Question 1: A 45-year-old female presents to the emergency room with severe weakness, confusion, and a blood pressure of 80/50 mm Hg. Her vital signs reveal tachycardia, fever, and electrolyte imbalances. Laboratory results show hyponatremia, hyperkalemia, and elevated plasma adrenocorticotropic hormone (ACTH) levels. Which diagnostic test is most appropriate to confirm the diagnosis of adrenal crisis?
A) EKG
B) Chest X-ray
C) 24-hour urinary cortisol
D) Serum aldosterone level
E) Serum cortisol level
Explanation: Measurement of serum cortisol levels is the gold standard for diagnosing adrenal crisis. In adrenal crisis, cortisol levels are significantly decreased, leading to the characteristic symptoms and laboratory findings.
Question 2: A 32-year-old male with known Addison’s disease presents to the clinic with complaints of nausea, vomiting, and abdominal pain. His vital signs reveal hypotension and tachycardia. Laboratory results show hyponatremia, hyperkalemia, and an elevated plasma ACTH level. What is the initial treatment of choice for this patient in adrenal crisis?
A) Intravenous (IV) hydrocortisone
B) Intravenous (IV) normal saline
C) Intravenous (IV) dextrose
D) Intravenous (IV) insulin and glucose
E) Intramuscular (IM) epinephrine
Explanation: The initial treatment of choice for adrenal crisis is the administration of IV hydrocortisone to replace deficient cortisol levels and stabilize the patient’s condition.
Question 3: A 55-year-old male presents with fatigue, weight loss, and muscle weakness. On physical examination, he has hyperpigmentation of his skin and mucous membranes. Laboratory tests reveal hyponatremia, hyperkalemia, and an elevated plasma ACTH level. What is the most likely diagnosis?
A) Cushing’s syndrome
B) Primary hyperaldosteronism
C) Hypothyroidism
D) Addison’s disease
E) Pheochromocytoma
Explanation: The clinical presentation of fatigue, hyperpigmentation, and electrolyte imbalances, along with an elevated ACTH level, is characteristic of Addison’s disease.
Question 4: A 28-year-old female with a history of adrenal insufficiency presents to the emergency room with confusion and severe dehydration. Her blood pressure is 60/40 mm Hg, and her heart rate is 120 bpm. Laboratory results show hyponatremia and hyperkalemia. Which of the following should be administered initially in the management of this patient’s dehydration?
A) Intravenous (IV) dextrose
B) Intravenous (IV) hydrocortisone
C) Intravenous (IV) normal saline
D) Intravenous (IV) potassium
E) Oral electrolyte replacement
Explanation: Initial management of dehydration in adrenal crisis includes IV normal saline to address volume depletion, followed by IV hydrocortisone to replace cortisol.
Question 5: A 40-year-old male with known primary adrenal insufficiency presents with abdominal pain, diarrhea, and a low-grade fever. Physical examination reveals mild dehydration. Laboratory results show hyponatremia, hyperkalemia, and an elevated plasma ACTH level. What is the most appropriate initial treatment for this patient’s acute symptoms?
A) Intravenous (IV) hydrocortisone
B) Intravenous (IV) normal saline
C) Intravenous (IV) potassium
D) Oral rehydration solution
E) Intravenous (IV) antibiotic therapy
Explanation: In a patient with known adrenal insufficiency experiencing acute symptoms, the initial treatment should involve IV hydrocortisone to address the underlying cortisol deficiency, which can worsen during stress or illness.
Question 6: A 45-year-old male presents to the emergency room with severe weakness, confusion, and a blood pressure of 80/50 mm Hg. His vital signs reveal tachycardia, fever, and electrolyte imbalances. Laboratory results show hyponatremia, hyperkalemia, and elevated plasma adrenocorticotropic hormone (ACTH) levels. Which diagnostic test is most appropriate to confirm the diagnosis of adrenal crisis?
A) Lumbar puncture
B) Chest X-ray
C) 24-hour urinary cortisol
D) Serum aldosterone level
E) Serum cortisol level
Explanation: Measurement of serum cortisol levels is the gold standard for diagnosing adrenal crisis. In adrenal crisis, cortisol levels are significantly decreased, leading to the characteristic symptoms and laboratory findings.
Question 7: A 30-year-old female with known Addison’s disease presents to the clinic with complaints of nausea, vomiting, and abdominal pain. Her vital signs reveal hypotension and tachycardia. Laboratory results show hyponatremia, hyperkalemia, and an elevated plasma ACTH level. What is the initial treatment of choice for this patient in adrenal crisis?
A) Intravenous (IV) hydrocortisone
B) Intravenous (IV) normal saline
C) Intravenous (IV) dextrose
D) Intravenous (IV) insulin and glucose
E) Intramuscular (IM) epinephrine
Explanation: The initial treatment of choice for adrenal crisis is the administration of IV hydrocortisone to replace deficient cortisol levels and stabilize the patient’s condition.
Question 8: A 50-year-old male presents with fatigue, weight loss, and muscle weakness. On physical examination, he has hyperpigmentation of his skin and mucous membranes. Laboratory tests reveal hyponatremia, hyperkalemia, and an elevated plasma ACTH level. What is the most likely diagnosis?
A) Cushing’s syndrome
B) Primary hyperaldosteronism
C) Hypothyroidism
D) Addison’s disease
E) Pheochromocytoma
Explanation: The clinical presentation of fatigue, hyperpigmentation, and electrolyte imbalances, along with an elevated ACTH level, is characteristic of Addison’s disease.
Question 9: A 25-year-old female with a history of adrenal insufficiency presents to the emergency room with confusion and severe dehydration. Her blood pressure is 60/40 mm Hg, and her heart rate is 120 bpm. Laboratory results show hyponatremia and hyperkalemia. Which of the following should be administered initially in the management of this patient’s dehydration?
A) Intravenous (IV) dextrose
B) Intravenous (IV) hydrocortisone
C) Intravenous (IV) normal saline
D) Intravenous (IV) potassium
E) Oral electrolyte replacement
Explanation: Initial management of dehydration in adrenal crisis includes IV normal saline to address volume depletion, followed by IV hydrocortisone to replace cortisol.
Question 10: A 35-year-old male with known primary adrenal insufficiency presents with abdominal pain, diarrhea, and a low-grade fever. Physical examination reveals mild dehydration. Laboratory results show hyponatremia, hyperkalemia, and an elevated plasma ACTH level. What is the most appropriate initial treatment for this patient’s acute symptoms?
A) Intravenous (IV) hydrocortisone
B) Intravenous (IV) normal saline
C) Intravenous (IV) potassium
D) Oral rehydration solution
E) Intravenous (IV) antibiotic therapy
Explanation: In a patient with known adrenal insufficiency experiencing acute symptoms, the initial treatment should involve IV hydrocortisone to address the underlying cortisol deficiency, which can worsen during stress or illness.