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A 45 year old female presents for folllow-up labs from her recent physical. She has no complaints and has a normal ECG. Her TSH was 16 (normal 0.4-5.5) and her free T4 was 0.5 (normal 0.7-2.0 ) and her T3 was 3 (normal 2.3 -4.2). What is your next step for her?

Guillane Barre attacks the Peripheral Nervous System:

A 37 year old male with no significant past medical history presents to the office complaining of pain in his left metatarsal-phalangeal joint which started last night. He reports that it is so painful that he can barely walk. On exam, the joint is red, hot and tender.  Which of the following statements is true?

A 65 year old female presents with a past medical history of hypertension and hyperlipidmeia presents to the office for complaints of knee pain for the past several months. She denies recent trauma or injury to the knee. She notes that it is painful to walk more than 1/2 mile and she is getting fatigued much sooner. She notes some swelling in the knee as well. On exam, you note that she has mild swelling over the medial joint with crepitus. There is no warmth or redness. She has good range of motion, but it is painful for her to internally rotate the knee. You advise her the best treatment for her right now is:

A 39 year old African American male presents to the office for routine physical. He was seen 2 months ago and his blood pressure was 152/86. Today his blood pressure is 155/82 and he has no other medical problems. What is the best treatment for him?

A 43 year old white male presents to the office for follow-up to hypertension. He has been taking HCTZ 25 mg for 3months. His blood pressure in the office today is 150/80 in the office. What do you recommend? 

A 64 year old male presents to the office for follow-up. He has a history of an diabetes, hypertension and heart failure.  He takes losartan, atorvastatin, carvedilol, nitroglycerin, glucophage and aspirin. He reports that he is having sexual dysfunction. You reply this is most likely due to:

A 62 year old female with a history of hypertension presents to the office for follow-up after feeling short of breath. Her CXR shows congestion without any evidence of pneumonia or COPD.  Her echocardiogram shows an EF of 45% and EKG shows LVH.  She reports that she is out of breath after walking up 1 flight of stairs. She has no allergies. What are the appropriate medications for this patient?

A 35 year old female presents to the office complaining of daily headaches lasting about 2-3 hours after work for the past 2 months. She describes bilateral pain which is not aggravated by activity. She denies nausea, vomiting or sensitivity to light. She works as a social worker for the county and has been working a lot of overtime. Her vital signs and exam are normal. She is taking tylenol and ibuprofen with minimal symptomatic relief. What is the most likely diagnosis and treatment?

During a new office visit your 70 year-old patient complains of being easily short of breath and is often tired.  He has been a smoker for 50 years.  On exam you hear decreased breath sounds bilaterally , hyperresonance and hypertrophied accessory muscles.  His hematocrit it elevated and his pulmonary function test shows increased total lung capacity with FEV1 of 60%.  His mMRC is 3. How would you treat him?