic hormone (ADH)
B. Psychogenic polydipsia
C. Cerebral salt wasting
D. Early cirrhosis

Question 2# Print Question

A 49-year-old man who presented with chief complaint of “severe headache” was diagnosed with a subarachnoid hemorrhage (SAH) without hydrocephalus and significant neurological defects. After successful intravascular coiling of a right posterior communicating artery aneurysm, he is admitted to the intensive care unit (ICU). On postoperative day 1, patient complains of feeling weak, then becomes progressively more confused. Labs drawn prior to his seizure demonstrate the following:

  • sodium 122 mEq/L
  • potassium 3.4 mEq/L
  • chloride 91 mEq/L
  • bicarbonate 26 mEq/L
  • urea 12 mg/dL
  • creatinine 0.6 mEq/L
  • Fingerstick glucose is 89 mg/dL

Additional studies are ordered which demonstrate urine sodium of 40 mmol/L, urine osmolality of 452 mOsm/kg, and serum osmolality of 265 mOsm/kg. The patient then suffers a grand mal seizure which is terminated with intravenous levetiracetam.

Which is the most appropriate next step in management?

A. Immediate reimaging and neurosurgical consult
B. Administration of hypertonic saline
C. Demeclocycline
D. Fluid restriction

Question 3# Print Question

Which of the following is NOT associated with nephrogenic diabetes insipidus (DI)?

A. Amphotericin B
B. Lithium
C. Hyperkalemia
D. Hypercalcemia

Question 4# Print Question

A 26-year-old, previously healthy, G1P0 female at 36 weeks gestational age comes to the emergency department due to polyuria, nocturia, and polydipsia. Her pulse is 78 beats/min, blood pressure 102/63 mm Hg, and weight 53 kg (BMI 22.6 kg/m2 ). Physical examination is normal except for decreased skin turgor and dry mucous membranes. Laboratory data reveal:

  • low urine osmolality 89 mOsmol/kg (normal 350-1000)
  • serum osmolality 308 mOsmol/kg (normal 278-295)
  • serum sodium 144 mEq/L
  • potassium 4.1 mEq/L
  • chloride 109 mEq/L
  • blood urea nitrogen 10 mg/dL
  • creatinine 0.7 mg/dL
  • glucose 110 mg/dL
  • HbA1c 5.3%

Serum ADH is 0.5 pg/mL (normal 1-5 pg/mL). MRI of her brain demonstrates no acute findings.

Which of the following statements best explains her symptoms?

A. Kidney disease affecting renal sensitivity to ADH
B. Ischemic insult decreasing release of ADH
C. Placental trophoblasts producing excessive vasopressinase
D. Autoimmune destruction of the pituitary

Question 5# Print Question

A 70-year-old male with past medical history of hypertension and headaches presents to the emergency department with a severe headache, double vision, nausea, and vomiting. Initial evaluation demonstrated hyponatremia, hyperkalemia, and intravascular volume depletion. Given concern for an intracranial process, an MRI was performed which demonstrated a hemorrhagic pituitary macroadenoma. You would like to initiate corticosteroid therapy.

Which of the following choices has the correct order of steroids from least to most potent?

A. Hydrocortisone < cortisone < prednisone < dexamethasone
B. Cortisone < hydrocortisone < dexamethasone < prednisone
C. Cortisone < hydrocortisone < prednisone < dexamethasone
D. Cortisone < dexamethasone < hydrocortisone < prednisone

Category: Critical Care Medicine-Endocrine Disorders--->Pituitary
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