Sunday, 3 April 2011

mcqs today : 1

Question `1  :
A 35 year old female develops a swollen, very painful neck. She has a fever, chills and generally feels ill. She is initially evaluated by a physician assistant for pharyngitis. Her group A, beta hemolytic strep test is negative. She returns to see her doctor the next day On physical examination her heart rate is 95 and her blood pressure is 120/80. She has a temperature of 100F and a mildly enlarged thyroid gland. When her doctor goes to examine her thyroid, she objects, as this area is very sensitive, actually painful. She then lets him palpate her neck, and the physician is able to detect a mildly enlarged thyroid gland. Thyroid tests are done, but the results are pending. What is the most likely diagnosis? 
a) myxedema
b) cretinism
c) Graves disease
d) Jod-Basedow phenomenon
e) De Quervain's thyroiditis
Please post your answer in the mbbspg discussion zone on the right. Help others by posting explanation however this is optional. Answer to this question will be posted tommorrow

answer with explanation: click read more below

Answer to question 1: "e".

De Quervain's thyroiditis classically presents with a very tender thyroid. There are systemic symptoms, associated with it. There may be symptoms of hyperthyroidism, or as in this case, there may not be symptoms of hyperthyroidism. (Inflammation in the thyroid gland is associated with release of colloid and stored thyroid hormone,but also with damage to the follicular cells and impaired synthesis of new thyroid hormones.As a result T4 and T3 levels are raised for 4-6 weeks until the preformed colloid is depleted .Therefore there is usually a period of hyperthyroidism followed by a period of hypothyroidism of variable severity before the follicular cells recover and normal thyroid function is restored)

Myxedema (choice a) would present with symptoms of weakness, fatigue, cold intolerance, constipation, weight gain.
Cretinism (choice b) is congenital hypothyroid. This is not the case here, as her symptoms developed later in her life.

Graves disease (choice c) present with symptoms of hyperthyroidism. Symptoms of hyperthyroidism would include weight loss, loose stools, and heat intolerance. Signs would include tachycardia, a brisk return on the Achilles reflex, exophthalmos and a palpable thyroid.

Jod-Basedow phenomenon (choice d) is hyperthyroidism cause by iodine ingestion.
 Jod is the German word for' iodine'. Induction of thyrotoxicosis in patients previously euthyroid as a result of exposure to large quantities of iodine; occurs most often in geographic areas of endemic iodine-deficient goiter and in patients with multinodular goiter; can also develop following use of iodine-containing agents for diagnostic studies. SYN: iodine-induced  hyperthyroidism

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