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Myxoedema coma — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute Renal and Metabolic EmergenciesMyxoedema comaSCE Acute Medicine

A 29-year-old man presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show hypothermia, bradycardia, hypoventilation, low free T4 and high TSH. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Give thyroid hormone replacement with hydrocortisone and supportive critical care

The key discriminator is that hypothermia, bradycardia, hypoventilation, low free T4 and high TSH, which makes Give thyroid hormone replacement with hydrocortisone and supportive critical care the single best answer. Optimise chronic medication and discharge is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Society for Endocrinology endocrine emergency guidance