Endocrinology: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology

Sample item

A 35-year-old woman with known autoimmune adrenalitis develops vomiting and diarrhoea, then collapses with a blood pressure of 70/40 mmHg, sodium 122 and potassium 6.1 mmol/L. What is the most appropriate immediate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Intravenous hydrocortisone with saline

Adrenal crisis is a medical emergency in which glucocorticoid replacement is life-saving. Intravenous hydrocortisone 100 mg is given with rapid isotonic saline. Hydrocortisone at this dose also provides sufficient mineralocorticoid activity.

Option by option

  • A. Oral fludrocortisone alone

    Fludrocortisone alone is oral and inadequate for glucocorticoid deficiency in crisis.

  • B. Intravenous dexamethasone alone with no fluids

    Dexamethasone lacks mineralocorticoid action, and fluids are essential in crisis.

  • C. Intravenous hydrocortisone with saline (correct)

    Correct. Hydrocortisone and saline reverse adrenal crisis.

  • D. Intravenous levothyroxine

    Levothyroxine would not help and may worsen the crisis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Intravenous hydrocortisone with saline. Adrenal crisis is a medical emergency in which glucocorticoid replacement is life-saving.

Why is "Oral fludrocortisone alone" not the answer?

Fludrocortisone alone is oral and inadequate for glucocorticoid deficiency in crisis.

Why is "Intravenous dexamethasone alone with no fluids" not the answer?

Dexamethasone lacks mineralocorticoid action, and fluids are essential in crisis.

Why is "Intravenous levothyroxine" not the answer?

Levothyroxine would not help and may worsen the crisis.

What concept does this question test?

It tests Endocrinology in General Medicine. Intravenous hydrocortisone 100 mg is given with rapid isotonic saline. Hydrocortisone at this dose also provides sufficient mineralocorticoid activity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.