Blog

Melinda is a 58-year-old who presents to clinic today with sudden onset of shortness of breath and slight sharp chest pain.  She indicates she flew in from Australia last night and initially thought that her symptoms may be due to jet lag from travel. However, the shortness of breath has become more intense and she wonders if she could have contracted COVID pneumonia on the plane.  Routine meds include lisinopril, metformin, atorvastatin, premarin, and provera.  What is your primary differential diagnosis?

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?

You are reviewing labs from the preceding day’s clinic. You note that a 30-year-old female with history of stable hypothyroidism and who is on Levothyroxine 75 mcg, now has a TSH of 14.1. What is your approach to this case? Select all that apply.

Anne is a 62-year-old who presents to clinic with complaints of a chest tightness and upper arm pain for the last two or three days. The pain is worse with activity, but improves if she sits down and rests. She denies fever, chills, vomiting or diarrhea. She has been somewhat nauseated and tells you that she felt poorly yesterday and sat down in her recliner. She doesn’t remember falling asleep and doesn’t know how long she was out, but when she awakened, her clothes were wet and her skin felt cool and clammy. Your most likely diagnosis is:

Lily White is a 48-year-old female who presents to clinic today with wanting to speak to someone about her recent hyperthyroidism diagnosis. She does not want to start the medication (Methimazole 15 mg PO daily) the endocrinologist prescribed. What are the potential complications of untreated Grave’s disease?   

Ken is a 20-year-old college wrestler who presents to clinic today with complaints of “going bald”. Upon inspecting his scalp you note a well demarcated circular area with hair broken off at the shaft. The most likely diagnosis is:

Cranial nerve number I is the                                 nerve and its function is                                  .

You make a home visit with your next patient who is receiving hospice care. His wife reports to you that all of the inhalers and breathing treatments are not working. She can’t stand to see him struggle to for each breath anymore. You note the patient is gasping for breath though his O2 sat is 98%. What is your best response to the patient’s wife?

Alivia is a 32-year-old you are following for iron deficiency anemia.  In addition to a CBC, what lab parameter would you monitor to show she is responding to therapy early in the treatment process?

Isaiah is a 73-year-old who presents with complaints of left flank pain for the last week.  The pain is gradually worsening and radiates from the lower thoracic area around to the abdomen.  He describes the pain as burning, “almost like little electrical shocks” and now has a deep ache and throb accompanying the electric shocks.  He states he has been able to sleep at night, but did have to take 400 mg of ibuprofen last night to do so.  He denies pain with urination, frequency, urgency.  No change in bowel movements and he is eating and drinking normally.  Upon entering exam room he is sitting quietly on the exam table and repositions self easily for exam.  Urinalysis is negative for blood, leukocytes, nitrites.  What is the best plan of care?