65-year-old female with palpitation, nervousness, decrease exercise tolerance and weight loss for 3 months. Her sister has hyperthyroidism. BP = 148/80, HR = 90/MIN, BMI = 19. She has bilateral chemosis and proptosis. After examination there is smooth, enlarge thyroid gland. Cardiac exam reveals regular tachycardia. Her TSH = undetectable and free T4 = 60 (12-22). What is the most appropriate management?
سؤال مجاني 6 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: B. Carbazole
- إجابة ثانية: A. Propranolol
This is Graves disease with ophthalmopathy (chemosis, proptosis, smooth goiter, family history). One cohort summary lists antithyroid drugs (methimazole/carbimazole, written here as "Carbazole") as the first treatment option and keeps β-blockers for severe adrenergic symptoms. Her HR is only 90.
- Radioiodine is contraindicated in moderate–severe Graves ophthalmopathy.
- "Radioactive iodine uptake" (C) is a test, not a treatment.
- Why disputed: other sources give a β-blocker (propranolol) first for immediate symptom control, which is what the old bank chose (A).
ليش كل خيار صح أو غلط
-
A
ليش صح
Supported by the Thyroid disorders lecture: a beta blocker (propranolol) is listed for immediate control of the adrenergic symptoms of hyperthyroidism of any cause.
✓ Thyroid disorders.pdf · p. 6 -
B
ليش صح
Supported by the Endocrine lecture: for Graves disease antithyroid drugs (methimazole, carbimazole, PTU) are the first option, with a beta blocker listed for severe adrenergic symptoms.
✓ Endocrine ✳️.pdf · p. 12 -
C
ليش غلط
Radioactive iodine is contraindicated in moderate to severe Graves ophthalmopathy, and she already has chemosis and proptosis.
✓ Thyroid disorders.pdf · p. 6 -
D
ليش غلط
Subtotal thyroidectomy is very effective but only about 1% of hyperthyroid patients are treated with surgery because of its side effects; it is not the initial management.
✓ Thyroid disorders.pdf · p. 6 -
E
ليش غلط
PTU is preferred in pregnant patients with Graves disease; for non-pregnant patients the lecture starts methimazole instead.
✓ Thyroid disorders.pdf · p. 6
- المصدر
- Endocrine ✳️.pdf · p. 12
Thyroid disorders.pdf · p. 6 - المحاضرة
- Thyroid Disorders · Endocrinology · Module B
- ظهر في
- Endo bank