USMLE Forum Archives - USMLE Step 3 - Next Best Step ?
Next Best Step ?
harry206 - 05-05-09 02:31
A 30-year-old female presents with tingling and numbness in both of her distal lower extremities for the last three months. Her symptoms are gradually worsening. She also complains of intense fatigue. She denies weight change, constipation, skin dryness, headaches or visual changes. She was diagnosed with primary hypothyroidism secondary to Hashimoto’s thyroiditis when she was 10 years old. She is currently on 100 mcg per day of levothyroxine orally. Her mother also has hypothyroidism. She does not smoke or drink alcohol. She denies the use of recreational drugs. Her menstrual cycles have been irregular for the last six months. Her last menstrual period was two months ago. She is sexually active with one partner. Her blood pressure is 114/78 mm Hg and heart rate is 72/min. She weighs 152 pounds and is 5’4" tall. Her thyroid is nonpalpable. Her mucous membranes are moist and pale. Her tongue appears to be bald. She does not have any scleral icterus. Vibration and proprioception are decreased in both of her lower extremities distally. Pain and temperature sensations appear normal. Her ankle jerks are absent, but other reflexes are brisk. Babinski and Romberg’s signs are positive. The rest of the physical examination is unremarkable. Stool obtained from the rectal examination is negative for occult blood. Lab investigations reveal a hemoglobin of 8 g/dL and hematocrit of 24%. Her total WBC count is 3,200 per cubic millimeter. Her platelet count is 300,000 per cubic millimeter. Basic serum chemistries are within normal limits. Her Total T4 level is 8.2 mcg/dL (normal 4-12 mcg/dL) and TSH level is 2.4 micro IU/mL (normal 0.5 to 5 micro IU/mL).
What is the next best step in the management of this patient?
harry206 - 05-05-09 02:31
A 30-year-old female presents with tingling and numbness in both of her distal lower extremities for the last three months. Her symptoms are gradually worsening. She also complains of intense fatigue. She denies weight change, constipation, skin dryness, headaches or visual changes. She was diagnosed with primary hypothyroidism secondary to Hashimoto’s thyroiditis when she was 10 years old. She is currently on 100 mcg per day of levothyroxine orally. Her mother also has hypothyroidism. She does not smoke or drink alcohol. She denies the use of recreational drugs. Her menstrual cycles have been irregular for the last six months. Her last menstrual period was two months ago. She is sexually active with one partner. Her blood pressure is 114/78 mm Hg and heart rate is 72/min. She weighs 152 pounds and is 5’4" tall. Her thyroid is nonpalpable. Her mucous membranes are moist and pale. Her tongue appears to be bald. She does not have any scleral icterus. Vibration and proprioception are decreased in both of her lower extremities distally. Pain and temperature sensations appear normal. Her ankle jerks are absent, but other reflexes are brisk. Babinski and Romberg’s signs are positive. The rest of the physical examination is unremarkable. Stool obtained from the rectal examination is negative for occult blood. Lab investigations reveal a hemoglobin of 8 g/dL and hematocrit of 24%. Her total WBC count is 3,200 per cubic millimeter. Her platelet count is 300,000 per cubic millimeter. Basic serum chemistries are within normal limits. Her Total T4 level is 8.2 mcg/dL (normal 4-12 mcg/dL) and TSH level is 2.4 micro IU/mL (normal 0.5 to 5 micro IU/mL).
What is the next best step in the management of this patient?
The correct answer and explanation will be available after you answer.
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#7
Re: Next Best Step ?
harry206 - 05-06-09 03:28 WAO 100% ppl answered correctly
yes Ans: D
Explanation:
Patients with primary hypothyroidism are predisposed to get other autoimmune diseases such as pernicious anemia. Vitamin B12 deficiency in pernicious anemia is due to a deficiency of intrinsic factor secreted by the stomach. Neurologic involvement in Vitamin B12 deficiency is characterized by subacute combined degeneration of the spinal cord and peripheral neuropathy.
#16
Re: Next Best Step ? zkadhem - 08-03-09 15:51 My answer is: d.
Typical of Vit.B 12 deficiency...
Could be pernecious anemia!
#25
Re: Next Best Step ? babbu5508 - 07-07-10 13:22 My answer is: d.
Subacute combined degeneration of spinal cord refers to degeneration of the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency.
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