A 54 year old African American male with a history of asthma and seasonal allergies presents to the office with complaints of severe itching on his hands. He notes this has been going on for the past several weeks and it is driving him crazy. He works as a pilot and feels like the itching it getting in the way of his job.  He has used some over the counter anti-itch lotions but they do not seem to be helping him. On examination you note dry, flaky skin, that has erythematous papules with lichenification. There is no drainage or signs of infection. How would you treat this patient?

A 48 year old female with history of HIV and Rheumatoid arthritis presents to the office with complaints of a “red, itchy, painful” rash on her left flank area. She states it started about 24 hours ago and it is progressively getting worse. On examination you note fluid filled vesicles along the dermatone. What is the best treatment option for her? She is not allergic to any medications.

Which part of a patient’s history places them at highest risk for a stroke?

A 47 year old male presents to the office for headaches that he has had for the past 6-7 months. He indicates the headaches start on the right side and they last for about an hour. He notes that his right eye will also tear when this occurs and he may experience congestion as well. He notes for a period of time, they will occur everyday and then he will go a month without them and then they return to daily again. What would be the best treatment for him?

A patient comes into the office for his diabetes. You advise the patient that you are going to start him on liraglutide and explain to this patient the medication works by the following:

A 37 year old female presents to the office for feelings of l dizziness and palpitations. She reports some weight loss and increased bowel movements. She has a past medical history of gerd and take protonix. She drinks 2-3 glasses of wine a week but denies smoking and drug abuse. On exam, you note the following: T: 98.8, HR 133, RR 12, BP 140/88; BMI 27 HEENT: Normal Cephalic head, sclerae and conjunctiva normal, mild protusion of the globes bilaterally, Tympanic Membrane is reflexive and clear, thyroid is normal CVS: S1 and S2, tachycardic no murmurs, rubs or gallops Lung: Clear bilaterally, no rales, rhonchi or wheezing Abdomen: soft, non-tender/non-distended and normal bowel sounds Extremities;no edema, normal sensation  The following are her fasting lab results:  Glucose 110 Electrolytes- normal WBC 6,000 Free T4- 2.3 ng/dL (Normal 0.7-1.5 ng/dL) T3- 0.9 ng/dL (Normal 0.2-0.5ng/dL) TSH 0.02mIU/L  (Normal 0.3-4.5 mIU/L)  What is the next best step for this patient?  

A 22 year old female presents to the office for complaints of rhinorrhea, sneezing, and watery eyes  for the past 3 weeks. She reports a cough and congestion that started 2 weeks ago. On exam you note that vital signs are stable, nares are swollen with watery discharge. The remainder of her exam is normal. What is the best treatment for her symptoms?

The underlying pathological basis of Multiple Sclerosis is best described as which of the following?

The initial treatment for a symptomatic patient with a TSH of 7.3 ( 0.3-4.5) and free T4 0.5 (0.7-1.5) would be:

¿Me lo traes? Match each question with the correct response.