Kamsi
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A 61-year-old woman presents to her primary care clinic with difficulty breathing and swallowing, as well as throat and neck pain and voice changes over the past two months. She is very sensitive to cold and constantly feels tired. She also has fatty, foul-smelling stools. She denies abdominal pain, vomiting, or weight changes. She has itching, which has increased over the past month, and constantly experiences dryness of the mouth, which is unrelieved by drinking fluids. During the last visit to her gynecologist, she was found to have an immobile, painful, thickened cervix and was diagnosed with sclerosing cervicitis. The diagnosis was supported by cervical biopsy.
On physical examination, her temperature is normal, and the pulse is 62/min. Her face looks slightly puffy, and her skin is dry and pale. There are xanthomatous lesions around the eyelids and on the face. The mucous membranes are dry. The thyroid gland is palpable, enlarged, asymmetrical, hard, and immobile. There is no tenderness on palpation of the thyroid. There is a mild lower extremity edema. Laboratory studies show: sodium 132 mEq/L, potassium 3.4 mEq/L, BUN 24 mg/dL, creatinine 0.9 mg/dL, cholesterol 290 mg/dL, triglycerides 168 mg/dL, TSH 34 mU/L (normal 0.4-5.0 mU/L), and free T4 0.6 ng/dL (normal 0.9-2.4 ng/dL). The thyroid radioiodine uptake is low, and the scan reveals uneven uptake. Antimitochondrial antibodies are present, and thyroid autoantibodies are negative. Thyroid-gland ultrasound reveals diffuse changes, with no nodular structures. An ultrasound-guided, thyroid-gland biopsy reveals an increased amount of fibrotic tissue. What would be the most effective treatment in this thyroid gland disorder?
(A) Surgical decompression
(B) Corticosteroids
(C) Tamoxifen
(D) Levothyroxine
(E) Radiation therapy
A 52-year-old woman is complaining of several weeks of swelling of both hands and ankles. She notes stiffness in the morning that subsides during the day. She has also experienced generalized weakness, cough, and intermittent low-grade fevers. The patient denies having a skin rash or dryness of the eyes. Examination reveals symmetrical swelling and warmth of the wrists, knees, and proximal interphalangeal and metacarpophalangeal joints of the hands. There are small subcutaneous nodules palpated over the tendons of her fingers and elbows. A faint pericardial rub is auscultated. Initial laboratory tests reveal: white cell count 11,200/mm3, hematocrit 32%, mean corpuscular volume 92 μm3, platelets 660,000/mm3, creatinine 1.2 mg/dL, and glucose 150 mg/dL. What should be the first diagnostic test performed?
(A) X-rays of hands, wrists, and ankles
(B) Rheumatoid factor and sedimentation rate
(C) Antinuclear antibody
(D) Examine the synovial fluid
(E) Echocardiogram
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| hgheith
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where do u get ur q's from?
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| gr8doc
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D
B
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| Kamsi
Forum Guru
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They are Fischer questions
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| hgheith
Forum Elite
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wow they are twisted and complicated.
D
D
From what I've read RF and ESR are not specific?
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| kpmle2
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(B) Corticosteroids
(A) X-rays of hands, wrists, and ankles
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| salo
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D
C
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| peraspera
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1.E?
2.D.
Edited by peraspera on 09/10/07 - 04:49 PM
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| dr19
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1-Riedel's thyroiditis---->A
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| dr19
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2-SLE------>C
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| gr8doc
Forum Senior
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On second thought, msy be a case of Hashimoto with positive antimicrobial antibodies & causing difficulty breathing ------------> A.
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| dermatology
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1 D
2 C
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| dermatology
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2nd thought ... 2. B .... rheumatoid arthritis
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| dermatology
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man these questions are real twisted ... i hope these type of questions are not asked in exams ...
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| hgheith
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The first one is somekind of hypothyroid, typical treatment is with levo, but somehow I think this question has more about it, and the treatment might be somthing else.
The second one is Rheumatoid, but there is no best test for diagnosis, that is why this one is confusing. Do u have the answers Kamsi?
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| Kamsi
Forum Guru
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1 C Riedel's thyroiditis
2 E echocardiogram pts has rheumatoid athritis with pericarditis which shld be investigated first
the questions are twisted
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| Justice
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1. ...difficulty breathing and swallowing... No meds out of the given options would resolve this. Thus, I go with (A)
2. Symmetric lesions, probably not SLE, no need for (C)... (B) will be not specific... I would go with (A)
Edited by Justice on 09/12/07 - 03:22 PM
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| hgheith
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Oh!!  That is not fair! Wow that one small sentenced made a big difference in the answer, I should have seen it, Echo!
That is a good one, tricky, is step 2 ck going to be like this??
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| dr19
Forum Senior
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Good cases,but the answers do Not convince
Can somebody explain the reason why to be asked this or that exam?
another question:
2nd case.....platelets :660000.what does it mean?
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| Dr.D
Forum Senior
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1-Riedel's thyroiditis----> C , In kaplan step 2ck/internal medicine notes/under endocrinology/ Tamoxifen I don't know why?
2. Echo
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| aaroho
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1-c
2-e
platelet count increased coz it's an acute phase reactant.
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| aaroho
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1-c coz tamoxifen can induce partial to complete remission in most pts.within 3-6 mts.tamoxifen Rx must be continued for years.
Not A cos surgical decompression usually fails to permanently alleviate compression symptoms;such surgery is difficult due to dense fibrous adhesions,making surgical complications more likely.
From CMDT.
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