A 56-Year-Old Woman Is Brought to the Emergency Department After

question 168

Multiple Choice

A 56-year-old woman is brought to the emergency department after several hours of severe nausea, vomiting, palpitations, and altered mental status.  She was diagnosed with Graves' hyperthyroidism 6 months ago and received methimazole, which was stopped 2 months ago due to a skin rash.  The patient was treated with radioactive iodine (RAI) 3 days ago.  She was not taking any medications before this admission.  She does not use tobacco or alcohol.
On examination, the patient is agitated and confused.  Temperature is 39.4 C (103 F) , blood pressure is 160/90 mm Hg, pulse is 160/min, and respirations are 24/min.  Pulse oximetry is 98% on room air.  The thyroid is diffusely enlarged but nontender.  The patient has a fine hand tremor and mild lid lag.  The lungs are clear to auscultation.  Her abdomen is soft and nontender.  She has no muscle rigidity, and deep tendon reflexes are 2+ bilaterally throughout.  Laboratory results are as follows:

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Which of the following is the best next step in management of this patient?

• A)Blood cultures and empiric antibiotics
• B)Dantrolene
• C)Dexamethasone
• D)Lorazepam
• E)Propranolol and propylthiouracil

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Definitions:

Focused Messages

Communications specifically designed to capture attention and convey information or directives effectively to a targeted audience.

Evaluation Messages

Feedback or information provided to individuals that assesses their performance, behavior, or characteristics.

Orientation Messages

Communications designed to introduce, familiarize, or provide guidance about a particular subject or environment to individuals.

Stimulation Messages

Stimulation Messages are messages designed to provoke or encourage a response, often used in marketing, therapy, or education to engage individuals and prompt action.