Related Quizzes From Smartest Doc
Recall that a 43-year-old female was brought to the ED for evaluation of acute mental status changes. On examination, she appeared to be a healthy woman in her 40s. She had global disorientation and cognitive blunting, and responded inappropriately to simple questions. She was non-combative.
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- Vital signs: BP, 94/52 mmHg; HR, 96 bpm; RR, 22/min; and T, 37.4oC
- Physical findings: Notable for central obesity and a vulvar lesion that was 1 cm in depth and 3 cm in diameter with a purulent discharge
- Laboratory evaluation: Most significant for pancytopenia
- Urine drug screen, blood alcohol level: Both negative
Vulvar, blood, urine, and CSF cultures were obtained, and the patient was transferred to the ICU.
Radiographic studies indicated extensive necrotizing fasciitis extending from the left labium into the left flank. Broad-spectrum antibiotic therapy was begun and wide debridement of the groin and left flank was done. Frozen section biopsy at the time of surgery met the diagnostic criteria for necrotizing fasciitis.
The blood cultures revealed Escherichia coli, Proteus mirabilis, and mixed anaerobic bacteremia. The CSF and urine cultures were negative. She received inotropic support, daily sharp wound debridement in the operating room, continued broad-spectrum antibiotic therapy, insulin therapy for severe hyperglycemia (>500 mg/dL) and twice daily hyperbaric oxygen therapy. Despite recovery from the acute sepsis episode, the mental status changes persisted with paranoid delusions.
Testing showed that serial urine free cortisol levels were elevated (8518-9703 μg/24 h). Plasma cortisol levels were markedly elevated at 138 μg/dL and 127 μg/dL in the morning and evening, respectively. An ACTH level was well above the normal range at 317 pg/mL. The cortisol response to a CRH stimulation test was flat and elevated (137 μg/dL at baseline and 182 μg/dL after stimulation). There was suppression of urine free cortisol or 17-hydroxysteroids after high-dose dexamethasone suppression testing. A CT of the adrenal glands revealed massive bilateral adrenal hyperplasia.
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True or False: EoE should be included in the differential diagnosis of abnormal FDG accumulation in the esophageal wall along with malignant and nonmalignant conditions.
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An otherwise healthy 32-year-old man sought evaluation at an urgent care center for back pain that began insidiously 2 weeks earlier. It was not associated with trauma to the back. His medical history was benign, and he had no surgical history. He does not smoke cigarettes, drinks beer occasionally, and is on no medications.
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On examination, the man was well-developed and well-nourished. The vital signs were normal. Gross inspection of the back revealed no asymmetry, and no lesions, ecchymoses or erythema. No masses were palpable; however, there was tenderness to deep palpation lateral to T12-L1 on the right. Range of motion (forward flexion, extension, lateral flexion, and rotation) was normal.
What would you do at this point?