Board Review Questions of the Week – Adrenal Disorders

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This week’s case-based question:


A 32-year-old woman with a history of severe asthma presents to you with swelling, redness, fever, and heat in her left leg. You make a diagnosis of cellulitis and admit the patient for antibiotic therapy. She was recently treated for a severe exacerbation of asthma and continues on a tapering steroid regimen. However, she is unable to remember her current dose.

After being in the hospital for 12 hours, the patient’s fever worsens and she starts vomiting after complaining of nausea. In addition, she complains of fatigue and generally feeling weak. When the medical intern is asked to see the patient, she reports severe generalized abdominal pain.

On examination, her abdomen is rigid but it is difficult to elicit pain on any particular quadrant of the abdomen. Blood pressure is 110/74. Respiratory rate is 16 breaths per minute.

Labs drawn a few hours before reveal a potassium of 4.5 mEq/l, a sodium of 131 mEq/l, and a glucose of 50.5 mg/d L. Her white cell count is 8,300 cells/ml and her platelet count is 250,000.

Which of the following is the most important next step in the treatment of this patient?

Answer Options

Administer STAT morphine for the pain and consult surgery for acute abdomen.
Increase the rate of the fluids the patient is receiving to 150 cc/hour.
Administer STAT intravenous hydrocortisone 100 mg followed by 50 mg every 8 hour.
Order STAT chemistries, arterial blood gas values, and Synacthen test.

And the answer is …


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