Metastatic prostate cancer and GI symptoms - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
USMLE Articles
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam

Thread Tools Search this Thread Display Modes
Old 03-04-2013
USMLE Forums Addict
Steps History: 1+CK+CS+3
Posts: 151
Threads: 48
Thanked 109 Times in 60 Posts
Reputation: 119
Question Metastatic prostate cancer and GI symptoms

A 72 year old man with history of metastatic prostate cancer is admitted with severe weakness and lethargy. He has been having vomiting and abdominal pain for the past two weeks. He also reports intermittent diarrhea alternating with constipation over the past 2 months. Three months ago, he was noted to have progressive prostate cancer despite therapy with bicalutamide and leuprolide. His PSA at that time was 300ng/ml. He was started on Ketoconozole at that time and he is compliant with it. His most recent visit to the outpatient clinic was 4 weeks ago at which time his PSA was 60ng/ml. On examination, his temperature is 98F, Heart rate is 130/min, Respiratory rate 20/min and Blood pressure 70/40 mm Hg. Chest is clear to auscultation and abdominal examination is benign. A CT scan of the abdomen reveals enlarged prostate and osteoblastic bone metastases in pelvis but no evidence of bowel obstruction. Urinalysis and Chest x-ray are benign. The patient is started on intravenous isotonic saline. Which of the following is the most appropriate next step in managing this patient?

A) Start Chemotherapy
B) Refer to Hospice
C) Intravenous Hydrocortisone
D) Start Norepinephrine drip
E) Intravenous Biphosphonates
Reply With Quote Quick reply to this message

Old 03-04-2013
USMLE Forums Master
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,086 Times in 1,046 Posts
Reputation: 2106

E) Intravenous Biphosphonates
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
Old 03-05-2013
USMLE Forums Scout
Steps History: Not yet
Posts: 10
Threads: 1
Thanked 8 Times in 6 Posts
Reputation: 18

I think this patient suffers from adrenal suppression caused by Ketoconazole therapy. hypotension+ severe weakness are the major start hydrocortisone..
his condition is not compatible with hypercalcemia induced by metastases as hypercalcemia will increase blood pressure and induce constipation rather than intermittent no bisphosphonate...
Reply With Quote Quick reply to this message
The above post was thanked by:
Novobiocin (03-05-2013), stfidel (03-05-2013), wertheworld11 (03-22-2013)
Old 03-05-2013
Steps History: 1 + CK
Posts: 751
Threads: 133
Thanked 306 Times in 192 Posts
Reputation: 316

I agree with the above post that
the answer is IV hydrocortisone.
Reply With Quote Quick reply to this message
The above post was thanked by:
stfidel (03-05-2013)
Old 03-05-2013
USMLE Forums Addict
Steps History: Not yet
Posts: 105
Threads: 2
Thanked 42 Times in 37 Posts
Reputation: 52
Default C) Intravenous Hydrocortisone

C) Intravenous Hydrocortisone
Reply With Quote Quick reply to this message


Internal-Medicine-, Oncology-, Step-2-Questions

Quick Reply

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Please enter a password for your user account. Note that passwords are case-sensitive.
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Where you live. Leave blank if you don't want to tell.


Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Similar Threads
Thread Thread Starter Forum Replies Last Post
The histology of ostoeblastic metastatic prostate tumor? meka USMLE Step 1 Forum 11 12-29-2014 08:55 PM
Most common metastatic cancer to liver? tyagee USMLE Step 1 Forum 4 07-19-2012 07:49 PM
Back pain from metastatic prostate cancer tyagee USMLE Step 2 CK Forum 8 07-19-2012 02:54 PM
Management of metastatic lung cancer Dr.NickRiviera USMLE Step 1 Forum 6 03-27-2012 05:53 PM
Metastatic lung cancer biopsy question aktorque USMLE Step 1 Forum 5 02-27-2011 07:59 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)