Metformin causes little lowering of blood sugar level in:

Correct Answer: A

Rationale: Metformin, a commonly used medication for the management of type 2 diabetes, primarily works by decreasing glucose production in the liver and improving insulin sensitivity in muscle cells. In individuals without diabetes (nondiabetics), there is typically no significant effect on blood sugar levels since their bodies are already functioning properly in terms of glucose regulation. Therefore, metformin would cause little to no lowering of blood sugar levels in nondiabetic individuals.

Correct Answer: C

Rationale: Hydrocortisone is a glucocorticoid hormone that affects the regulation of electrolyte balance in the body. In the kidneys, hydrocortisone acts to increase the excretion of potassium (K+) while also enhancing the reabsorption of calcium (Ca2+). This results in a decrease in potassium levels in the blood (hypokalemia) and an increase in calcium levels (hypercalcemia). Therefore, the correct action of hydrocortisone is to decrease potassium excretion and increase calcium excretion.

Correct Answer: D

Rationale: The glucocorticoid receptor is a type of nuclear receptor that is located inside the nucleus of the cell. Upon activation by the binding of glucocorticoid hormones (such as cortisol), the glucocorticoid receptor translocates into the nucleus from the cytoplasm. Inside the nucleus, the activated glucocorticoid receptor regulates gene expression by binding to specific regions of DNA known as glucocorticoid response elements. This interaction leads to the modulation of various cellular processes and physiological responses controlled by glucocorticoid signaling. Therefore, the correct location of the glucocorticoid receptor is inside the nucleus.

Correct Answer: A

Rationale: Corticosteroid therapy can exacerbate or worsen several medical conditions. However, it typically does not aggravate congenital adrenal hyperplasia (CAH). CAH is a genetic disorder characterized by a deficiency of certain enzymes in the adrenal glands, leading to problems with hormone production. Corticosteroid therapy is actually a key component of the treatment for CAH, helping to replace the deficient hormones and manage symptoms. In contrast, corticosteroid therapy can worsen conditions such as diabetes mellitus, hypertension, and peptic ulcer disease by affecting glucose metabolism, blood pressure regulation, and gastric mucosal integrity, respectively.

Correct Answer: B

Rationale: Corticosteroids can cause a rise in blood pressure primarily due to their mineralocorticoid action. Mineralocorticoids such as aldosterone play a key role in regulating blood pressure by controlling sodium and water balance in the body. Corticosteroids, including synthetic ones like prednisone, can mimic the effects of aldosterone, leading to increased sodium reabsorption in the kidneys and subsequent water retention. This results in fluid buildup and elevated blood pressure. It is important for healthcare providers to monitor blood pressure regularly in patients who are prescribed corticosteroids, especially for long-term use, to manage and minimize this potential adverse effect.