MMA (methymelanic acid) levels are measured to see if an individual has a deficiency of:

Jacob is a 29-year-old who presents with complaints of a rash to the trunk of his body. He first noticed the rash two weeks ago and has been “scratching like crazy”. In fact, he tells you that it itches a lot worse at night and the lack of sleep is wearing him out. In addition to the rash on his trunk, he also has a few erythematous papules to the finger webs. He mentions that his 5-year-old son has the same thing. What is this rash?

Mr. Humphreys is a 38-year-old who presents to the office requesting advice on smoking cessation. He is healthy except for a history of idiopathic epilepsy, well controlled with Dilantin (phenytoin).  Please choose which are appropriate to offer Mr. Humphreys for smoking cessation.  Select all that apply.

David is a 60-year-old male who presents to clinic with his wife with a 1-day history of substernal chest pain that radiates into his left jaw and left posterior shoulder blade.  He became acutely short of breath this morning after breakfast.  After completing a history and physical on David you suspect he is having an acute MI.  In addition to obtaining an EKG and giving David supplemental oxygen if available, what next steps are most appropriate for David?  

Joyce is a 67-year-old that you discovered a smooth, mobile, 8 mm in diameter thyroid nodule with routine physical exam.  Her TSH and FT4 are both normal.  What is your plan of care?

Your patient has had some declining health and is now experiencing delirium. Her daughter is identified as the patient’s Power of Attorney. Which statement by the daughter indicates a need for further education on the Power of Attorney document?

What characteristics are associated with Non-Hodgkin’s Lymphoma? Please select all that apply.

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.