QuestionSBA
QuestionChoice
Although this patient is indeed expressing signs and symptoms of hypovolaemic shock (tachycardia, hypotension), the underlying cause is an adrenal crisis which is therefore the most correct answer. Adrenal crisis is one of the most important and life-threatening complications of long-term steroid use and is most common following a gastrointestinal illness.
10000430
e
Hypovolaemic shock
QuestionChoice
Although a vital differential diagnosis in patients presenting with impaired consciousness, tachycardia, and hypotension, sepsis is not the underlying cause in this case. The two key clues lie in the absence of pyrexia and the history of long-term prednisolone use in the context of GI illness. Adrenal crisis secondary to steroid therapy is therefore the most likely cause in this case.
10000427
b
Sepsis
QuestionChoice
An unlikely underlying diagnosis in a patient with no history of thyroid disease, thyroid storm is very rarely the first presentation of thyrotoxicosis. There are also important differentiating factors in the clinical examination. Thyroid storm classically presents with fever, tachycardia, hypertension, and altered mental state. This patient is not pyrexic and is hypotensive, making thyroid storm an unlikely cause of their presentation.
10000429
d
Thyroid storm
QuestionChoice
Another important differential in a patient presenting with cardiogenic symptoms. However, in a patient with a history of long-term steroid use who has been suffering from a gastrointestinal illness in the days preceding presentation, it is vital to rule out adrenal crisis.
10000428
c
Myocardial infarction
QuestionChoice
This patient has presented with circulatory collapse (indicated by loss of consciousness, hypotension, and tachycardia) which has occurred secondary to an adrenal crisis. Long-term steroid use suppresses the body's natural production of glucocorticoids by negatively feeding back on the hypothalamic-pituitary-adrenal axis. Adrenal crisis can then occur in the presence of additional physiological stress or if the patient is unable to take their medication. This patient should be urgently managed with IV hydrocortisone and fluid replacement.
10000426
a
Adrenal crisis
Concept
Chapter
2693
3762
Adrenal insufficiency & Addison's
Topic
133
Endocrinology
12632
A 70-year-old female is brought to the emergency department by ambulance. Her husband reports that she has been unwell for the past 4 days with vomiting and diarrhoea. He found her this morning unconscious on the sofa and immediately dialled 999.

On examination, the patient is unresponsive, with a heart rate of 134 bpm, a blood pressure of 88/72 mmHg, and a temperature of 37.1 C. Her husband reports that she has a history of polymyalgia rheumatica for which she has taken prednisolone for 18 months. Which of the following is the most likely diagnosis?
a