Adrenal Disorders USMLE Step 1 Practice Question
A 42-year-old man on warfarin for atrial fibrillation presents to the emergency department with acute onset severe left flank pain, fever (38.9°C), and hypotension (BP 88/54 mmHg). He reports nausea and vomiting for 6 hours. His INR is 8.2 (therapeutic range 2-3). Laboratory studies show: hemoglobin 9.8 g/dL (previous 12.2 g/dL one week ago), serum cortisol 3 µg/dL (normal 10-20 µg/dL at 8 AM), ACTH 220 pg/mL (normal 10-46 pg/mL), and potassium 5.8 mEq/L. Abdominal CT imaging is pending. Which of the following is the most likely diagnosis?
Answer choices
- AAcute pancreatitis with disseminated intravascular coagulation
- BMeningococcal sepsis with secondary adrenal insufficiency
- CAcute myocardial infarction with cardiogenic shock and elevated potassium
- DAcute adrenal hemorrhage with secondary adrenal insufficiencyCorrect answer
- ERetroperitoneal hematoma from warfarin overdose
- FAcute pyelonephritis with urosepsis and prerenal azotemia
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