Tingling and Numbness after Thyroidectomy! - USMLE Forums
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Old 10-17-2011
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Thyroid Tingling and Numbness after Thyroidectomy!

A 71-year-old woman undergoes a total thyroidectomy and removal of a suspicious jugular lymph node, which reveals lymphoma. The operation went well and there was minimal blood loss. The patient was transferred to the recovery room and then to the surgical floor, where her recovery was originally unremarkable. However, she is now quite agitated and anxious, and is complaining of tingling and numbness around her lips. A medical student who did a full history and physical thinks she might also have papilledema. Which of the following is an associated physical finding likely to be found in this patient?

A. An inspiratory pause when the right upper quadrant is palpated
B. A large, nonreactive or only mildly reactive pupil
C. Orbicularis oculi muscle spasm with gentle tapping of the facial nerve
D. Pain induced by extension of the legs with hip flexed
E. Flexion of the hips induced by passive flexion of the neck
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Old 10-17-2011
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c...orbicularis oculi spasm
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Old 10-17-2011
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C. Orbicularis oculi muscle spasm with gentle tapping of the facial nerve
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Old 10-17-2011
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Can someone please give an explanation of this one ? im not sure what im looking at here . I initially thought something like injury to the recurrent laryngeal nerve.
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Old 10-17-2011
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its like total thyroidectomy will remove parathyroid gland so whole the stuff is about hypocalcemic symptoms
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Old 10-17-2011
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crap how could i forget that ! totally forgot all about the parathyroid damage in a thyroidectomy. thanks for the explanation
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The correct answer is C. This patient has acute hypocalcemia, likely from the surgeons not leaving one of the parathyroid glands during thyroidectomy. Acute hypocalcemia can cause papilledema, neuropsychiatric changes including depression and anxiety, and tetany. Tetany can be induced with gentle tapping of the facial nerve. This will result in orbicularis oculi muscle spasm.
Murphy sign (choice A) is an inspiratory pause seen when the right upper quadrant is palpated in patients with cholecystitis. As the diaphragm lowers, it displaces the inflamed gallbladder down toward the physician’s palpating hand. The increased pressure on the inflamed gallbladder will cause the patient discomfort, causing the patient to stop inspiration.
Adie pupil (choice B) is the benign finding of a tonic pupil on physical exam, usually in younger women. The pupil will appear larger than its counterpart and will be either nonreactive or only mildly reactive. It is of no clinical significance and is not associated with hypocalcemia.
Brudzinski sign (choice E) and Kernig sign (choice D) are evidence of meningeal irritation
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Endocrinology-, Internal-Medicine-, Step-2-Questions

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