]> 2026-07-31T11:51:56+00:00 WBR0269 0 en Sputum cultures for mycobacterium tuberculosis Drug susceptibility testing '''Incorrect'''-A drug susceptibility testing is only a reliable lab test done before initiating treatment for the multi drug resistant strain. It is not useful in diagnosing the cause of hypotension in this patient. Early morning serum cortisol and cosyntropin stimulation '''Correct'''-This patient’s hypotension along with symptoms of weakness, fatigue, and weight loss in combination extensor hyperpigmentation are all consistent with Addisons disease. Tuberculosis can involve the adrenal glands as an extra pulmonary manifestation and result in adrenal insufficiency. Measurement of serum cortisol baseline and then stimulation with ACTH will confirm the clinical suspicion. Cortisol response is measured after cosyntropin is given intramuscularly or intravenously. The ACTH stimulation test is used to determine the adrenal reserve capacity for steroid production. Blood culture '''Incorrect'''-Blood culture is not useful as the patients temperature is normal and septic shock is not suspected. Chest X ray Community Medical Health Center Primary Care Office Inpatient Facilities Vendhan Ramanujam A 46 year old alcoholic male is being treated for tuberculosis, but he has not been compliant with his medications. He comes to his physicians office and complains of increasing weakness, fatigue and febrile episodes on and off over the past one week. He appears to have lost weight. His temperature is 99.6 F (35.6 C), pulse is 96/minute and blood pressure is 80/50 mmHg. There are some pigmentation over the elbows. Cardiac exam is normal. There is a possibility that he has developed a multi drug resistant strain of tuberculosis. The next best step in evaluation of the patients low blood pressure will be C Endocrine Infectious Disease 2020-10-28T00:00:51Z 2459150.5005903 WBR0269