05-02-2008, 07:24 PM
63.
A 50-year-old woman is evaluated for a 7-day history of rash that originally developed on her lower extremities but has spread to her trunk and arms. Except for intermittent fevers, she feels well. She was diagnosed with Graves' disease 3 months ago, and therapy with propylthiouracil and labetalol was initiated.
On physical examination, vital signs are normal. There are scattered palpable purpuric lesions 1 mm to 2 mm in diameter on her lower extremities, trunk, and arms. The remainder of her examination is unremarkable.
On laboratory studies, erythrocyte sedimentation rate is 50 mm/h, perinuclear antineutrophil cytoplasmic antibodies directed against myeloperoxidase are present, and hepatitis B surface antigen is negative. Urinalysis is normal. Skin biopsy reveals leukocytoclastic vasculitis.
Which of the following is the most appropriate next step in this patient's management?
A Discontinue labetalol
B Discontinue labetalol; begin prednisone
C Discontinue propylthiouracil
D Discontinue propylthiouracil; begin prednisone
A 50-year-old woman is evaluated for a 7-day history of rash that originally developed on her lower extremities but has spread to her trunk and arms. Except for intermittent fevers, she feels well. She was diagnosed with Graves' disease 3 months ago, and therapy with propylthiouracil and labetalol was initiated.
On physical examination, vital signs are normal. There are scattered palpable purpuric lesions 1 mm to 2 mm in diameter on her lower extremities, trunk, and arms. The remainder of her examination is unremarkable.
On laboratory studies, erythrocyte sedimentation rate is 50 mm/h, perinuclear antineutrophil cytoplasmic antibodies directed against myeloperoxidase are present, and hepatitis B surface antigen is negative. Urinalysis is normal. Skin biopsy reveals leukocytoclastic vasculitis.
Which of the following is the most appropriate next step in this patient's management?
A Discontinue labetalol
B Discontinue labetalol; begin prednisone
C Discontinue propylthiouracil
D Discontinue propylthiouracil; begin prednisone