PAEA EOR Blueprint IM Questions With Complete Solutions

CRITICAL CARE Acute adrenal insufficiency correct answer: aka Addisonian Crisis worsening due to stressful event (pts unable to increase cortisol sufficiently) Cause: 1. MC=Abrupt withdrawal of glucocorticoids 2. prior undx + stress 3. exacerbation of addison dz (didn't increase glucocorticoid in time of stress) 4. bilateral adrenal infarction (MC hemorrhage) Sx: 1. MC= shock 2. HoTN, hypovolemia Dx: Labs: BMP (LOW Na, K, glucose); cortisol; ACTH; CBC Tx: 1. IV fluids (NS) (if low glucose then D5NS) 2. glucocorticoids (if undx--> dexamethasone) (if known Addison's dz-->hydrocortisone) 3. correct -lyte abnorm 4. Fludrocortisone Thyroid Storm correct answer: rare complic. of undertreated thyrotoxicosis (us. after stress event) 1-2% hyperthyroid pts present this way *high mortality Sx: hyper metabolic state: palpitations, Afib, tachycardia, high fevers, N/V, psychosis, delirium, tremors Dx: high Free T4/T3 ; low TSH (may be undetectable) Tx: Anti-thyroid meds: methimazole, PTU BB- for sx IV fluids- supportive glucocorticoids- prevents conversion of T4 to T3 PO/IV sodium iodide- decreases thyroid hormones *avoid ASA (increases T4) DKA/Acute hypoglycemia/HHS correct answer: *results of insulin def./resp. to stress (infect, infarct, noncompliance with insulin) DKA (ketoacidosis; us. younger/DMT1) -AG metabolic acidosis (pH <7.3)