On exam of a 15 month-old infant, a continuous machinery mur…

On exam of a 15 month-old infant, a continuous machinery murmur is auscultated in the second intercostal space beneath the left clavicle.  The rest of the examination is otherwise normal.  The murmur continues when the infant is examined in the supine position.  Which of the following is the most likely cause of this murmur?

A 68 yo woman with past medical history of MI and atrial fib…

A 68 yo woman with past medical history of MI and atrial fibrillation presents to the clinic with a chief complaint of increased fatigue and weight gain. Her weight today is 80 kg. Her TSH is 15.2 mIU/L and free T4 is 0.5ng/L (normal 0.8-1.8). Which of the following is the BEST therapeutic approach?