Welcome to MedSmarter’s USMLE Style Question Break Down of the Week. For those preparing for the USMLE Step 1, this week we break down a high-yield Pharmacology question. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
An unresponsive 35-year-old female with a history of Graves’ disease is brought to the emergency department following a bout of confusion and agitation. On physical examination her temperature is 39.4° C (102.9° F), her blood pressure is 104/72 mm Hg, and her pulse is 160/min. A systolic ejection murmur is heard at the apex of the heart, and the patient has 3+ pitting edema at the ankles. Following primary stabilization, which of the following would constitute appropriate pharmacotherapy for this patient’s underlying condition?
A) Iodine
B) Dobutamine
C) Aspirin
D) Propylthiouracil
E) Levothyroxine
The correct answer choice is D: This patient is presenting with a medical emergency: an extreme form of thyrotoxicosis known as “thyroid storm.” The symptoms of this syndrome are due primarily to increased β-adrenergic outflow stimulated by thyroid hormones. After primary stabilization (airway, breathing, and circulation), propylthiouracil or methimazole is the most appropriate pharmacologic treatment for this condition. These agents inhibit the endogenous synthesis of thyroxine, which can cause or worsen this condition.
Did you think the answer was different?
Did you think that the correct answer choice was other than C? You can view this video for a deeper discussion of why A, B, C, and E are not the correct answer choices.
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