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NBME 18 Answers

nbme18/Block 2/Question#9

19 yo woman being treated for meningococcal meningitis

Adrenocorticotropic hormone stimulation test

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submitted by chai_md(1),

Neisseria meningitides can lead to Waterhouse-Friderichsen syndrome (adrenal insufficiency, fever, DIC, shock)

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submitted by dorsal_vein(2),
  1. Administer ACTH and monitor cortisol response
  2. If cortisol increases --> shock is due to pituitary insufficiency
  3. If cortisol does not increase --> shock is due to adrenal insufficiency

Dexamethasone suppression test is indicated for patients who present with signs of cortisol EXCESS.