elitoki
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A25 y.o woman comes to the physician because of a 3 mo history of the unexplained urge to eat a few tablespoons of cornstarch daily. The amount of cornstarch ingested has increased gradually during this time. She has leiomyoata uteri’ she is otherwise healtht. Her weight is unchanged from her last visit 1yr ago; she weights 61 kg, 168 cm tall. Her BP 120/80, p 100. PE shows mild pallor. Neurologic examination shows no abnormalities. She is embarrassed about her problem. She has no compulsive behavior or obsessive thoughts. ECG shows sinus tachycardia. Which of the following is the most appropriate next step in management?
a) psychiatric assessment
b) complete blood count
c) thyroid fuction studies
d) urine toxicology screening
e) admission to an eating disoreders clinic
f) antipsychotic therapy
g) folic acid supplementation
h) SSRi
A26 y/o woman is brought to the ED because of marked confusion for 2 hrs. she also has had a flue like illness for 3 days. Over the past 6 wks, she has had increased fatigue, weakness and nausea. Se recently started thyroid hormone replacement therapy for autoimmune thyroiditis; 1 wk ago, her serum TSH level was 3 micro/mL. Her temperature is 38C, BP 80/40, pulses is 140min. there is generalized hyperpigmentation, especially involving the palmar creases. The lungs are clear to auscultation. Abd Ex shows diffuse mild tenderness and no rebound. Lab studies show:
Hemoglobin 10 g/dL
Leukocyte count 9000/mm3
Segmented neutrophils 55%
Eosinophils 20%
Lymphocytes 25%
Serum Na 124
cl- 92
K 6.4
HCO3- 16
An x-ray film of the chest and urinalysis show normal findings. And ECG shows sinus tachycardia with peaked T waves. Which of the following is most likely to confirm the primary cause of this pt condition.
a) measurement of pulmonary artery pressure
b) measurement of right atrial pressure
c) measurement of serum antithyroglobulin ab level
d) measurement of seum lactate dehydrogenase activity
e) measurement of serum TSH level
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| Justice
Forum Fanatic
Topics: 101
Posts: 1,970
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1. Pica: b) complete blood count
2. really confused... This is acute adrenal failure, but what to choose from the answers? D? E?
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| SkiKidd
Forum Newbie
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I'd go with C? Because she has autoimmune thyroiditis and one of the causes of hypoadrenalism is autoimmune mechanisms and this is the only answer addressing autoimmunity??
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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FOUND OF ANTITHYROGLOBULIN AB
CONFIRM THE DIAGNOSE OF ADRENAL INSUFICIENCY ??
MAY BE ASSOCIATED BUT IT CAN CONFIRM THE DIAGNOSIS ?
STILL NEED EXPLAINATION
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| Korotkoff
Forum Senior
Topics: 15
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B
C
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| guangyu
Forum Elite
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Posts: 308
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B
D not sure
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| aspire
Forum Senior
Topics: 24
Posts: 158
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1.B
2. C? I thought this was addison's disease , with an exacerbation due to an illness...The electrolyte abnormalities causing confusion...Given , these options I thought it is anti-thyroglobulin antibody as her TSH level had already been measured before.
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| doc_clotaire
Forum Guru
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1.- B
2.- C 
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| mildus
Forum Guru
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Addison's disease explains blood findings, its common cause is autoimmune adrenalitis, can be associated with autoimune thyreoiditis, but antithyreoglobulin antibody can't confirm the diagnosis of autoimmune adrenalitis but autoimune thyreoiditis
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| sherry39
Forum Junior
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bbbbb...right atrial pressure show picture of shock
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| farnsworth
Forum Newbie
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Posts: 165
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26: C
the clinical pictures resembles that of Carpenter syndrome.
(B - right atrial pressure has to be measured as the patient will need a central line anyway. But this does not give the diagnosis, but confirms symptoms of shock, which we already know the patient is in...)
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