q146 - sami2004 - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 3 (https://www.usmleforum.com/forumdisplay.php?fid=6) +--- Thread: q146 - sami2004 (/showthread.php?tid=546212) Pages:
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q146 - sami2004 - ArchivalUser - 11-05-2010 A 32-year-old male presents to the office complaining of severe anxiety. For the last 4 months, he has had difficulty sleeping, progressively worsening nervousness, a 25-pound weight loss, and constant feeling of “too warm.” He feels “shaky” and has difficulty concentrating. He denies diarrhea, but reports having normally-shaped stools 4–5 times per day, more than usual for him. The patient denies neck or eye discomfort, and has not noticed any neck swelling. He admits to smoking a half pack of cigarettes per day, a habit that he started recently to “help him calm down.” He denies alcohol or illicit drug use. His only medication is an antihistamine for seasonal allergies. He has no other significant medical history. His mother, who died 3 years ago from coronary artery disease, had a “thyroid problem,” but he doesn’t know any more details. Physical exam reveals an anxious young adult male. He has a noticeable resting tremor. You note mild exophthalmos, conjunctival injection, and lid lag. His thyroid is diffusely, mildly enlarged and a bruit is audible over the gland. The cardiac exam reveals tachycardia with a flow murmur. The rest of the exam is unremarkable. What is the most likely diagnosis? A) Viral thyroiditis. B) Graves disease. C) Anaplastic thyroid carcinoma. D) Hyperactive thyroid adenoma. E) Surreptitious thyroid hormone ingestion Which of the following tests is most SPECIFIC for Graves disease? A) Antithyrotropin receptor antibody. B) Antithyroglobulin antibody. C) Antithyroid peroxidase antibody. D) Markedly suppressed TSH. E) No futhur testing How should the patient be treated acutely? A) Propanolol and propylthiouracil (PTU) started immediately. B) Control the patient’s symptoms with propanolol now, then start PTU when the patient feels better. C) Iodine (Lugol solution). D) Radioablation with I131 . E) Thyroidectomy. Which of the following is a possible side effect of PTU therapy? A) Granulocytopenia. B) Aplastic anemia. C) Elevated liver transaminases. D) Inhibition of fetal thyroid gland. E) All of the above 0 - ArchivalUser - 11-05-2010 b d a a 0 - ArchivalUser - 11-05-2010 b d a e 0 - ArchivalUser - 11-05-2010 B E A C 0 - ArchivalUser - 11-06-2010 b,e, a, a 0 - ArchivalUser - 11-06-2010 bdae 0 - ArchivalUser - 11-06-2010 b a b a 0 - ArchivalUser - 11-06-2010 BADE 0 - ArchivalUser - 11-06-2010 bade 0 - ArchivalUser - 11-06-2010 beae |