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  #1  
Old 04-02-2015
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Default repeated USMLE question 12

A 33 year-old woman presents to her physician complaining of fatigue, general muscle aches, weight gain, irregular menstrual cycles and milky discharge from both breasts for 3 months. Her vital signs are pulse 64/min, blood pressure 123/88 and temp 96.3. Her physical examination reveals galactorrhea of both breasts and dry skin.

Her lab results are as follows:

Thyroid stimulation hormone (TSH): 23uU/ml

Prolactin level: 55ng/ml

What is the best next step in management of this patient?

A- Repeat lab tests
B- Start levothyroxine therapy
C- Start estrogen therapy
D- Start anti-dopamine therapy
E- MRI of the pituitary gland
http://medical-usmle.com/?p=812
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  #2  
Old 04-02-2015
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[QUOTE=sohag100;712546]A 33 year-old woman presents to her physician complaining of fatigue, general muscle aches, weight gain, irregular menstrual cycles and milky discharge from both breasts for 3 months. Her vital signs are pulse 64/min, blood pressure 123/88 and temp 96.3. Her physical examination reveals galactorrhea of both breasts and dry skin.

Her lab results are as follows:

Thyroid stimulation hormone (TSH): 23uU/ml

Prolactin level: 55ng/ml

What is the best next step in management of this patient?

A- Repeat lab tests
B- Start levothyroxine therapy
C- Start estrogen therapy
D- Start anti-dopamine therapy
E- MRI of the pituitary gland


b
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sohag100 (04-02-2015)
  #3  
Old 04-04-2015
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my answer is .... E do MRI
but the qstn says, management so..may be levothyroxine.
could u tell me correct answer.
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  #4  
Old 04-04-2015
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Default Yes you are right

It is levothyroxine. There is typical hypothyroidism. Feedback causes increase of production of TSH as well as prolactin causing galactorrhea. The patient may need MRI but it is not the appropriate step now as we aim to improve the level of thyroxine first before any action. Thank you flywidcolors...
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