Patients under long use of glucocorticoids are advised NOT to:

Correct Answer: A

Rationale: Glucocorticoids (e.g., prednisone) suppress the HPA axis with prolonged use, requiring gradual tapering to avoid adrenal insufficiency (choice A), a potentially fatal withdrawal effect. Monitoring blood glucose (choice B) is advised due to hyperglycemia risk. A potassium/calcium-rich diet (choice C) counters hypokalemia and osteoporosis. Salt reduction (choice D) manages fluid retention. Sudden cessation is the key precaution, emphasizing the need for tapering schedules to restore adrenal function safely.

Correct Answer: C

Rationale: In the context of the pharmacology of CNS drugs, understanding the treatment of Type I diabetes mellitus is crucial due to its implications on CNS function and overall patient health. The correct answer is C) Should be treated by insulin. Insulin is necessary for individuals with Type I diabetes mellitus because their bodies do not produce insulin on their own. Insulin therapy helps regulate blood glucose levels and prevent complications associated with uncontrolled diabetes, including CNS-related issues such as diabetic neuropathy and cognitive impairments. Option A) Commonly observed in old patients is incorrect because Type I diabetes mellitus is typically diagnosed at a younger age due to autoimmune destruction of pancreatic beta cells. Option B) Could be treated by oral hypoglycemic drugs is incorrect because oral hypoglycemic drugs are not effective for treating Type I diabetes mellitus, as they work by increasing insulin sensitivity or production, which is not applicable in individuals who do not produce insulin. Option D) May respond to dietary regimens alone is incorrect because while diet and exercise are important components of diabetes management, individuals with Type I diabetes mellitus require insulin therapy to survive as dietary regimens alone cannot provide the necessary insulin for glucose regulation. Educationally, understanding the specific treatment requirements for Type I diabetes mellitus is important for healthcare professionals involved in the management of diabetes and its potential CNS complications. It highlights the critical role of insulin therapy in controlling blood glucose levels and preventing long-term complications associated with uncontrolled diabetes, emphasizing the importance of personalized and evidence-based treatment approaches in clinical practice.

Correct Answer: B

Rationale: The correct answer is B) Acute adrenocortical insufficiency. Explanation: When glucocorticoids are withdrawn suddenly after prolonged therapy, the body's natural production of cortisol may be suppressed. This can lead to acute adrenocortical insufficiency because the adrenal glands have become dependent on exogenous glucocorticoids. As a result, the body is unable to produce enough cortisol to meet its needs, leading to symptoms of adrenal insufficiency such as weakness, fatigue, hypotension, and in severe cases, adrenal crisis. Why others are wrong: A) Hypertensive crisis: Sudden withdrawal of glucocorticoids is more likely to cause hypotension rather than hypertension due to the lack of cortisol to maintain blood pressure. C) Cardiac arrhythmias: While prolonged corticosteroid use can have cardiac effects, sudden withdrawal is more likely to cause systemic effects related to cortisol deficiency rather than isolated cardiac arrhythmias. D) Angina pectoris: Glucocorticoid withdrawal is not typically associated with the development of angina pectoris. Educational context: Understanding the effects of prolonged glucocorticoid therapy and the consequences of sudden withdrawal is essential in pharmacology education. It highlights the importance of tapering off glucocorticoid therapy gradually to allow the body's natural cortisol production to resume. This knowledge is crucial in clinical practice to prevent adverse effects and manage patients on corticosteroid therapy effectively.

Correct Answer: D

Rationale: Octreotide (choice D), a somatostatin analog, treats acromegaly by inhibiting growth hormone from pituitary tumors, reducing symptoms. Cosyntropin (choice A) tests adrenal function, Desmopressin (choice B) manages diabetes insipidus, Leuprolide (choice C) targets sex hormones. Octreotide is specific.

Correct Answer: C

Rationale: In the scenario presented, the correct answer is C) Insulin plus fluid therapy plus potassium. Explanation of why C is correct: 1. **Insulin**: Essential for correcting hyperglycemia by promoting glucose uptake. 2. **Fluid therapy**: Helps correct dehydration and electrolyte imbalances secondary to ketoacidosis. 3. **Potassium**: Replacement is crucial as insulin administration can lead to intracellular shift of potassium, potentially causing hypokalemia. Explanation of why others are wrong: 1. **A) Insulin alone**: While insulin is necessary, it alone does not address the electrolyte imbalances seen in diabetic ketoacidosis. 2. **B) Insulin plus fluid therapy**: Fluid therapy is crucial, but without potassium replacement, there is a risk of hypokalemia. 3. **D) Insulin plus fluid therapy plus sodium bicarbonate**: Sodium bicarbonate is no longer routinely recommended in the treatment of diabetic ketoacidosis as it may lead to paradoxical cerebrospinal acidosis. Educational context: Understanding the comprehensive approach to managing diabetic ketoacidosis in pediatric patients is vital for healthcare providers. This case emphasizes the importance of addressing not only hyperglycemia with insulin but also correcting dehydration and electrolyte imbalances to ensure a successful outcome for the patient.