Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Endocrine Disorders--->Management During Critical Illness
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Question 6# Print Question

A 68-year-old woman presents to the emergency department after being found at home with confusion and lethargy. Her medical history includes GERD, obesity, non–insulin dependent type 2 diabetes, and depression with prior suicide attempts. Empty bottles of omeprazole, glyburide, and sertraline were found in her home. She is intubated for airway protection. Her admission laboratory test results are notable for a blood glucose of 33 mg/dL, and she is treated with an IV bolus of dextrose 50. Repeat laboratory tests an hour later show blood glucose 52 mg/dL.

Which of the following is most appropriate to treat her hypoglycemia?

A. Glucagon IM
B. D50 bolus and octreotide
C. D50 bolus followed by glucose infusion
D. D50 bolus and recheck glucose in 1 hour

Question 7# Print Question

A 22-year-old man with type 1 diabetes since age 11 presents with fever, drowsiness, and abdominal pain. These symptoms started 2 days ago, and he has been unable to tolerate food or water. Vital signs are T 38.2 HR 122 and BP 105/70 mm Hg. Laboratory tests are notable for:

  • glucose 480 mg/dL
  • Sodium 154 mEq/L
  • Potassium 5.5 mEq/L
  • Chloride 114 mEq/L

An ABG shows:

  • pH 7.2
  • PaCO2 28 mm Hg
  • PaO2 95 mm Hg
  • HCO3 9 mEq/L

erum and urine ketones are positive. He undergoes fluid resuscitation with normal saline and receives an IV insulin bolus followed by a continuous insulin infusion. After 3 hours of treatment, his blood glucose is 250 mg/dL.

What is the most appropriate IV fluid management at this time?

A. Continue normal saline infusion and add glucose and potassium
B. Continue normal saline infusion and add glucose
C. Start half-normal saline with glucose and potassium
D. Start half-normal saline with glucose

Question 8# Print Question

A 58-year-old man is admitted to the ICU with pneumonia and sepsis. His medical history is notable for coronary artery disease and COPD. He is intubated and receiving a norepinephrine infusion to support blood pressure. On his serum, glucose has ranged from 191 to 283 mg/dL over the last 12 hours.

What is the most appropriate treatment at this time for his blood glucose?

A. No treatment is necessary
B. Start insulin infusion with target blood glucose <150 mg/dL
C. Start Lantus insulin
D. Start sliding scale insulin and target blood glucose <180 mg/dL

Question 9# Print Question

A 60-year-old man with bipolar disorder on chronic lithium therapy undergoes an uncomplicated appendectomy. In the PACU he becomes delirious and agitated. His vital signs are within normal limits. He weighs 75 kg. Laboratory values are notable for sodium 148 mEq/L. He is maintained overnight on dextrose in half-normal saline at 125 mL/h. Urine output is approximately 300 mL/h overnight. In the morning serum sodium has increased to 155 mEq/L. His urine osmolality is 120 mOsm/kg, and urine sodium is 22 mEq/L. Arginine vasopressin is administered without a change in urine output.

What is the most appropriate change in IV fluids for treatment of his hypernatremia? 

A. Increase the infusion rate to 400 mL/h
B. Change to D5 water at 200 mL/h
C. Change to D5 water at 400 mL/h
D. Change to D5 water at 300 mL/h and add desmopressin

Question 10# Print Question

A 22-year-old, 70-kg man sustained unrecoverable traumatic brain injury and is undergoing evaluation for donation of his heart, liver, and lungs. During transplant evaluation and preparation, he becomes progressively hypotensive, with increased urine output, and laboratory evaluation is notable for a sodium of 148 mEq/L (from initial of 139 mEq/L). Administration of which of the following medications is most appropriate to increase the chances of successful organ recovery?

A. Vasopressin infusion 0.04 U/min and desmopressin 1 µg every 6 hours
B. Methylprednisolone 1000 mg IV
C. Levothyroxine IV 20 µg followed by infusion
D. All of the above

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