Sample question from Medquest Q bank - Come back tomorrow for the answer. #SHARETHIS #LIKETHIS #KNOWTHIS FOR STEP 2 and STEP 3 A 57-year-old woman presents to the clinic for a followup visit. She complains of swelling in her extremities and generalized headaches, which she has noted for the past few weeks. She also reports an elevated blood pressure during her last visit to her pharmacy, which has an automated blood-pressure machine. Her past medical history is significant for Addison’s disease, atrophic gastritis, and hypercholesterolemia. Her current medications include prednisone 5 mg, simvastatin, and ranitidine. She was recently started on fludrocortisone acetate 0.3 mg daily. The patient states that she has been compliant with her medications. Her blood pressure is 182/91mm Hg, temperature is 96.9 F, and pulse is 70/min. Laboratory studies show: white blood cell count 6,200/mm3, sodium l56 mEq/L, potassium 2.6 mEq/L, chloride 102 mEq/L, bicarbonate 28 mg/dL, BUN 16 mg/dL, creatinine 0.9 mg/dL, and glucose 80 mg/dL. Which of the following is the best next step in the management of this patient? (A) Advise the patient to limit free water intake to 1 liter per day and to weigh herself daily (B) Add stress-dose hydrocortisone to the current regiment of prednisone (C) Decrease the dose of fludrocortisone (D) Start spironolactone therapy (E) Order a panel of thyroid function testing
Posted on: Mon, 12 May 2014 12:45:44 +0000
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