Quiz 31

Question 1

Routine vaccination against which one of the following organisms has significantly reduced the
risk of bacterial meningitis among young children?

Answer 1

Conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae have been highly
effective in reducing the incidence of bacterial meningitis in young children and are now routinely
recommended for infants and older patients who fall into appropriate risk groups

Question 2

A 68-year-old female presents with a several-month history of weight loss, fatigue, decreased appetite, and vague abdominal pain. The most appropriate initial test to rule out adrenal insufficiency is:

Answer 2

A single morning serum cortisol level >13µg/dL reliably excludes adrenal insufficiency. If the morning cortisol level is lower than this, further evaluation with a 1µg ACTH stimulation test is necessary, although the test is somewhat difficult. It requires dilution of the ACTH prior to administration, and requires multiple blood draws. The insulin tolerance test and metyrapone test, although historically considered to be “gold standards,” are not widely available or commonly used in clinical practice. MRI does not provide information about adrenal function.