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Thread: a new case

  1. #1
    Isabella21's Avatar
    Isabella21 is offline Junior Member 510 points
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    a new case

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    45 years old caucasian male,undergoes evaluation for intense fatigability. He denies chest pain,dyspnea, palpitations, or lower extremities edema. He has no other medical problem. His lab. values are significant for elevated CPK. Which of the followings is the most reasonable next step in managing this patient:
    a.-Oral glucose tolerance test
    b.-24 hs urine cortisol excretion
    c.-serum prolactin level
    d.-serum TSH level
    e.-EKG


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    st_55 is offline Member 510 points
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    i would have said either e or b..but i think i will go with b

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    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    what can elevate the CPK
    IM
    muscle injury or dead
    endocarditis
    extreme exercise

    for the choices the only one that I will go with is E

    because from top of my head neither of the others are asociated with increase cpk. even do he doesnot j=have the sign and synptons.

    now B could also be because of muscle waisting in cushing.

    Now with A diabetics may give you a IM that asyntomatic but firts will be ekg.


    WHATS the answer?
    Moderator: USMLE AND Residency Forums.

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    why even bother with the obvious. Just know where you are need it and where you can help the most.

  4. #4
    st_55 is offline Member 510 points
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    i was thinking of the ekg too but there is no pmh of htn, dm, cad and the man had no complaints of chest pain or other symptoms that point to an mi...that is why i chose the increased cortisol levels...okay Isabella do u have the answer to this one? i really would like to know what it is.

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    Fox
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    I'll go for A guys......whats

  6. #6
    Fox
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    the answer?

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    Isabella21's Avatar
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    the answer is......

    The answer is: d .-
    Hypothyroidism is a common cause of elevated CPK because hypothyroid myopathy. Sometimes can be the first manifestation of hypothyroidsm. Other common causes of elevated CPK are (in a patient WITHOUT cardiac symptoms):
    * HMG CoA reductase inhibitors (statins),
    *polymyositis/dermatomyositis,
    *muscular distrophies (Duchenne).
    The patient DOES NOT have cardiac symptons, or Cushing symptoms , so the options b & e : NO
    The patient IS NOT diabetic, option a: NO.
    And option c, is a distractor.

  8. #8
    st_55 is offline Member 510 points
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    good question

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