05-13-2007, 04:44 PM
A 53-year-old female presents to the emergency room after a syncopal episode at work. This is her first episode of syncope, although she describes feeling very fatigued and weak for the past several weeks. She has also been quite nauseated and she describes a weight loss of approximately 5 pounds. She has had some vomiting and intermittent abdominal pain for the past few weeks. Today, she describes feeling somewhat flushed and then "passing out;" her co-workers believe that her loss of consciousness lasted less than 30 seconds. She denies any melena, hematochezia, palpitations, chest pain, shortness of breath, or headache. Her past medical history is positive for Hashimoto's thyroiditis and medications include a multivitamin and thyroxine.
Physical exam reveals a female appearing older than her stated age, looking very weak, lying on the stretcher. Vital signs reveal orthostatic hypotension and tachycardia (110beats/minute supine); she is afebrile. She has a brown suntan across her face and arms, with warm extremities distally. Cardiac exam reveals a feeble tachycardic pulse and very soft heart sounds. Rectal exam reveals guaiac negative stool. Exam is otherwise unremarkable.
Laboratory evaluation reveals 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. EKG reveals tachycardia, low voltage, and flattened T-waves. What is the most likely diagnosis causing this patient's symptoms?
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A
Addison's disease
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B
Upper GI bleed
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C
Lower GI bleed
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D
Hypothyroidism
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E
Pregnancy
Physical exam reveals a female appearing older than her stated age, looking very weak, lying on the stretcher. Vital signs reveal orthostatic hypotension and tachycardia (110beats/minute supine); she is afebrile. She has a brown suntan across her face and arms, with warm extremities distally. Cardiac exam reveals a feeble tachycardic pulse and very soft heart sounds. Rectal exam reveals guaiac negative stool. Exam is otherwise unremarkable.
Laboratory evaluation reveals 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. EKG reveals tachycardia, low voltage, and flattened T-waves. What is the most likely diagnosis causing this patient's symptoms?
|||||||||
A
Addison's disease
|||||||||
B
Upper GI bleed
|||||||||
C
Lower GI bleed
|||||||||
D
Hypothyroidism
|||||||||
E
Pregnancy