CIRCI Corticosteroid Insufficiency in the Critically Ill Patient *Please take the quiz below the video to receive credit. Lecture Quiz Name(Required) First Last 1. About 80-90% of cortisol is available in the blood, whereas the remaining 10-20% is bound to a protein called corticosteroid binding globulin (CBG)(Required) a. True b. False 2. Critical illness affects cortisol in all of the following ways except:(Required) a. Lack of diurnal secretions b. Tissue resistance to cortisol c. Continuous activation of mineralocorticoid receptor (MR) d. Decreased metabolism of cortisol 3. Which of the following is a symptoms of Critical Illness Related Corticosteroid Insufficiency (CIRCI)?(Required) a. Hypotension responsive to fluid and not pressors b. Hyperglycemia c. Hypernatremia d. Hypokalemia e. Hypotension refractory to fluid and pressor use 4. In the setting of septic shock refractory to pressor use and fluid administration, ACTH stimulation test is necessary prior to starting steroid therapy.(Required) a. True b. False 5. Steroid therapy in early sepsis does not stop progression into septic shock, and should not be used(Required) a. True b. False 6. Patients with persistent Acute Respiratory Distress Syndrome ARDS display all of the following except(Required) a. Persistently elevated levels of inflammatory mediators b. Glucocorticoid resistance c. Increased rates of mortality d. Depletion of inflammatory mediators 7. Which of the following is false in terms of steroid use and ARDS?(Required) a. Blunts inflammatory response b. Has increased lung tissue penetration c. Should be started prior to day 14 d. Must be started after day 14 8. Steroids given during and after cardiac arrest has shown:(Required) a. Increased survival b. Decreased post arrest shock c. Decreased rate of favorable neurological outcomes d. A & B e. B & C f. All of the above 9. Free cortisol has a significantly higher diagnostic benefit than total cortisol, and should be used due to its convenience and cost effectiveness.(Required) a. True b. False 10. Fludrocortisone should be considered when hyperkalemia and hyponatremia are present for which of the following reasons?(Required) a. Mineralocorticoid activity b. Increased absorption in the setting of septic shock c. Is the standard of care in septic shock d. None of the above
