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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam |
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#1
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A 6-year-old girl presents to the Emergency Room with profound weakness, headache, high fever, and shaking chills for the past 12 hours. According to the child’s mother, the girl has been complaining of intermittent fatigue, weakness, decreased appetite, nausea, abdominal pain, and diarrhea for the past few weeks, but her symptoms suddenly worsened last night. Now she seems confused and disoriented and is difficult to arouse from sleep. On exam, she is pale, diaphoretic, and tachypneic, with a temperature of 40°C (104.5°F), BP of 60/36, and a pulse of 140. The physician notices some hyperpigmentation over her knuckles, elbows, knees, and mucous membranes (see figure) but the rest of her exam is normal. Laboratory testing reveals serum sodium of 127 mmol/L, plasma adrenocorticotropic hormone (ACTH) 224 pmol/L, and plasma cortisol of 62 nmol/L. 17-Hydroxyprogesterone and deoxycortisol levels are within normal limits. What is the most appropriate next step in this patient’s treatment?
A. Fludrocortisone B. Growth hormone C. Hydrocortisone D. Infusion of isotonic NaCl E. Levothyroxine |
The above post was thanked by: | ||
doc_study (09-02-2012) |
#2
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C. Hydrocortisone- more imp to adm in crisis
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#3
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how much fluids u pump in, it will be futile if u do not administer steroids for cardiovascular support(vascular tone) so hydrocortisone first
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#4
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Answer C Hydrocortisone .Cortisol not on board ,patient will have circulatory collapse .No iv fluids can help till steroids are infused.
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"Don't Forget they need us too" |
#5
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ans given is IV fluids. thats why i asked. i accept answer given is wrong and in test, i would pick steroids.
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#6
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Answer given is correct. Never forget your ABC's. This patient is hyponatremic and hypotensive (confusion & disorientation). The next step in management is resuscitation which in this case means isotonic fluids. Steroids takes time since their mechanism of action is via nuclear receptors. Quote:
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The above post was thanked by: | ||
Dr Egl (08-10-2017), erickven (01-09-2017), patient doctor (02-07-2013), rocketprinciple (09-02-2012), tyagee (09-03-2012) |
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Endocrinology-, Internal-Medicine-, Step-2-Questions |
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