Repeated Medical PG Question- 78

 #MEDICINE(INI-CET) 

Q-  A 60-year-old male diabetic and hypertensive patient was found unconscious in the morning. On examination pulse - 120/min, bp-160/100 mm Hg, and bilateral extensor plantar are elicited. What is the next step to be done for management?

A. Order CT scan

B. Check blood glucose

C. Give Intravenous mannitol

D. Immediately reduces by with antihypertensives

Answer: B. Check blood glucose

• "In any unconscious diabetic patient first evaluate the CNS event Capillary Blood sugar and urinary ketones of patient"

• The patient is Diabetic, unconscious so it could be simple hypoglycemia then he could have seizure, which resulted in an extensor plantar in this patient he could be in postictal deficit.

Option A - CT scan to evaluate the damage, Hypertensive encephalopathy, stroke, cerebrovascular accident.

Option C - Ruled out because there is no evidence of raised ICP

▪️Raised ICP → HR with 1 BP

▪️Mannitol is given for Cushing reflex, papilledema, Ventricular dilation.

Option D- No immediate reduction of BP with other antihypertension.

• Conceptual permissive Hypertension

• Keep the BP on the higher side in patient with CNS events because that maintains the perfusion of the brain.

• Cerebral perfusion pressure= Mean Arterial pressure-ICP

Q- A young lady with symptoms of hyperthyroidism with elevated T4 and TSH levels were 8.5. Further examination reveals bitemporal hemianopia. Next step of management:

A. Start antithyroid drugs, and do urgent MRI brain

B. Start beta-blockers

C. Conservative management

D. Start antithyroid drugs and wait for symptoms to resolve.

Answer is A. Start antithyroid drugs, and do urgent MRI brain

Hyperthyroidism with elevated T4 and TSH levels and bitemporal hemianopia is highly suggestive of TSH-secreting adenoma.

MRI - Confirm TSH-secreting pituitary adenoma diagnosis.

TSH producing macroadenomas:

>Rare

>Often large & locally invasive.

>Along with thyroid goiter & hyperthyroidism, reflecting TSH overproduction.

Diagnosis:

>Elevated serum free T4 levels.

>Inappropriately normal or high TSH secretion.

>MRI - Evidence of pituitary adenoma.