Answers:
A patient with hyperthyroidism who recently underwent a laparoscopic appendectomy complicated by wound infection and who is noncompliant with her home medications presents to the ED with fever, agitation and abdominal pain. On exam the patient is diaphoretic, tachycardic and in afib. Which of the following is part of appropriate initial management of this patient?
A) Propranolol 1-2 mg IV
B) Propylthiouracil 250mg q6
C) Saturated Iodine PO
D) Aspirin 325
E) All of the above
F) None of the above
MC Questions:
A patient complains of hearing loss. A Weber test causes lateralization to the left ear and a Rinne test shows greater air conduction than bone conduction in the right ear. What is the patient's likely diagnosis?
A)R CHL
B)L CHL
C) R SNHL
D) L SNHL
A) Propranolol 1-2 mg IV
B) Propylthiouracil 250mg q6
C) Saturated Iodine PO
D) Aspirin 325
E) All of the above
F) None of the above
Appropriate management includes:
-Propranolol 1-2mg IV, Methimazole 20mg/6h (propylthiouracil is associated hepatocellular injury)
-Hydrocortisone (50g) given every 6 hrs while symptomatic.
-Giving oral saturated iodide one hour after giving methimazole can slow hormone release but it should not be given initially. Avoid aspirin as it displaces T3 from TBG and can worsen symptoms.
What antiarrhythmic drug may cause both hyperthyroidism and hypothyroidism?
Amiodarone Induced Hyperthyroidism
-amiodarone is 37.3% iodine (half life 50dys)
-more likely to cause hypothyroidism. Only 2% on the drug get hyperthyroidism.
-symptoms blunted be antiadrenergic effect of drug.
-may occur years after starting the drug.
-Two etiologies:
-excess iodine from drug w/ abnormal gland = increased hormone production
-thyroiditis causes be the drug
-Ultrasound useful in differentiating the two: increased doppler flow in excess hormone production, decreased in thyroiditis.
-Treat with higher dose thioamides and B-blockers.
-Can also give prednisone
A patient complains of hearing loss. A Weber test causes lateralization to the left ear and a Rinne test shows greater air conduction than bone conduction in the right ear. What is the patient's likely diagnosis?
A)R CHL
B)L CHL
C) R SNHL
D) L SNHL
Free Response Question:
Which test can confirm CHL, Rinne or Weber? Why?
Quick Facts:
-CHL in External Ear = Impacted Cerumen; Foreign Body; External Otitis
-CHL in middle ear = TM perforation; Tympanosclerosis; Retracted TMs; Otitis Media; Cholesteatoma; Eustachian Tube dysfunction; Temporal Bone Fracture; Otosclerosis
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