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Category: Critical Care Medicine-Endocrine Disorders--->Management During Critical Illness
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Question 1#Print Question

A 48-year-old woman presents with severe headache. She has a history of refractory hypertension, intermittent headaches, and palpitations. Her vital signs are notable for blood pressure of 242/100 mm Hg and oxygen saturation of 85% on room air. Chest Xray shows diffuse pulmonary edema, and oxygenation improves with high flow nasal cannula. She is admitted to the ICU for blood pressure management and respiratory support. Collection of 24- hour urinary vanillylmandelic acid and metanephrines are started.

Until these results return, which of the following medications would be most appropriate to start to manage her hypertension?

A. Labetalol
B. Esmolol
C. Phentolamine
D. Phenoxybenzamine


Question 2#Print Question

A 72-year-old woman is admitted to the ICU with hypoxemic respiratory failure and sepsis. Her medical history is notable for hypertension, COPD, and CKD (Cr 1.9). Her vital signs are:

  • temperature is 38.5°C
  • heart rate 107 bpm
  • blood pressure 87/55
  • O2 saturation 89% on 60% FiO2

She is intubated, undergoes fluid resuscitation and vasopressor support, and receives broad spectrum antimicrobials and is started on a norepinephrine infusion. In addition to routine laboratory studies a thyroid function panel is sent, which is notable for a T3 of 60 ng/dL (normal 80-180) and a TSH 8 µg/dL (normal 0.5-5).

Based on these laboratory studies, which of the following interventions is most appropriate?

A. No further treatment necessary
B. Send free T4, reverse T3
C. Start IV levothyroxine
D. Start iodine supplementation


Question 3#Print Question

A 48-year-old woman with a history of Grave’s disease undergoes an urgent appendectomy. Four hours after surgery she is found to be confused and diaphoretic. Her vital signs are:

  • T 102.7
  • HR 130/min
  • BP 184/106 mm Hg
  • O2 saturation of 93% on RA

On physical examination there is no evidence of rigidity. An arterial blood gas ABG shows:

  • pH 7.51
  • pCO2 30
  • pO2 98

Thyroid function tests are sent. Although awaiting the results, which of the following medications would be most appropriate to give?

A. Aspirin
B. Propranolol
C. Bromocriptine
D. Dantrolene


Question 4#Print Question

A 48-year-old woman with a history of Grave’s disease undergoes an urgent appendectomy. Fours hours after surgery she is found to have altered mental status and diaphoresis. Her vital signs are:

  • T 102.7
  • HR 130/min
  • BP 184/106 mm Hg

On physical examination there is no evidence of rigidity. ABG shows:

  • pH 7.51
  • pCO2 30
  • pO2 98

TSH is <0.01 µg U/mL. Two liters of normal saline and intravenous propranolol are administered.

Which of the following medications is NOT indicated for immediate treatment in this patient?

A. Iodine
B. Propylthiouracil
C. Methimazole
D. Corticosteroids


Question 5#Print Question

A 65-year-old woman is admitted to the ICU after being found down at home. Her only medical history is a remote history of Grave’s disease and thyroid ablation. Vital signs are:

  • T 89°F
  • HR 50 bpm
  • BP 105/61 mm Hg

On physical examination she obtunded, and brittle hair, macroglossia, and periorbital edema are noted. An ABG shows:

  • pH 7.30
  • PaCO2 55
  • PaO2 65

She is intubated for airway protection ventilatory support. Urine, sputum, and blood cultures are sent, and she is treated with broad spectrum antibiotics. Thyroid function tests are sent and she is started on IV levothyroxine.

Which of the following additional therapies is most appropriate at this time?

A. Hydrocortisone
B. Insulin
C. Iodine
D. Active rewarming




Category: Critical Care Medicine-Endocrine Disorders--->Management During Critical Illness
Page: 1 of 2