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MKSAP 18 Q & A
A 22-year-old woman is evaluated for tachycardia, fever, agitation, and confusion 3 days following laparoscopic cholecystectomy for acute cholecystitis.
Medical history is significant for type 1 diabetes mellitus well controlled on basal-bolus insulin and Graves disease previously treated with methimazole. Methimazole was discontinued 6 months ago when she was considered to be in remission. Medications are insulin glargine and insulin aspart.
On physical examination, temperature is 39.0 °C (102.2 °F), blood pressure is 95/50 mm Hg, pulse rate is 132/min and irregular, and respiration rate is 24/min. The patient is confused and appears flushed and diaphoretic. Lid lag is noted. The thyroid gland is diffusely enlarged with an audible bruit. Her deep tendon reflexes are brisk. There is a fine tremor of her hands. Her examination is otherwise normal.
Which of the following is the most likely diagnosis?
A: Adrenal crisis
B: Malignant hyperthermia
C: Myxedema coma
D: Thyroid storm