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  #1  
Old 09-02-2011
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Thyroid Thyroid patient with bleeding gums!

A patient with hyperthyroidism that is controlled by propranolol and methimazole now complains of recent lethargy. On exam, he has gingival bleeding and tender neck lymphadenopathy. Vital signs are: Temperature 39 degree Celsius, blood pressure 110/45, heart rate 66, respiratory rate 12, and oxygen saturation 99%. Your next step is to order:
  • A. CXR
  • B. complete blood count with differential
  • C. Basal metabolic laboratory values
  • D. EKG
  • E. CT scan of neck
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Old 09-02-2011
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cbc with differential.. ans B
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Old 09-02-2011
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Its B Complete blood count with differential
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Old 09-02-2011
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B. CBC w/differential
Methimazole SE- aplastic anemia and agranulocytosis
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Old 09-03-2011
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agree with b
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Old 09-05-2011
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The correct answer is B.
New onset fever or lethargy in a patient taking propylthiouracil or methimazole is concerning for agranulocytosis. A cbc with a differential will likely reveal a neutrophil count below 500. Agranulocytosis may be asymptomatic or clinically present as sudden fever, rigors, sore throat or gingival bleeding. Septicemia may progress rapidly. Besides methimazole, other antiepileptics, NSAIDS (indomethacin, naproxen), antibiotics (PCN, chloramphenicol), and antipsychotics (clozapine) are known to cause agranulocytosis.
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