Endocrine drugs: adrenal crisis management: practice question

A Pharmacology 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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Pharmacology · Endocrine drugs: adrenal crisis management

Sample item

A 35-year-old woman with Addison disease stopped her tablets during gastroenteritis. She presents with blood pressure 70/40 mmHg, sodium 124 mmol/L, potassium 6.2 mmol/L and glucose 50 mg/dL. What is the immediate treatment?

AIV hydrocortisone bolus with isotonic salineBOral fludrocortisone with a high-salt dietCIntravenous dopamine alone for blood pressureDHypertonic saline to correct sodium quickly

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

The answer and the reasoning

A. IV hydrocortisone bolus with isotonic saline

Adrenal crisis is a medical emergency treated at once with parenteral hydrocortisone and rapid isotonic saline with dextrose, without waiting for tests. Hydrocortisone at high dose also has enough mineralocorticoid action, and the precipitant is then treated.

Option by option

A. IV hydrocortisone bolus with isotonic saline (correct)
Correct. Hydrocortisone and isotonic saline replace the missing cortisol and volume.
B. Oral fludrocortisone with a high-salt diet
Oral fludrocortisone is too slow and does not replace cortisol in a collapsed patient.
C. Intravenous dopamine alone for blood pressure
Dopamine alone will not work without glucocorticoid, since vascular tone depends on cortisol.
D. Hypertonic saline to correct sodium quickly
Hypertonic saline risks rapid sodium correction and does not replace cortisol.

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.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, IV hydrocortisone bolus with isotonic saline. Adrenal crisis is a medical emergency treated at once with parenteral hydrocortisone and rapid isotonic saline with dextrose, without waiting for tests.

Why is "Oral fludrocortisone with a high-salt diet" not the answer?

Oral fludrocortisone is too slow and does not replace cortisol in a collapsed patient.

Why is "Intravenous dopamine alone for blood pressure" not the answer?

Dopamine alone will not work without glucocorticoid, since vascular tone depends on cortisol.

Why is "Hypertonic saline to correct sodium quickly" not the answer?

Hypertonic saline risks rapid sodium correction and does not replace cortisol.

What concept does this question test?

It tests Endocrine drugs: adrenal crisis management in Pharmacology. Hydrocortisone at high dose also has enough mineralocorticoid action, and the precipitant is then treated.

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 Endocrine drugs: adrenal crisis management?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.