05-13-2007, 04:35 PM
When you arrive for your shift at the Emergency Department, you are asked to take over care of a colleague's patients from earlier in the day.
One of the patients is a 53-year-old female, who presented after a syncopal episode at work. This was her first episode of syncope, although she described feeling very fatigued and weak for the past several weeks. In addition, she has been quite nauseated, and she describes a weight loss of approximately 5 pounds. She has also had some vomiting and intermittent abdominal pain for the past few weeks. Her past medical history is positive for Hashimoto's thyroiditis and medications include a multivitamin and thyroxine.
Laboratory evaluation revealed hemoglobin of 12.9 g/dL, TSH of 2.3mIU/L, sodium of 122 mEq/L, potassium of 5.8 mEq/L, and BUN of 38 mg/dL. As the doctor assigns this patient out to you, he states that he thinks this must a new presentation of chronic adrenal insufficiency. If this were the diagnosis, what findings would you expect as you go to meet and examine the patient?
A
Bradycardia
B
Increased axillary and pubic hair
C
Longitudinal pigmented bands in the nails
D
Horizontal pigmented bands in the nails
E
A normal physical exam
One of the patients is a 53-year-old female, who presented after a syncopal episode at work. This was her first episode of syncope, although she described feeling very fatigued and weak for the past several weeks. In addition, she has been quite nauseated, and she describes a weight loss of approximately 5 pounds. She has also had some vomiting and intermittent abdominal pain for the past few weeks. Her past medical history is positive for Hashimoto's thyroiditis and medications include a multivitamin and thyroxine.
Laboratory evaluation revealed hemoglobin of 12.9 g/dL, TSH of 2.3mIU/L, sodium of 122 mEq/L, potassium of 5.8 mEq/L, and BUN of 38 mg/dL. As the doctor assigns this patient out to you, he states that he thinks this must a new presentation of chronic adrenal insufficiency. If this were the diagnosis, what findings would you expect as you go to meet and examine the patient?
A
Bradycardia
B
Increased axillary and pubic hair
C
Longitudinal pigmented bands in the nails
D
Horizontal pigmented bands in the nails
E
A normal physical exam