An 82 year-old patient presents with new onset depression. T…

An 82 year-old patient presents with new onset depression. The family reports that the patient always had a positive outlook on life and until recently was socially active, slept and ate well, and was adored by her grandchildren. Her history and physical exam reveal weight gain, constipation, dry skin, and sluggish reflexes. What is the most likely cause of her new onset depression?

A 67-year-old man with a PMH of hypertension, high cholester…

A 67-year-old man with a PMH of hypertension, high cholesterol and diet-controlled diabetes presents to the primary care office for the first time in 3 years. He has let his prescription medications run out over 2 years ago and he has no complaints. His vital signs are BP:160/90 mm/Hg, HR: 88 and reg. Other than a systolic ejection murmur at the right intercostal space that radiates to the neck the physical exam is normal. On review of systems he does admit to intermittent lightheadedness when climbing steps for the past 3 weeks but no syncope, chest pain, shortness of breath or leg swelling. Based on his physical exam and ROS what is the next logical step?

A 75-year-old male has been brought to your ER following a s…

A 75-year-old male has been brought to your ER following a syncopal episode while moving furniture. He relates a history of similar episodes. EKG reveals left ventricular hypertrophy but is otherwise normal. Physical exam is remarkable for a systolic murmur which radiates to the carotid arteries. This suggests: