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

A 35-year-old man presents to the emergency department with fever, nausea, vomiting, and diarrhea for the last 2 days. His vital signs are:

  • temperature 100.6°F
  • HR 115 bpm
  • BP 70/50 mm Hg
  • RR 25/min

His abdominal examination is soft and nontender. His only past medical history is unexplained orthostasis. Despite administration of 6 L of normal saline over 3 hours, he remains hypotensive and is started on a norepinephrine infusion. Point of care ultrasound reveals normal cardiac function.

Which of the following laboratory tests would be most immediately helpful to establishing a diagnosis and to guide treatment?

A. Cortisol
B. ACTH stimulation
C. Insulin
D. Aldosterone


Question 2#Print Question

A 76-year-old man with COPD, and prior head and neck radiation for a pituitary tumor, and worsening dementia presents with hypotension after running out of his medications last week. He is admitted to the ICU for management of hypotension.

Which of the following electrolyte values are most likely present?

A. Na 129 mEq/L; K 5.4 mEq/L; HCO3 18 mEq/L; BUN 30 mg/dL; Glucose 84 mg/dL
B. Na 129 mEq/L; K 3.9 mEq/L; HCO3 20 mEq/L; BUN 12 mg/dL; Glucose 84 mg/dL
C. Na 140 mEq/L; K 2.7 mEq/L; HCO3 28 mEq/L; BUN 30 mg/dL; Glucose 180 mg/dL
D. Na 145 mEq/L; K 4.3 mEq/L; HCO3 24 mEq/L; BUN 12 mg/dL; Glucose 140 mg/dL


Question 3#Print Question

A 56-year-old woman with hypertension, rheumatoid arthritis, and gastroesophageal reflux disease presents with perforated diverticulitis. Her home medications include lisinopril 10 mg, prednisone 15 mg, and omeprazole 40 mg. After emergent small bowel resection she was admitted to the ICU with low-dose norepinephrine. She is initially treated with piperacillin-tazobactam, and her home prednisone is continued. She remains vasopressordependent despite 30 mL/kg of normal saline and the addition of vasopressin.

Which of the following treatment regimens is most appropriate at this time?

A. Change antibiotics to cefepime and metronidazole
B. Start intravenous corticosteroids
C. Give additional bolus of 2 L of albumin
D. Start an epinephrine infusion


Question 4#Print Question

A 26-year-old woman with a history of seizures controlled on phenytoin has been undergoing chemotherapy for treatment of acute myelogenous leukemia. She is admitted to the ICU with fungal pneumonia. She is intubated with etomidate and rocuronium, started on ketoconazole, and given 30 mL/kg of normal saline. Thirty-six hours later she becomes increasingly hypotensive despite escalating vasopressor doses. She is subsequently treated with hydrocortisone with good response.

Which of the following medications likely contributed to her clinical decompensation? 

A. Phenytoin
B. Etomidate
C. Ketoconazole
D. All of the above


Question 5#Print Question

A 56-year-old woman is admitted to the ICU with septic shock from community-acquired pneumonia. She is intubated with etomidate and rocuronium, fluid resuscitated with 30 mL/kg of normal saline and treated with cefepime and levofloxacin. Despite treatment she becomes increasingly hypotensive requiring escalating vasopressor doses. A random cortisol level is sent to test for adrenal insufficiency.

Which of the following levels would be the lowest indicating an ADEQUATE adrenal response?

A. 4 µg/dL
B. 13 µg/dL
C. 25 µg/dL
D. 50 µg/dL




Category: Critical Care Medicine-Endocrine Disorders--->Hypothalamic-Pituitary-Adrenal Axis
Page: 1 of 2