skip to main content

Bipolar disorder — ABIM Board MCQ

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

HardPsychiatry relevant to Internal MedicineBipolar disorderABIM Board

A 38-year-old woman with autoimmune thyroid disease presents with vomiting, abdominal pain, confusion, blood pressure 76/42 mm Hg, sodium 124 mEq/L, potassium 6.0 mEq/L, and glucose 54 mg/dL. Primary adrenal insufficiency is strongly suspected, but cortisol and ACTH results will not be available for several hours. What is the most appropriate immediate action?

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

Reveal the answer and explanation

Correct answer: C — Give intravenous hydrocortisone and isotonic fluid after drawing baseline hormones

The best answer is “Give intravenous hydrocortisone and isotonic fluid after drawing baseline hormones”. This is adrenal crisis, in which treatment cannot wait for biochemical confirmation. Blood can be drawn first only if doing so causes no delay; stress-dose hydrocortisone, volume resuscitation, glucose, and correction of dangerous electrolyte abnormalities follow immediately. Hydrocortisone at stress doses provides sufficient mineralocorticoid effect acutely. Increasing thyroid hormone first can worsen adrenal decompensation.

Reference: Endocrine Society Primary Adrenal Insufficiency Guideline: https://www.endocrine.org/clinical-practice-guidelines/primary-adrenal-insufficiency