A 43-year-old woman with a history of hydrocortisone use is found unconscious with severe hypotension. What is the most likely immediate diagnosis?

Study for the Medical FIDSAP v2 Test. Sharpen your skills with flashcards and multiple-choice questions, complete with hints and explanations. Prepare effectively for your upcoming test!

Multiple Choice

A 43-year-old woman with a history of hydrocortisone use is found unconscious with severe hypotension. What is the most likely immediate diagnosis?

Recognizing shock types based on history and presentation. In someone who is unconscious with severe hypotension, the immediate concern is to identify a type of shock causing poor cerebral perfusion. The fact she has been using hydrocortisone makes an adrenal crisis less likely, because steroid replacement can mitigate cortisol deficiency unless dosing has failed or there’s a stressor. With no signs pointing to an allergic reaction (no airway compromise or rash) or infection (fever or systemic illness suggesting sepsis), the scenario most strongly points to a loss of circulating volume leading to hypovolemic shock. In hypovolemic shock, reduced intravascular volume lowers venous return and cardiac output, precipitating deep hypotension and reduced brain perfusion, which can cause unconsciousness. Addisonian crisis would present with cortisol deficiency–related signs and electrolyte disturbances (hyponatremia, hyperkalemia) and often a history suggestive of steroid withdrawal or inadequate replacement during stress. Anaphylactic shock shows acute airway or skin/ mucous membrane signs after allergen exposure. Septic shock typically features infection-related signs such as fever and a progressive systemic inflammatory response.

Recognizing shock types based on history and presentation.

In someone who is unconscious with severe hypotension, the immediate concern is to identify a type of shock causing poor cerebral perfusion. The fact she has been using hydrocortisone makes an adrenal crisis less likely, because steroid replacement can mitigate cortisol deficiency unless dosing has failed or there’s a stressor. With no signs pointing to an allergic reaction (no airway compromise or rash) or infection (fever or systemic illness suggesting sepsis), the scenario most strongly points to a loss of circulating volume leading to hypovolemic shock. In hypovolemic shock, reduced intravascular volume lowers venous return and cardiac output, precipitating deep hypotension and reduced brain perfusion, which can cause unconsciousness.

Addisonian crisis would present with cortisol deficiency–related signs and electrolyte disturbances (hyponatremia, hyperkalemia) and often a history suggestive of steroid withdrawal or inadequate replacement during stress. Anaphylactic shock shows acute airway or skin/ mucous membrane signs after allergen exposure. Septic shock typically features infection-related signs such as fever and a progressive systemic inflammatory response.

More practice questions