zaki
Forum Guru
Topics: 92
Posts: 398
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A 26-year-old woman comes to see you because of hair loss, profuse itching,
pain in all her extremities, headache, sleep disturbance, edema, and increased fatigue.
Since early childhood, she has had a history of fatigue, aching joints, dizziness, headache,
nausea, diarrhea alternating with constipation, tingling in her extremities, palpitations,
shortness of breath, irregular menses, fainting spells, and periodic sweating. She has seen
several physicians and has had many extensive evaluations, including blood tests, imaging studies
(computed tomography of the head and abdomen, upper gastrointestinal series, small bowel follow-through,
and barium enema), cardiologic evaluation, including echocardiography and exercise stress testing,
and multiple emergency room visits. She says that Lyme serology was negative, but she was told
she is hypoglycemic.
Physical examination shows a diffuse erythema, some thinning of the hair, glossitis, mild edema of the extremities, hepatomegaly, and tenderness of her extremities, particularly her shins. Laboratory examination shows elevated alkaline phosphatase and a calcium level of 11 mg/dL.
The most likely diagnosis is:
(A) Vitamin A toxicity
(B) Systemic lupus erythematosus
(C) Chronic fatigue syndrome
(D) Hypothyroidism
(E) Hyperparathyroidism
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Maverick
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| alice8
Forum Guru
Topics: 37
Posts: 643
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(E) Hyperparathyroidism :?:
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Dream on 'til your dream comes true.
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| zaki
Forum Guru
Topics: 92
Posts: 398
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try again
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Maverick
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| tamriko
Forum Elite
Topics: 23
Posts: 296
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The patient has classic signs of primary hypothyroidism, so the answer is D.
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| sd
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(B) Systemic lupus erythematosus
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| tamriko
Forum Elite
Topics: 23
Posts: 296
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Zaki, can you tell us the answer, please?
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| dr_ashishg
Forum Newbie
Topics: 4
Posts: 32
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hypothyroidism
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| zaki
Forum Guru
Topics: 92
Posts: 398
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ofcourse i will tell the answer but plz wait a little while
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Maverick
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Hi!
This one seems to be an SLE. Disorders of the thyroids would be easy to rule out, A hyperviteminosis is suspect but the disease is too colorful to be that simple.
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| zaki
Forum Guru
Topics: 92
Posts: 398
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HINT: SHE HAD EXTENSIVE EVALUATION BUT NO DIAGNOSIS.....
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Maverick
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| bakpity
Forum Senior
Topics: 28
Posts: 71
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Hi!
I suppose it is a Hashiomotho thyreoiditis, so hypothyreosis is the answer. I would say the core of the symptomps come from the disease itself, and I would explain the lab findings with other associated autoimmun disorder connected to the diseease eg. Addison disease. Together Addison and hypothyreosis is called Schmidt syndrome.
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| fried water
Forum Junior
Topics: 4
Posts: 57
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hey is she taking vitamin supplements since childhood??
>> crazy if she took so much of vitamin A!>> i don't know.. just a vague guess   . Sorry if i sound stupid!
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i think its A, agree with fried water
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| zaki
Forum Guru
Topics: 92
Posts: 398
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Anwer is A
This woman shows classic vitamin A toxicity, with characteristic hepatic and bone effects. She exhibits signs of somatization
and, accordingly, is at increased risk of alternative therapies, including megavitamin therapy. She has undergone extensive evaluation
in the past for a variety of disorders. Systemic lupus erythematosus would have been suspected on many previous occasions; moreover,
lupus almost never is associated with hypercalcemia. One characteristic of chronic fatigue syndrome is that it does not demonstrate
laboratory abnormalities nor such dramatic physical findings. Erythema, hepatomegaly, and tenderness of the extremities are uncommon in hypothyroidism.
Hyperparathyroidism may certainly cause bone pain and hypercalcemia, but the skin findings and glossitis suggest another etiology for the hypercalcemia.
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Maverick
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| gballarino
Forum Senior
Topics: 12
Posts: 96
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nice question!! too bad i didnīt get to see it before you told us the answer. I was going to say hyperparathyroidism anyway...
Do you see a lot like this in the actual step 2 CK??
If so... Iīd better go back to my books at once!
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Guillermo Ballarino
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| usmledoctor1
Forum Junior
Topics: 4
Posts: 77
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i did got it right at first instance
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