Your patient does not want to take levothyroxine replacement for her hypothyroidism. Her goal in life is to never be on any medications. As part of your rationale, you explain to her that untreated hypothyroidism can progress to respiratory depression and death. This state is called:

Cho-Hee is diagnosed with Grave’s Disease.  The primary care provider has initiated a referral to endocrinology; however, the patient won’t be seen for approximately 4 weeks (you have begged the endocrine office to see her sooner, and they will do their best).  In the meantime, Cho-Hee states her nervousness and anxiety, along with palpitations have gotten worse.  What medication should be considered to relieve Cho-Hee’s symptoms until the Grave’s Disease can be managed?

Harold is a 56-year-old male who presents with complaints of fatigue. A CBC as part of your work up reveals a macrocytic anemia. What are potential etiologies?  Select all that apply.

Kyle presents to your office Monday morning at 8 a.m. requesting that you take a look at his hand.  His right hand is erythematous, edematous, warm as well as painful.  You finally get him to sheepishly admit that he “acted the fool” Saturday night in a bar when he was out with friends and punched a guy right in the mouth.  “Dang, that hurt way more than I thought it would and now it REALLY hurts”.  Focal area of involvement seems to be two bite wounds to the third and fourth PIP joints with significant erythema, edema, and pain to palpation with the entire hand involved as well.  “It just keeps getting worse and worse”.  He denies fever and remainder of exam is normal.  What is the best plan of care for Kyle?

This dermatological condition is characterized by a “Herald Patch” on the torso:

Sally, a 45-year-old female comes to see you in clinic today with what she describes as “an interesting issue”. She went camping with her husband 2 months ago and had a wonderful time; however, she was bit by a lone-star tick. She received immediate treatment in an urgent care center of doxycycline 100 mg po bid x 10 days, and thought everything was fine. Last night, Sally and her husband grilled big T-bone steaks and baked potatoes for dinner. Food she has always enjoyed. After eating the steak, she broke out in hives and had an episode of diarrhea. She has no residual symptoms this morning. Her assessment is totally normal. What is the best plan of care for Sally? 

Margo is a 58-year-old female who has been having syncopal symptoms for the past two months. She has a history of MI with 3 stents, HTN, DM II, and hyperlipidemia. She tells you that she as been more tired and short of breath with light activity to the point where during these episodes, she feels the world go gray as if she were about to pass out. Physical exam reveals moist oral mucous membranes, carotids without bruits bilaterally, LS CTA, S1S2 with grade III systolic murmur heard best at the 2nd ICS right sternal border, and CN II-XII intact. You order an ECG with the lead II showing below. What is your primary differential diagnosis?

The gray commissure is a space in the center of the spinal cord containing cerebrospinal fluid (CSF).

Which is most likely to be noted in a 45-year-old woman with laboratory evidence of chronic excessive alcohol ingestion?

ID: Which muscle is indicated by “D” in the image below?