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Adaptations can result from which of the following evolutionary force(s)? 

A 70-year-old male presents for evaluation of severe pain in his left eye, decreased vision, “seeing halos around lights,” nausea and vomiting. On examination, the patient’s left pupil is moderately dilated and nonreactive. The cornea is ‘steamy’ in appearance and the eye appears  generally red.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

An 8-year-old female presents to the Family Medicine clinic with her mother.  Her mother reports that the patient has had nasal congestion and nighttime cough for almost two weeks. The patient’s 3-year-old brother had similar symptoms that began around the same time and have since resolved. The patient initially seemed to be improving, but four days ago she began developing worsening nasal discharge and fever to 102.6°F at home. Her mother denies any change in appetite. The patient denies sore throat, ear pain, and headache. She is otherwise healthy. In the office, her temperature is 102.2°F, blood pressure is 96/71 mmHg, pulse is 128/min, and respirations are 18/min. On physical exam, the nasal turbinates are edematous and erythematous. She has a dry cough. Purulent mucoid drainage can be visualized dripping from the posterior nasopharynx. Her maxillary sinuses are tender to palpation. Which of the following organisms is most likely to be causing this patient’s current condition?

A 42 year-old female presents with complaints of ongoing fatigue, “always feeling cold”, and mild constipation. During your diagnostic evaluation her TSH result is found to be elevated. Which of the following skin findings would you expect on examination?

A 25-year-old female presents to your office with a several month history of anxiety, palpitations, heat intolerance, diarrhea, and weight loss despite increased appetite.  On exam her thyroid is diffusely enlarged.  You also note bilateral exophthalmos.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A 44-year-old man presents for follow-up of poorly controlled type I diabetes mellitus, which was diagnosed 32 years ago. What change on his funduscopic examination would indicate a need for urgent referral to an ophthalmologist?

Hypothyroidism is an important secondary cause of elevated total cholesterol and LDL cholesterol.

Adult bone cannot increase in length when stimulated by an excess of growth hormone because of the lack of epiphyseal cartilage, but they do increase in width by periosteal growth.  In adults, an excess of growth hormone causes which of the following conditions:

Which of the following laboratory results indicate that your diabetic patient has achieved acceptable glycemic control on her current medication regimen?

Which of the following tests is used to monitor the levothyroxine (Synthroid) dose when treating primary hypothyroidism?