A 32-year-old woman presents to the emergency department with a 1-month history of heat intolerance, a racing heart, unintentional 4-pound weight loss, and sweating. She states she is generally healthy and only takes a multivitamin. Her temperature is 100°F (37.8°C), blood pressure is 122/82 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 100% on room air. Physical exam is notable for a nontender and enlarged thyroid. HEENT exam is notable for the finding shown (see image), which is mild. The patient’s urine hCG is negative. Laboratory values are notable for a TSH of 0.1 mIU/L. What is the most appropriate definitive treatment for this patient?

Potential side effects of systemic glucocorticoid use include each of the following EXCEPT:

A 42-year-old female, who loves food laden with salt, is very puzzled about her recent unexplained weight loss. She also has complaints of lethargy. She has had several recent episodes of nausea and vomiting. Because of her symptoms, she goes to her primary care physician. Upon questioning, she is surprised that her doctor asks her about salt craving but acknowledges this. On physical examination, there is a hyperpigmentation to her skin and mucous membranes. Her blood pressure is 85/60 mmHg. Her laboratory results show hyponatremia and hyperkalemia.  Her serum ACTH level is elevated.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A 34-year-old male with Type I diabetes, presents for an acute office visit complaining of uncontrolled blood sugars, with high and low readings throughout the day and night.  When he called to make the appointment, he was advised to bring in his blood glucose log, and to check a few 3:00AM blood sugar levels.  His current daily insulin regimen is 40 units NPH insulin and 20 units of Regular insulin before breakfast, and 20 units of NPH insulin and 10 units of Regular insulin before dinner. Time 7am 11 am 5 pm 11 pm 3 am Average blood glucose mg/dL 393 210 175 140 50 Which of the following insulin adjustments is most appropriate, based on the patient’s average glucose readings?

You are asked to evaluate a 72-year-old female patient who complains of recent onset of polyuria, constipation, and nausea. Physical examination is essentially unremarkable, and laboratory studies are ordered including a complete metabolic profile and routine urinalysis.  Results of tests are as follows: Urinalysis: negative for nitrite, glucose, leukocytes, blood, ketones, and bilirubin, leukocyte esterase, protein, and urobilinogen. Metabolic profile: (abnormal results in boldtype): Serum Ca+2     13.2 (8.2-10.2 mg/dL)Serum PO4−3    1.8 (2.5-4.5 mg/dL)Serum albumin 4.0 (3.5-5.0 g/dL) The patient has normal renal function, and no other abnormalities are noted on results of complete metabolic profile.                                                          Based on these initial laboratory results, which of the following additional laboratory test results would be helpful in establishing a diagnosis of primary hyperparathyroidism?

A 6-year-old child presents for evaluation of excessively tall stature.  Diagnostic imaging with MRI scan confirms the presence of a pituitary adenoma.  Laboratory testing reveals elevated levels of growth hormone and insulin-like growth factor-1 (IGF-1).  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A 49-year-old female patient presents with an incidentally discovered 2 cm left thyroid nodule identified during a routine pre-employment examination. The patient reports no symptoms of dysphonia, dysphagia, or dyspnea. She has no family history of endocrine malignancies nor any history of exposure to ionizing radiation. On physical examination, there is no evidence of palpable cervical lymphadenopathy. The patient inquires about the subsequent steps in diagnostic evaluation and expresses concern regarding the potential for malignancy. What is the most appropriate next step?

A 50-year-old female is evaluated by her physician for recent weight gain. Physical examination is notable for truncal obesity, wasting of her distal musculature and moon facies. In addition she complains of abnormal stretch marks that surround her abdomen. The physician suspects pituitary adenoma. Which of the following high-dose dexamethasone suppression test findings and baseline ACTH findings would support his view?

A 72-year-old woman with a past medical history of diabetes and obesity presents to the clinic with joint pain. She has severe pain in both of her knees for which she has been taking ibuprofen daily. Her temperature is 98.2°F (36.8°C), blood pressure is 177/109 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in the image (see below). Radiography of the knee shows narrowing of the joint space. Which of the following is the most likely diagnosis?

A 65-year-old female is admitted to the ER with a 3-hour history of cyanosis, shortness of breath, and substernal chest pain.  She had been discharged 5 days earlier after having a total hip replacement due to severe osteoarthritis.  The hip surgery was uneventful.  On examination, the patient is in obvious acute respiratory distress.  Her respiratory rate is 40/min and her breathing is labored.  The patient’s room air oxygen saturation level is 86%.  Her blood pressure is 100/70 mm Hg.  Cyanosis is present.  Cardiac examination reveals increased pulmonic component of the second heart sound (S2).  Abnormal lung sounds, including rales and wheezes, are present bilaterally.  Based on the information provided, which of the following tests will be the preferred intervention to establish the diagnosis?