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WorksheetsTopic 1: Adrenal and Renal Clinical Management
Total questions: 30
Worksheet time: 15mins
A patient on >20 mg/day steroids with cushingoid features is NPO before surgery. What is the best plan to prevent Addisonian crisis?
Switch to oral hydrocortisone morning of surgery
Hold all steroids until postoperative day two
Administer IV hydrocortisone perioperatively
Give a single dose of loop diuretics preop
Which clinical finding most consistently suggests Addisonian crisis in the perioperative setting?
Hypokalemia with severe hypotension and bradycardia
Hypercalcemia with normal blood pressure and tachypnea
Hypernatremia with severe hypertension and bradycardia
Hyponatremia with mild hypotension and tachycardia
In patients experiencing adrenal crisis due to exogenous steroid use, how is the crisis classified?
Primary adrenal crisis from autoimmune disease
Secondary adrenal crisis from pituitary suppression
Tertiary adrenal crisis from hypothalamic failure
Iatrogenic primary adrenal cortical necrosis
For a hemodialysis-dependent patient scheduled for surgery, when should dialysis ideally be performed?
One week prior to the planned surgery
Two days after the planned surgery
The day before the planned surgery
Same day immediately before surgery
Which preoperative question is most important for a patient with ESRD because of substantial mortality risk with surgery?
Recent travel history and malaria exposure
Advance directive or code status discussion
Preferred dialysis access type and location
Vaccination status for hepatitis B series
Which intervention can correct hyperkalemia in a CRI patient who is not dialysis-dependent but is fluid overloaded?
IV hydrocortisone infusion titration
Loop diuretics such as furosemide
Conjugated estrogens infusion
Continuous heparin during dialysis
Match each therapy to its primary role in managing uremic bleeding risk.
Desmopressin
Improves platelet function transiently
Cryoprecipitate
Supplies fibrinogen and vWF factors
RBC transfusions
Addresses anemia to reduce bleeding tendency
Conjugated estrogens
Enhances hemostasis via hormonal mechanism
What should be discussed with the patient’s nephrologist prior to planned surgery to reduce bleeding complications during dialysis?
Postoperative calcium supplementation
Routine diuretic administration preop
High-dose intraoperative vasopressors
Heparin-free dialysis arrangement
Which intraoperative hemodynamic change increases the risk of developing acute renal failure, particularly in CRI patients?
Hypotension requiring vasopressor escalation
Hypernatremia with reduced urine osmolarity
Sustained hypertension with high cardiac output
Hyperthermia with tachycardia and sweating
Identify the three intraoperative factors collectively associated with higher risk of acute renal failure.
Hyperkalemia, calcium infusion, beta-blockade
Hypertension, vasodilators, blood transfusions
Hypotension, vasopressors, diuretic administration
Hypothermia, opioid use, ventilator settings
Which condition is a contraindication for NSAID use in pain management?
Mild osteoarthritis without comorbidities
Young adult with minor musculoskeletal strain
History of GI bleed or peptic ulcer disease
Controlled hypertension with normal renal function
Acetaminophen is preferred for mild fever when what concern limits NSAID use?
History of gout flares controlled
Chronic kidney disease or gastrointestinal risk
Uncontrolled type 1 diabetes mellitus
Active bacterial infection with fever
What is the typical maximum daily dose for acetaminophen in adults?
(a)
Which caution applies to tricyclic antidepressants used for neuropathic pain in elderly patients?
Profound neutropenia after first dose
High risk of acute liver failure
Anticholinergic burden leading to falls
Severe hypoglycemia risk
Gabapentinoids require what adjustment in patients with renal impairment?
(a)
Which adverse effect is commonly associated with gabapentin or pregabalin?
Hyperkalemia causing arrhythmias
Dizziness and somnolence with edema
Acute hepatitis with jaundice
Profound bradycardia with syncope
Which muscle relaxant precaution is accurate for cyclobenzaprine?
First-line for spasticity in multiple sclerosis
Avoid in cardiac arrhythmias or heart block
Safe in all elderly without sedation
Requires abrupt discontinuation to prevent rebound
Tizanidine carries a caution related to which effect?
Nephrotoxicity requiring dialysis
Hypotension risk with therapy
Photosensitivity reactions
Severe hyperthyroidism exacerbation
Which statement about baclofen is true regarding discontinuation?
Discontinuation always leads to hypertension
Tapering causes permanent neuropathy
Abrupt cessation is safe and recommended
Avoid abrupt withdrawal due to risks
Topical lidocaine patches should be avoided in patients with what allergy?
Iodinated contrast media
Lidocaine or amide local anesthetics
Penicillin-class antibiotics
Macrolide antibiotics
Which indication best matches corticosteroids like methylprednisolone in pain care?
Acute inflammatory conditions such as arthritis flare
Immediate relief of acute muscle spasm
Chronic insomnia without pain
Primary treatment of febrile seizures
Match each drug class to a key caution or contraindication.
NSAIDs
GI bleed or peptic ulcer risk
Acetaminophen
Severe hepatic impairment caution
Gabapentinoids
Dose adjust for renal impairment
TCAs
Anticholinergic burden and falls
Which topical analgesic may cause local burning or irritation?
Tizanidine immediate-release
Capsaicin cream during application
Diclofenac oral tablets
Baclofen intrathecal pump
Which patient factor warrants caution with NSAIDs due to cardiovascular risk?
Heart failure or uncontrolled hypertension
Young athlete without comorbidities
Controlled hyperlipidemia alone
History of migraines responsive to triptans
A patient has pH 7.30, HCO3− 18 mEq/L, PaCO2 40 mmHg. What primary disorder is present using the quick guide?
Metabolic alkalosis with partial compensation
Respiratory alkalosis with no compensation
Respiratory acidosis with full compensation
Metabolic acidosis with no compensation
Which statement correctly applies the ROME mnemonic to classify respiratory alkalosis?
pH decreases and PaCO2 increases
pH increases and HCO3− increases
pH decreases and HCO3− decreases
pH increases and PaCO2 decreases
Fill in the blank: Anion gap for metabolic acidosis is calculated as AG = Na+ − [Cl− + (a) ].
Match each lab pattern to the disorder using ROME.
pH down, PaCO2 up
Respiratory acidosis
pH up, PaCO2 down
Respiratory alkalosis
pH down, HCO3− down
Metabolic acidosis
pH up, HCO3− up
Metabolic alkalosis
A patient’s pH is 7.44 with reduced PaCO2 and low HCO3−. Which compensation status best fits the quick guide?
No disorder, all values normal
Partial compensation, some compensatory change
Uncompensated, no change in other value
Full compensation, pH near normal
You find pH 7.28, HCO3− 12 mEq/L, Na+ 140 mEq/L, Cl− 100 mEq/L. Calculate the anion gap and identify the likely acid–base category.
AG 28, high anion gap metabolic acidosis
AG 12, normal anion gap metabolic acidosis
AG 40, severe respiratory acidosis
AG 20, metabolic alkalosis
