Corticosteroids

A 38-year-old woman with systemic lupus erythematosus (SLE) presents with acute lupus nephritis (Class IV). She is started on high-dose intravenous methylprednisolone 1 g daily for 3 days, followed by oral prednisolone 1 mg/kg/day. After 2 weeks of therapy, she develops severe hypokalemia (K⁺ 2.8 mEq/L), hypertension (160/100 mmHg), and hyperglycemia (fasting glucose 280 mg/dL). Which of the following best explains the mechanism underlying these adverse effects?

A 52-year-old man with chronic obstructive pulmonary disease (COPD) exacerbation is prescribed oral prednisolone 40 mg daily for 7 days. He has a past medical history of well-controlled type 2 diabetes mellitus (HbA1c 6.8%) and hypertension. After 5 days of prednisolone therapy, his fasting blood glucose rises to 240 mg/dL and his blood pressure increases to 155/95 mmHg. He also reports new-onset insomnia and mood changes. Which of the following best describes the pharmacologic basis for the glucose elevation in this patient?

A 28-year-old man with acute severe asthma exacerbation unresponsive to bronchodilators presents to the emergency department with severe bronchospasm and hypoxia. Which corticosteroid is the drug of choice for rapid anti-inflammatory effect in this acute setting?

A 35-year-old woman with systemic lupus erythematosus (SLE) on prednisolone 20 mg daily for 6 months presents with severe osteoporosis on DEXA scan (T-score −2.8). She has no history of fractures. What is the most appropriate next step in management?

A 52-year-old man with rheumatoid arthritis has been on long-term corticosteroid therapy for 3 years. He now presents with severe bone pain and pathological fracture of the femoral neck. Which is the most common skeletal complication of chronic corticosteroid use?