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

A 27-year-old man with primary sclerosing cholangitis and ulcerative colitis presents with high ileostomy output and abdominal pain for last few weeks associated with a 9-kg weight loss. He has no other medical history. Despite fluid resuscitation and pharmacologic therapy, his symptoms persist. He develops fever to 39.7°C and is transferred to the ICU with concerns for sepsis. On admission to the ICU:

  • he is somnolent and lethargic
  • heart rate is 160 beats/min
  • blood pressure is 156/80 mm Hg
  • respiratory rate is 25/min
  • his pulse oximeter reads 98% on room air

His sepsis workup is negative, but his laboratory work is remarkable for a low TSH level.

What is the diagnosis?

A. Serotonin syndrome
B. Hyperthyroidism
C. Thyroid storm
D. Malignant hyperthermia
E. Malignant neurolept syndrome


Question 2#Print Question

A 27-year-old man with primary sclerosing cholangitis and ulcerative colitis presents with high ileostomy output and abdominal pain for last few weeks associated with a 9-kg weight loss. He has no other medical history. Despite fluid resuscitation and pharmacologic therapy, his symptoms persist. He develops fever to 39.7°C and is transferred to the ICU with concerns for sepsis. On admission to the ICU:

  • he is somnolent and lethargic
  • heart rate is 160 beats/min
  • blood pressure is 156/80 mm Hg
  • respiratory rate is 25/min
  • his pulse oximeter reads 98% on room air

His sepsis workup is negative, but his laboratory work is remarkable for a low TSH level.

What is the best initial treatment?

A. High-dose Iodine
B. Propanolol
C. Diltiazem
D. Hydrocortisone
E. Cholestyramine


Question 3#Print Question

A 79-year-old female is admitted to the ICU after repair of a pathologic femur fracture with an estimated blood loss of 1.2 L. She is oxygenating well on room air, is hemodynamically stable, and is appropriately alert and oriented. Physical examination is remarkable for incision site tenderness and signs of malnutrition. Laboratory studies reveal normal electrolytes, normal liver function tests, normal TSH and T4, and decreased levels of T3.

What would be the most appropriate management of her deranged thyroid function test? 

A. Supportive care with appropriate nutrition
B. Supplementation with T4
C. Supplementation with T3
D. Hydrocortisone


Question 4#Print Question

A 78 year-old female is admitted to the ICU with a 6 month history of generalized fatigue and muscle cramps, which are worsened with exercise. Her symptoms have been progressively worsening and now she is unable to ambulate. On physical examination, pressure stimulus on the muscles of the arm leads to formation of a palpable, painless ridge around the site of the stimulus, which subsides gradually returning the muscle contour to normal in a few seconds. She is also noted to have delayed deep tendon reflexes and anasarca. Her laboratory studies are within normal limits, except for an elevated TSH level.

Which of the following is most likely the cause of her symptoms?

A. Recent influenza vaccine
B. Recent CVA
C. Multiple sclerosis
D. Muscular dystrophy
E. Chronic hypothyroidism


Question 5#Print Question

An 81-year-old female is admitted to the ICU with altered mental status. She is lethargic and does not provide a good history. On physical examination, her skin is dry and pale, and her temperature is 35°C. She is noted to have decreased deep tendon reflexes.

Which of the following clinical/physiologic derangements is most likely to be present in the patient?

A. Decreased systemic vascular resistance
B. Decreased cardiac contractility
C. Respiratory Alkalosis
D. Diarrhea
E. Hyperglycemia




Category: Critical Care Medicine-Endocrine Disorders--->Thyroid
Page: 1 of 1