Monday, January 1, 2018

Repeated USMLE Questions Step 1- 217

A 46 year-old woman with a history of fibromyalgia presents to the clinic with a complaint of anxiety, frequent diarrhea and occasional palpitations. She also noticed an unexplained loss of weight and irregular menstrual periods over the last 3 months.

What is the most likely laboratory investigation that could lead to a diagnosis in this case?

A-CT scan of the head

B-MRI of the brain


D-Cosyntropin stimulation test

E-Serum Thyroid Stimulation Hormone (TSH) level


This is most likely a case of Graves’ disease. It is an autoimmune disease characterized by the presence of antibodies bind to thyroid-stimulating hormone receptors. They lead to excess thyroid hormone production which results on this patient’s symptoms such as anxiety, diarrhea, arrhythmias, and unexplained loss of weight, heat intolerance and irregular menstrual periods. If serum TSH level is normal then, other tests can be done to exclude other conditions such as pituitary adenoma or GIT abnormalities.

The correct answer is E

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