UWorld 3 Flashcards
Clinical findings of cholecystitis and choledocholithiasis
Obstruction of bile duct causing inflammation of gall bladder (cholecystitis)
-biliary colic = intermittent RUQ pain
vs. obstruction of common bile duct (choledocho…)
- obstructive jaundice => severe icterus and high Alk phos
What drugs besides NSAIDs and triptans can be used as tx for acute migraine headaches
IV antiemetics such as chlorpromazine, prochlorperazine, or metoclopramide
D2 receptor antagonist
What is endophthalmitis?
(a) Biggest predisposing factor
Endophthalmitis = inflammation of the internal coats of the eye
(a) Most common after intraocular (cataracts) surgery
36 yo M from Wisconsin presents w/ warty, heaped up skin lesions w/ violaceous hue and sharply demarcated border
- dry cough and mild malaise
- wet prep shows yeast
(a) Dx
(b) Tx
(a) Blastomycosis- disseminated disease can even occur in immunocompromised
- S/S-central US states
- usually lung, but outside the lung most commonly goes to skin: wartlike lesions, violaceous, skin ulcers
(b) Tx = oral itraconazole in mild disease
- if disease is very severe: IV amphotericin B
Pt presents w/ spinal cord injury due to MVA
2 large-bored IV lines are in place
-CT scans of abdomen and spine are scheduled
Next steop?
Urinary catheter- assess for urinary retention, prevent acute bladder distention and damage
Abx of choice for
(a) sinusitis
(b) Moraxella and pneumococcus
(c) aspiration pneumonia
(d) nosocomial pneumonia
Abx of choice for
(a) Sinusitis = Augmentin (amox/clavulanate)
(b) Ceftriaxone
(c) Clindamycin is good for anaerobes => abx of choice in aspiration pneumonia
(d) Vanco for nosocomal pneumonia, where probability of MRSA is higher
67 yo F w/ acute onset of severe orthopnea and dyspnea
-3rd heart sound, bilateral crackles, SpO2 98% on 40% inspired O2 => intubated and given nitrates and diuretics
Afterwards, breath sounds on left side are markedly decreased
(a) How to restore breath sounds to left hemithorax?
Rather complication of intubation to go down the right mainstem bronchus, instead of sitting right above the carina =>
(a) Restore breath sounds to left hemithorax by repositioning the endotracheal tube to btwn the carina and vocal cords
68 yo 5 day post-op M presents w/ new-onset abdominal pain
- spontaenous voiding of 200 ml of urine
- new BUN and creatinine elevation
Next steps
Post-op urinary retention is a common complication of surgery and anesthesia => first assess bladder volume w/ portable scan
If portable scan is inconclusive, foley cath: important to restore normal urine output and resolve or prevent hydronephrosis, tubular atrophy, and renal injury
-if catheterization doesn’t relieve the oliguria, AKI may be pre-renal or intrinsic in etiology
Clinical significance of urinary 5-hydroxyindoleacetic acid excretion
5-HIAA = metabolic of serotonin
Elevated urinary excretion can indicate carcinoid tumor (neuroendocrine tumor usually in the small intestines)
What lab finding is crazy elevated in Zollinger-Ellison syndrome?
Markedly elevated serum gastrin (>1,000 pg/ml)
-well duh the syndrome is due to a gastrin-producing tumor
Describe the extrahepatic sequelae of Hep C
(a) Heme
(b) Renal
(c) Skin x2
(d) Endocrine
(a) Heme = essential mixed cryoglobulinemia
- immune deposition in BVs
(b) Renal = MPGN
(c) Skin: porphyria cutanea tarda (fragile skin, vesicles and erosions on dorsum of hands, photosensitivity), lichen planus (purple itchy flat-topped papules)
(d) Endocrine- increased risk of diabetes
Purpose of abdominal fat pad biopsy
To test for amyloidosis
Xanthochromia
Xanthochromia = yellow discoloration of the CSF due to the presence of bilirubin
-suggestive of SAH
44 yo G3P3 w/ intermenstrual bleeding and heavy menses.
BMI of 40
When would you use
(a) Low dose estrogen-progestin contraceptives
(b) Progestin therapy
(b) Hysterectomy
PTs w/ abnormal uterine bleeding should undergo endometrial biopsy to evaluate for hyperplasia vs. cancer
(a) Woudn’t use combined low-dose estrogen/progesterone therapy in obese pt- increased risk for venous thromboembolism
Next step = do endometrial biopsy
(b) If biopsy shows hyperplasia w/o atypia => tx is progestin therapy
(c) If biopsy shows hyperplasia w/ atypia => hysterectomy
First line medication tx for HOCM and how they help
HOCM first line = beta-blockers, and CCB if pt can’t tolerate beta-blockers
Beta-blockers help by slowing the HR => prolonging diastole => ventricles have more time to fill
Describe the following findings in aortic regurgitation
(a) BP finding
(b) Pounding sensation and uncomfortable awareness of heartbeat, espeically in left lateral decubitus position
Aortic regurgitation
(a) BP finding = widened pulse pressure (ex: 150/45)
(b) portion of the LV outleaks back into the LV => increase in LVEDV, myocardial hypertrophy, chamber enlargement
- LV enlargement brings the ventricular apex closer to the chest wall => pounding sensation and awareness of heart beat
35 yo M w/ nocturnal wheezing and chest tightness x3 mo
- new hoarseness
- non smoker
- chest CTA
- laryngoscope: red and inflamed posterior pharynx and larynx
(a) Dx
(b) Tx
Tx = omeprazole
GERD is present in 75% of pts w/ asthma, and is often the primary trigger for asthma
asthma in adulthood: worse after meals, exercise, or lying down (nocturnal asthma)
Adult w/ new onset asthma should always be questioned regarding reflux symptoms
First line tx for chemotherapy-induced nausea and vomiting
Ondansetron (Zofran) = Serotonin receptor antagonist: targets the 5HT3 receptor
3 choices for inpatient coverage of pseudomonas
- zosyn (piperacillin/tazobactam)
- meropenem
- cefepime
Endomysal and tissue transglutaminase IgA antibody are found in what disease?
Celiac disease
-pts typically present under 40 yoa w/ diarrhea, foul-smelling stools, flatulence
Hallmark triad of trichinellosis
Trichellosis = GI complaints followed by characteristic triad: periorbital edema, myositis, eosinophilia
Common comorbidity of carpel tunnel syndrome
Carpel tunnel and hypothyroidism often co-occur, carpel tunnel syndrome is present in about 30% of pts that have hypothyroidism
Carpel tunnel symptoms often improve if hypothyroidism is treated
Bence Jones protein
Paraproteins (abnormal antibodies) produced in multiple myeloma (plasma cell cancer) that deposits and causes renal insufficiency
Differentiate types of therapy:
Adjuvant
Neoadjuvant
Salvage
Types of therapy: (using example of radiation to treat re-elevated PSA after radical prostatectomy)
Adjuvant = additional therapy given at the same time as the standard therapy
-if the radiation was given at the same time as the surgery
Neoadjuvant = tx given before the standard tx
ex: radiation before doing the radical prostatectomy
Salvage = tx given when standard therapy fails
Differentiate lupus and RA type arthritis
Both Lupus arthritis and RA most commonly affect the metacarpophalangeal (MCP) and proximal interphalagneal (PIP) joints, but lupus arthritis is not deformign (while RA is)
63 yo M w/ fever and left-sided scrotal pain x2 radiating to the flank days
- urinary frequency and urgency w/ dysuria
- tender prostate
- leukocytosis
- UA: bacteriuria and pyuria
Acute epididymitis = fever, painful enlargement of testes, irritative voiding symptoms
Effect of the following drugs on kidney function
(a) IV acyclovir
(b) MTX
(c) Beta-lactam abx
(d) PPIs
(a,b) IV acyclovir, methotrexate- can cause crystal-induced acute kidney injury
-rapidly excreted into urine but the drug has low urine solubility => readily precipitates and obstructs the renal tubules
(c,d) Beta-lactams (penicillin, amox, cephalosporins) and PPIs can cause AIN (acute interstitial nephritis)
57 yo M returned from cruise to the Bahamas w/ fever, nonproductive cough, SOB x 2 days
- HA, abd pain, diarrhea x1 day
- 102.6 F
- crackles bilaterally, bilateral interstitial infiltrates
- confused
Legionella pneumonia
-typical to have history of travel
High fever, GI and neurologic symptoms differentiate from other community acquired pneumonia
=> tx w/ levofloxacin
Mechanism of ascites in
(a) Portal HTN
(b) Malignant ascites
Mechanism of ascites in
(a) Portal HTN = increased capillary hydrostatic pressure
(b) Malignant ascites (aka ascites caused by cancer)= increased capillary permeability
56 yo M w/ intermittent dizziness x2 weeks
- brief spinning when turning over in bed
- II/VI ejection murmur at LSB
- precordial palpation and carotid upstroke are normal
- normal EKG findings
Dx?
BPPV = benign paroxysmal positional vertigo: brief episodes often predictably occurring w/ certain movements or position changes
AS suggesed by murmur, but no pulses parvus et tardus (as expected in AS)
Not Meniere’s b/c that comes w/ unilateral hearing loss and tinnitus
Vaccines recommended for adults w/ HIV
HepA, HepB, Pneumococcus (PCV13 once then PPSV23 8 weeks later then once every 5 yrs), Tdap, anual flu
- HPV if btwn 9-26
- meningococcus if large group in close proximity (college, jail, military)
Live vaccines contraindcated if CD4 count is under 200
-so now MMR, VZV
Guidelines for colonoscopy screening for pts w/
(a) Family history of adenomatous polyps
(b) Family history of CRC
(c) Ulcerative colitis
(d) Chron colitis
(e) FAP
(f) HNPCC/Lynch
Colonoscopy guidelines
(a,b) FHx of adenomatous polyps or CRC- begin at age 40 or 10 yrs before index case, repeat every 3-5 years
(c, d) IBD: begin 8 years post diagnosis (12-15 yrs if disease in only left colon), repeat every 1-2 years
(e) FAP: annually starting at age 10-12
(f) Lynch: every 1-2 yrs starting at age 20-25
45 yo M w/ sudden onset skin and oral lesions w/ fever after starting batrum 5 days ago
Erythema, blistering, ulceration of oral mucosa
Erythematous rash w/ scattered involvement on trunk, hands, arms, feet
Stevens-Johnson- from bactrum
SJS denotes less than 10% of body surface area involvement, vs over 30 = TEN (toxic epidermal necrolysis)
63 yo Asian F presents w/ severe right-sided HA x2 hrs
+ 1 episode vomit
-seeing “halos” around lights
-on Bactrum for UTI
-mother has hx of migranes
-Nonreactive, dilated r. pupil and erythematous r. eye w/ excessive lacrimation and decreased visual acuity
-elevated sed rate
Acute angle-closure glaucoma = sudden narrowing or closure of the anterior chamber angle
- affected eye: severe pain, dilated pupil w/ poor response to light, vision loss
- HA, N, V
Describe how exogenous progestin would affect the endometrium
Potent progestin given to treat abnormal uterine bleeding when endometrial biopsy shows hyperplasia w/o atypia b/c it will stop the effect of unopposed estrogen and reverse endometrial hyperlasia
-progestin activates progesterone receptors in the endometrium => decidualization of the stroma and thinning of endometrium
55 yo F presents w/ one week of pain in multiple joints
- worse in morning and takes 10-15 minutes before she regains her dexterity
- no swelling or tenderness on exam
- normal ESR
(a) Dx
(b) Etiology
Viral arthritis due to parvovirus B19- presents w/ acute onset of polyarticular and symmetric arthritis
Describe the cause of the following in scleroderma pts
(a) Right heart failure
(b) GERD
(c) Renal dysfunction
(d) Skin findings
Scleroderma- CT thickening due to myofibroblast proliferation => increased collagen and ground substance production
(a) Pulmonary HTN => r. heart failure
(b) GERD due to esophageal and gastric dysmotility
(c) Thickening in tubular structures => hypertension
- before ACEi were invented, renal crisis was the most common cause of death in scleroderma pts
(d) Skin finding: “mask-like” face due to dermal thickening, thickening of skin of hands and feet => flexion contractures. Raynaud phenomenon and calcinosis
What is it called when there is herpes on the finger?
Herpetic whitlow- about 14% of adults w/ it are healthcare workers (ex: dentists) b/c can be caused by direct contact w/ infected secretions
Confounding vs. effect modification
ex: alcohol use –> bladder cancer, smoking
ex: OCP –> breast cancer, family hx of breast cancer
Confounder = extraneous factor that is associated w/ both the exposure and the disease
Effect modification = external variable directly impacts the effect of a risk factor on the disease of interest
ex: alcohol use and its association w/ bladder cancer is confounded by smoking (smoking associated w/ both, but alcohol use and bladder cancer when stratified btwn smokers and non-smokers are not associated)
ex: OCP use associated w/ breast cancer, effect modified by family history of breast cance
72 yo w/ sudden onset non-productive cough, fever, malaise, runny nose, severe body aches
-spO2 88% on room air
-diffuse crackles w/ occasional wheeze
CXR: diffuse interstitial infiltrates b/l
(a) Dx
(b) Tx
(a) Influenza pneumonia: abrupt onset fever, chills, malaise, myalgias, cough, coryza
- febrile w/ variety of pulmonary findings
(b) Start antivirals w/in 48 hrs to be effective
Oseltamivir and zanamivir = neuraminidase inhibitors
Elderly pt w/ bone pain, renal failure, and hypercalcemia
Multiple myeloma until proven otherwise
Strongest predictor of abdominal aortic aneurysm explansion
Current smoking
-NOT uncontrolled HTN
50 yo M presents w/ acute onset of respiratory difficulty
-periorbital, circumoral, facial edema
-2 weeks s/p stent in RCA
On aspirin, clopidogrel, metoprolol, enalapril, simvastatin, isosorbide mononitrate
^Which drug most likely caused his symptoms
Angioedema = ACEi = Enalapril
-angiogedema from ACEi can occur at anytime, not just w/in weeks of starting the medication
17 yo M in MVA in a coma. 4 weeks after initial injury he develops nausea, polyuria
serum Ca 12.1
serum albumin 3.0
TPH 9 (low)
What is the cause of his hypercalcemia?
Hypercalcemia due to immobilization- median onset about 4 weeks after immobilization due to balance btwn magnitude of bone turnover and renal calcium excretion
-pts w/ chronic renal insufficiency may develop hypercalcemia earlier
Clinical presentation of multiple myeloma: CRAB
CRAB: Calcium (hyper) Renal failure- 50% of multiple myeloma pts develop some degree of renal insufficiency Anemia Bone lesions
Drug given for acne that can cause photosensitivty reaction
Most common = tetracyclines
Development of digital clubbing and sudden-onset joint arthropathy in a chronic smoker
Suggestive of hypertrophic osteoarthropathy- subset of which can be attributable to underlying lung disease (ex: lung cancer, COPD)
-presents w/ digital clubbing w/ sudden onset arthropathy most commonly affecting wrist and hand joints
33 yo presenting w/ TC seizure afetr IV cocaine/heroin use
- no post-ictal state but complains of muscle pain
- crazy high CPK, AST, ALT
(a) Dx
(b) Acute tx
(a) Rhabdomyolysis and seizure after simultaneous use of cocaine and heroin (= speedball)
- cocaine and opiates both predispose to seizures
- cocaine can lead to rhabdo
Muscle breakdown can => myoglobinuria => renal failure =>
(b) Initial tx w/ aggressive fluid resuscitation to treat rhabdo and prevent renal failure
38 yo w/ progressive SOB and productive cough x6 mo, worse w/ exertion
- previous soker
- breath sounds decreased at the bases, no crackles or wheezes
- CXR: bilateral basilar lucency
- normal CBC and BMP
(a) Next step for dx
(b) How to differentiate this from COPD
(a) Test for alpha-1 antitrypsin deficiency: chronic SOB, productive cough, and evidence of destruction of the lower lobes (key here is lower lobes)
(b) COPD presents w/ more disease in the upper lobes and at older age
Alpha-1 antitrypsin: smokers present in their 30s, a decade earlier than non-smokers
-can confirm dx w/ serum alpha-1 antitrypsin levels
Noncontrast head CT showing hyperdense signal in a cistern
Cisterns = subarachnoid space that fill up w/ blood (hyperdense/bright signal on noncontrast CT) due to an SAH
Lab indication of pre-renal azotemia
BUN:creatinine > 20:1 indicates pre-renal azotemia
-usually due to volume depletion causing hypoperfusion of the kidneys
Febrile pt w/ new soft systolic crescendo-decrescendo murmur at LSB
Fever induces a hyperdynamic state, during which an audible flow murmur may be heard
-hyperkinetic flow murmur due to fever
2 manifestations of alpha-1 antitrypsin deficiency
Liver and lung involvement due to deposition of abnormal A1AT protein
lung involvement: COPD or severe panacinar emphysema
Describe how a pulmonary embolism can alter calcium homeostasis
PE => tachypnea => blowing off tons of CO2 = respiratory alkalosis
Due to respiratory alkalosis H+ dissociates from albumin => increasing albumin affinity for Ca2+ => increase in Ca2+ bound to albumin and decrease in serum ionized (active) calcium
What dose tracheal deviation indicate?
Associated w/ tension pneumothorax
Most common cause of primary adrenal insufficiency in
(a) developing countries
(b) developed countries
Primary adrenal insufficiency
(a) Developed countries- adrenal tuberculosis
(b) Developed countries- autoimmune adrenalitis
2 antibodies present in scleroderma
Antinuclear and anti-topoisomerase I antibodies
Specifically where are bile acids reabsorbed
In the ileum => get decreased bile acid reabsorption if have extensive ileal resection (ex: secondary to Crohn’s)
Clinical presentation of craniopharyngioma
Craniopharyngioma = sellar mass (benign tumor arising from Rathke’s pouch)
Compresses on optic nerve => bitemporal hemianopsia
- headache
- hormonal deficiency (b/c impacts pituitary)
Name some causes of acute nephritic syndrome
Glomerular damage due to
- post strep GN
- IgA nephropathy
- lupus nephritis
- MPGN
- RPGN
AIDS pts should be on what prophylactic meds once their CD4+ count drops below
(a) 200
(b) 150
(c) 100
(d) 50
Once CD4+ count drops below
(a) 200: bactrum for pneumocystis jirovecii
(b) 150: Itraconazole (antifungal) for histoplasma capsulatum
(c) Under 100: batrum for toxoplasma gondii
(d) Under 50: Azithromycin (or clarithromycin) for MAC (mycobacterium avium complex)
76 yo M w/ stiffness in pelvis and shoulders w/ elevated ESR
(a) Dx
(b) Associated disease
(a) Polymyalgia rheumatica = pain/stiffness in shoulders, neck, hips/pelvis
(b) Associated w/ temporal arteritis
- have to have elevated ESR
52 yo F w/ gradualonset weakness in leg muscles
- difficulty climbing stairs and rising from a chair
- mild weakness of thigh muscles b/l w/o tenderness
(a) Dx
(b) Test for dx
(a) Polymyositis = idiopathic inflammatory muscle disease
Characteristically presents w/ progressive LE proximal weakness
-proximal arm weakness usually follows => difficulty combing hair or working w/ hands
-pts may develop dysphagia
(b) Muscle biopsy
How to prevent bone loss due to prolonged immobilization
Hydration and bisphosphonates- prevent bone loss (and therefore hypercalcemia) due to immobilization
32 yo F w/ h/o advanced Chrons diesease presents w/ LE paresthesias and difficulty balancing
- tingling in feet
- macrocytic anemia
Vitamin B12 deficiency due to chronic malabsorption from Crohn
Typical presentation of rabies
Motor weakness, paresthesias, encephalitis that can acutely progress to coma/death
Typical presentation of uveitis
Uveitis = inflammation of uvea (middle layer of the eye), presents w/ blurred vision + moderate pain, conjunctival injection, and constricted pupils
Describe how Risperidone can cause breast tenderness and milky-white discharge from both nipples
Risperidone = dopamine and serotonin antagonist
-inhibiting dopamine => elevated serum prolactin => amenorrhea and galactorrhea
What is Addison’s disease
(a) Tx
Addison’s disease = autoimmune cause of primary adrenal insufficiency
(a) Hydrocortisone
Zolendronic acid indications
= Zolendronate = IV bisphosphonate
- Annual injection for osteoporosis
- One time injection for tx of Paget’s disease
- Prevent fractures in cancers (multiple myeloma and prostate cancer), tx hypercalcemia or malignancy, can help w/ pain from bone mets
Most common cancer of the lip
Squamous cell carcinoma
-sun exposure
3 symptoms to help distinguish atypical Legionella pneumonia from other causes of community-acquired pneumonia
- High-grade fever (>102.2)
- GI symptoms
- neurologic symptoms: confusion, ataxia
63 yo F w/ ho HTN that collapses in church after severe CP that radiated to her back
- lungs clear
- variation of SBP during respiratory cycle
- CXR: widening of mediastinum
Tearing CP radiating to back = acute aortic dissection
Common complication of acute aortic dissection = cardiac tamponade = pericardial fluid accumulation
Most common cause of necrotizing fasciitis- mechanism wise
(a) Most common causative organism
Generally caused by trauma, can result from significant peripheral vascular disease
(a) Usually polymicrobial, most frequently recovered pathogen is GAS
Classic physical exam findings of cardiac tamponade
Classic triad of distant heart sounds, hypotension, and distended neck veins
Amantadine
(a) Indications
(b) Side effects
Amantadine: mechanism not fully understood, possibly NMDA inhibition and some dopamine activity
(a) Antiviral, anti-Parkinsonian agent and treat EPS of antipsychotics
(b) Livedo reticularis and ankle edema
Tinea corporis vs. tinea versicolor
Tinea corporis = body ringworm- ring-shaped lesion w/ advancing scaly border and central clearing
Tinea versicolor- hyper or hypo pigmented macules, skin flora that grows in exposure to hot and humid weather
-involved areas never tan
-both fungal
Describe the possible danger of supplemental O2 in pts w/ advanced COPD
Supplemental O2 can worsen hypercapnia in advanced COPD pts due to
- increased dead space perfusion => V/Q mismatch
- decreased affinity of oxyHgb for CO2
- reduction in alveolar ventilation
This CO2 retention can cause stroke and neurologic symptoms
Indications for surgical repair of aortic aneurysm
Aneurysm > 5.5cm, rapid rate of aneurysm expansion, presence of symptoms (abdominal, back, or flank pain; limb ischemia)
What rare diagnosis to suspect when newly diagnosed diabetic presents w/ erythematous papules on face, extremities, diarrhea, anemia, and wt loss
Glucagonoma
-confirm dx w/ glucagon > 500
Typically mild and diet or oral-agent controlled diabetes (doesn’t require insulin)
GI symptoms:
General symptoms: wt loss, neuropsychiatric
50 yo w/ worsening jaundice, anorexia, RUQ pain x3 days
-scleral icterus and tender hepatomegaly
LFT: Alk phos 120 AST 212 ALT 99 Amylase 91
Dx
Alcohol hepatitis
- AST:ALT ratio over 2
- leukocytosis
44 yo w/ severe epigastric pain radiating to the back
- Amylase 2610 (crazy high)
- AST 133 ALT 172 Alkpho 271
(a) Dx?
(b) Next step?
(a) Dx = acute pancreatitis
(b) Next step = RUQ ultrasound
- ultrasound is better for detecting gallstones than CT scan
- 2 most common causes of acute pancreatitis = gallstones and EtOH, she doesn’t drink so think gallstones until proven otherwise
Describe the predominant mechanism of HF in HOCM
Primarily diastolic heart failure => impaired ventricular filling and outflow obstruction
(inability of myocardium to properly relax)
2 most common causes of acute pancreatitis
Chronic alcoholic use and gallstones
What is Whipple disease?
(a) Most common presenting symptoms
(a) Whipple disease = multisystem d/o caused by gram-positive bacillus Tropheryma whippeli
(b) Most common presenting symptoms: chronic malabsorptive diarrhea, wt loss, migratory non-deforming arthritis, lymphadenopathy, low grade fever
Splenectomy
(a) What vaccines to be given
(b) Prophylactic abx protocol
(a) Several weeks before splenectomy pt should get anti-pneumococcal, Haemophilius, and meningococcal vaccines
(b) daily oral penicilin prophylaxis for 3-5 years following splenectomy
Clinical signs to distinguish lower leg DVT vs. cellulitis
Common in that they present w/ swelling, fever, erythema, and warmth
Cellulitis: higher fever, presence of regional lymphadenopathy
38 yo Mexican M presents w/ wt loss, fever, productive cough x 3 mo
CT scab revealed calcification of both adrenal glands
(a) Dx
(b) Cause of adrenocortical insufficiency
Tuberculosis- most common cause of primary adrenal insufficiency in developing countries
-adrenal calcification = typical feature of adrenal TB
34 yo F w/ fatigue for several months
- difficulty combing hair
- afebrile, HR 115
- anxiety, irritability, unintentional 8 lb wt loss over 2 mo
- fine finger tremor
- decreased shoulder muscle mass
- normal DTRs
Cause of pt’s symptoms
Symptoms suggest proximal muscle weakness like myopathy, then w/ fatigue anxiety tremor wt loss and tachycardia = hyperthyroidism
Would be an inflammatory muscle disease (myositis) but that wouldn’t account for the other symptoms => acute thyrotoxic myopathy