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virgola82
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06/21/07 - 11:05 AM       #1

A 40 yo alcoholic male is being treated for TB but he has not been compliant with his medications. He complains of weakness and fatigue. He appears to have lost weight, and his blood pressure is 80/50. There is increased pigmentation over the elbows. Cardiac exam is normal. The best treatment for ths patient is

A. Hydrocortisone once a day

B. Hydrocortisone twice a day plus fludrocortisone

C. Hydrocortisone Three times a day plus fludrocortisone

D. Fludrocortisone once a day

E. Daily ACTH


vradojc1
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06/21/07 - 11:13 AM       #2

C - hydrocortisone should be given every 6-8 h (+ if needed fludrocortisone)

doyoudig
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06/21/07 - 11:14 AM       #3

A. Hydrocortisone once a day

Luckyall
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06/21/07 - 12:03 PM       #4

hydrocortisone x3/day & fludrocortisone

sprint123
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06/21/07 - 01:22 PM       #5

This patient has weakness and fatigue suggesting hypokalemia due to mineralocorticoid deficiency..

So, Hydrocortisone 2 times a day PLUS fludrocortisone

dr in trouble
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06/21/07 - 01:35 PM       #6

i will go with C

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CocaCola
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06/21/07 - 02:13 PM       #7

seems like tb destroyed his adrenals...
hydrocortisone plus fludrocortisone
but whether its 2 or 3 times a day???

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virgola82
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06/22/07 - 10:52 AM       #8

According to the expalnation given the best initial regimen to treat this adrenal insufficiency is hydrocortisone 2 times a day + fludrocortisone

Justice
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06/22/07 - 11:52 AM       #9

virgola82 wrote:
According to the expalnation given the best initial regimen to treat this adrenal insufficiency is hydrocortisone 2 times a day + fludrocortisone

Is this Q for CK exam? Do we need to know regiments and schedules?

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virgola82
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06/23/07 - 12:44 AM       #10

I took it from pretest medicine which is thought to be for step 2ck. Anyway I got it wrong when tried to do it because I am not studying regimens either so I hope we are not supposed to do so. But because I went through this I thought it could be useful to remember and decided to post it. Again, I think that we won't have a lot of qs on regimens but I think the point here is that we should try to resemble the biological pattern of cortisol secretion while starting giving cortisone for an adrenal insufficiency. This is not written in the explanation, in which they don't give too many details, but I thought this is why this q was written in this book.









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