Which of the following drugs should be administered first to control hormone-related effects that could be rapidly lethal in this patient?

Correct Answer: B

Rationale: Step 1: Identify the rapidly lethal hormone-related effects – likely thyroid storm. Step 2: Propranolol is a beta-blocker that helps control symptoms like tachycardia and hypertension in thyroid storm, making it crucial for immediate management. Step 3: Betamethasone (A) is a corticosteroid, not the first-line for thyroid storm. Potassium iodide (C) is used for thyroid blockade in radiation emergencies, not initial treatment. Propylthiouracil (D) is used for long-term management but not the initial control of symptoms.

Correct Answer: A

Rationale: The correct answer is A: Hyponatremia. Glucocorticoids without salt-retaining activity do not cause sodium retention, leading to hyponatremia. This is due to their lack of mineralocorticoid effects. The other choices are incorrect because hypercalcemia (B) is associated with hyperparathyroidism or excessive vitamin D, hypokalemia (C) is linked to potassium-wasting diuretics or renal tubular acidosis, and hyperglycemia (D) can be caused by factors like diabetes or excessive carbohydrate intake.

Correct Answer: D

Rationale: The correct answer is D. Therapy typically suppresses the immune system, leading to a decrease in lymphocytes. Lymphocytes are a key component of the immune system, so a decrease is expected with therapy. Neutrophils are primary defenders against infections, so they would not decrease. Erythrocytes are red blood cells responsible for oxygen transport and their decrease would lead to anemia, not a typical therapy response. Basophils are involved in allergic reactions and inflammation, so an increase in basophils would not be a typical response to therapy.

Correct Answer: B

Rationale: The correct answer is B: Fludrocortisone excess. In Addison's disease, there is adrenal insufficiency leading to low levels of cortisol and aldosterone. Fludrocortisone is a synthetic mineralocorticoid used to replace aldosterone in the treatment of Addison's disease. Excess fludrocortisone can cause retention of sodium and water, leading to hypertension, hypokalemia, weakness, and paresthesias. Constipation can also occur due to altered electrolyte balance. A: Cortisol-induced hyperglycemia is not the best explanation for the patient's symptoms as hyperglycemia is not a prominent feature of Addison's disease. C: Inadequate therapy of adrenal insufficiency would not cause the specific symptoms mentioned. D: Cortisol-induced myopathy is not the primary cause of weakness and paresthesias in Addison's disease; aldosterone deficiency leading to electrolyte imbalance is more relevant.

Correct Answer: C

Rationale: The correct answer is C: Finasteride. Finasteride is a 5-alpha reductase inhibitor that can decrease the size of uterine fibroids by inhibiting the conversion of testosterone to dihydrotestosterone. This can help reduce symptoms such as heavy menstrual bleeding and pelvic pain before surgery. Ethinyl estradiol (A) is a form of estrogen and can potentially worsen fibroid symptoms. Flutamide (B) is an antiandrogen used for conditions like prostate cancer, not for uterine fibroids. Mifepristone (D) is a progesterone receptor antagonist used for medical abortion, not for managing fibroid symptoms before surgery.