A 45 year old woman with a history of Hashimoto’s thyroiditis presents for routine follow up. She reports feeling well but has gained 10 lbs over the last three months. For laboratory tests show elevated TSH and decreased free T4. What is the most appropriate management for this patient?

A 58-year-old woman with no significant past medical history presents with a 2-month history of recurrent brief episodes of vertigo. The episodes are usually provoked by particular head movements and occur a few times each day. They occur when the patient is getting up from or rolling over in bed. She denies any hearing loss, tinnitus, nausea, vomiting, fever, vision changes, or other neurologic complaints. The woman also denies any recent upper respiratory infection or trauma. Physical examination is within normal limits. The Dix-Hallpike maneuver provokes nystagmus and vertigo. What is the most likely diagnosis?

A patient with diabetes presents for an annual visit. Which vaccine is most important to administer?  

A 19-year-old woman presents to her primary care provider with intense itching and a rash between her fingers, on her wrists, and around her waist. She reports that her symptoms began 2 weeks ago and have been progressively worsening. Upon examination, the provider notes small burrows and papules consistent with scabies. The provider decides to prescribe a topical treatment. How is Permethrin applied for scabies?

A 34-year-old man presents to the outpatient setting for a recurring skin condition. He reports developing a recurrence of painful, red pustules and papules in his armpits. He has had two lesions drained in the past and has been treated before with antibiotics. His past medical and social history is significant for obesity and tobacco use. What is the patient’s most likely diagnosis?

A 48-year-old woman presents to her primary care provider with complaints of persistent ringing in her ears (tinnitus) for the past six months. She reports that the tinnitus is more noticeable in quiet environments and sometimes interferes with her ability to concentrate. The provider takes a detailed history and conducts a physical examination to identify potential causes of her tinnitus. Which of the following is not a recognized cause of tinnitus in this patient?

A patient with diabetes presents for an annual visit. Which vaccine is most important to administer?  

A patient has a lesion on her nose that bleeds easily and has a pearly border. What is the likely diagnosis?

A 28-year-old woman with a history of migraines comes to the clinic for management of her condition. She describes her migraines as being triggered by various factors, including stress, certain foods, and hormonal changes. During the consultation, she discusses her daily routine and dietary habits. The provider gives advice on potential migraine triggers. Which of the following factors is least likely to trigger a migraine in this patient?

A 34-year-old man presents to the outpatient setting for a recurring skin condition. He reports developing a recurrence of painful, red pustules and papules in his armpits. He has had two lesions drained in the past and has been treated before with antibiotics. His past medical and social history is significant for obesity and tobacco use. What is the patient’s most likely diagnosis?