Which medical condition would warrant a prescription for high-dose corticosteroids?

Choice A rationale:

Uncontrolled diabetes mellitus: Corticosteroids can have a hyperglycemic effect, meaning they can raise blood sugar levels. This makes them generally unsuitable for use in patients with uncontrolled diabetes mellitus. In fact, corticosteroids might even worsen glycemic control in these patients. While corticosteroids might be used in some cases of diabetes mellitus, such as to treat diabetic retinopathy or nephropathy, they would be used cautiously and with close monitoring of blood sugar levels.

Choice B rationale:

A recent diagnosis of lung cancer: Corticosteroids are not a primary treatment for lung cancer. They might be used in some cases to help manage symptoms or side effects of other treatments, such as chemotherapy or radiation therapy. However, they would not typically be used as a first-line treatment for lung cancer itself.

Choice C rationale:

Acute exacerbation of COPD: Corticosteroids are a mainstay of treatment for acute exacerbations of COPD. They work by reducing inflammation in the airways, which helps to improve airflow and relieve symptoms such as wheezing, shortness of breath, and chest tightness. Corticosteroids can be given orally, intravenously, or by inhalation. The dose and duration of treatment will depend on the severity of the exacerbation.

Choice D rationale:

Chronic asthma: Corticosteroids are often used as a long-term control medication for chronic asthma. However, they are typically used at lower doses than those used for acute exacerbations of COPD. Inhaled corticosteroids are the preferred form of treatment for chronic asthma, as they deliver the medication directly to the airways and have fewer systemic side effects.

Choice A rationale:

Incorrect. Insulin pumps should be removed before bathing or swimming to prevent damage to the device. Water can enter the pump through the infusion set or through the battery compartment, causing it to malfunction. This can lead to inaccurate insulin delivery, which can result in hyperglycemia or hypoglycemia.

Additionally, the adhesive that holds the infusion set in place may not stick well to wet skin, which can increase the risk of the infusion set falling out.

It is important to note that some insulin pumps are now waterproof and can be worn while bathing or swimming. However, it is still important to check the manufacturer's instructions before doing so.

Choice B rationale:

Correct. Even though insulin pumps deliver insulin continuously, people who use them still need to monitor their blood glucose levels regularly. This is because many factors can affect blood glucose levels, such as food intake, exercise, stress, and illness.

Monitoring blood glucose levels allows people to adjust their insulin doses as needed to keep their blood glucose levels within a target range.

Recommended frequency of blood glucose monitoring:

Before meals and snacks Two hours after meals At bedtime

Before and after exercise During times of illness or stress

Whenever they feel symptoms of hypoglycemia or hyperglycemia

Choice C rationale:

Incorrect. People who use insulin pumps still need to count carbohydrates. This is because the amount of insulin that is needed to cover a meal depends on the amount of carbohydrates in the meal.

The insulin pump can be programmed to deliver different amounts of insulin for different meals, snacks, and corrections based on carbohydrate intake. This allows for more precise insulin dosing and better blood glucose control.

Choice D rationale:

Incorrect. Insulin pumps are not designed to help people lose weight. They are designed to help people manage their blood glucose levels.

While some people may lose weight when they start using an insulin pump, this is usually due to improved blood glucose control rather than the pump itself.