A 34-year-old female presents for a physical exam. She is new to the practice and enrolled because she and her family had recently moved to the area and her last physical was more than 1 year ago. On review of her history, the patient has had 2 normal vaginal deliveries and is currently on no oral contraceptive medication, as her husband has had a vasectomy. She has had no chronic medical problems. Her only medications are a multivitamin and Vitamin E. On review of her records, you note that she had a relatively normal fasting lipid profile performed 5 years ago, is up to date on her Tetanus shot, and has had normal Pap smears over the past 5 years. The records also seem to indicate that she has gained about 10 lbs in weight over the past year. Her physical exam is within normal; she is about 20% overweight. You ask the patient to do a repeat fasting lipid profile and the values are as follows: Total cholesterol is 342 mg/dL (normal under 200) LDL Cholesterol 225 mg/dL (normal 60-160) HDL Cholesterol 75 mg/dL (normal 30-80) Triglyceride level 210 mg/dL (normal under 150) What would be the most appropriate next step in the diagnostic evaluation of this patient?

A 49-year-old female patient presents with an incidentally discovered 2 cm left thyroid nodule identified during a routine pre-employment examination. The patient reports no symptoms of dysphonia, dysphagia, or dyspnea. She has no family history of endocrine malignancies nor any history of exposure to ionizing radiation. On physical examination, there is no evidence of palpable cervical lymphadenopathy. The patient inquires about the subsequent steps in diagnostic evaluation and expresses concern regarding the potential for malignancy. What is the most appropriate next step?

A 43-year-old woman presents with for evaluation of unintended weight gain of nearly 10.3 kg (22lb) over the past year. Her blood pressure is 160/100 mmHg, height 160 cm (5’3”) and weight 77 kg (170 lb). On physical examination, her face is round and flushed, and her weight is concentrated around her abdomen. Her arms and legs are comparatively thinner. Findings of her breast and pelvic examinations are unremarkable, except for thick, reddish-purple streaks around her breasts. Laboratory findings show an abnormal overnight dexamethasone suppression test and high 24-hour urine-free cortisol. Her adrenocorticotropic hormone (ACTH) level is 3 pg/mL (Reference value >10 pg/mL). Which of the following is the most likely diagnosis?

All of the following statements regarding Addison disease are true EXCEPT:

A 47-year-old woman with no significant past medical history, is sent to the Emergency Department for complaints of feeling “weak and dizzy.”  She states that she was feeling well up until about an hour ago, when she began to feel as if she were going to “pass out.” Her husband accompanied her to the hospital and stated that she appeared nervous, confused, and was tremulous. When he asked her what was wrong, she did not seem to understand him. However, she did not appear to have lost consciousness.  Upon arrival in the Emergency Department, she was found on examination to have tachycardia and generalized weakness. She was conscious, but slightly disoriented. She was afebrile. Her laboratory tests were normal with the exception of a blood glucose level of 47 mg/dL. The patient received treatment with 50% dextrose and improved immediately.  Based on this information, what is the most likely cause of this patient’s symptoms?

A 65-year-old male is noted by his family to have developed a short shuffling gait and difficulty getting up from a seated position.  On physical examination, you note a resting tremor and rigidity of the joints with passive range of motion.  Based on these findings, which of the following conditions is the most likely diagnosis for this patient?

 A 22-year-old female presents with urinary frequency. Her BMI is 41. A urinalysis is positive for glucose. Her random blood sugar is 257 mg/dL, hemoglobin A1c is 8.5%, and C-peptide is 1.5 ng/mL. She is diagnosed with type 2 diabetes; diet and exercise are recommended. What is the drug of choice for managing her diabetes?

A 72-year-old woman with a past medical history of diabetes and obesity presents to the clinic with joint pain. She has severe pain in both of her knees for which she has been taking ibuprofen daily. Her temperature is 98.2°F (36.8°C), blood pressure is 177/109 mmHg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in the image (see below). Radiography of the knee shows narrowing of the joint space. Which of the following is the most likely diagnosis?

A 70-year-old woman presents to the emergency department for evaluation of headache. She states that she has had headaches intermittently over the last several days over her right temple and jaw. She states that her pain is worse when chewing food. She also reports that she has been seeing “black spots” in her visual fields over the last few days intermittently. She has a history of hypertension, polymyalgia rheumatica and atrial fibrillation. Her temperature is 100.4°F (38.0°C), pulse is 80, blood pressure is 135/80 mmHg, and respirations are 16/min. On exam, there is tenderness to palpation over the right temple and anterior scalp. No focal neurologic deficits are appreciated. ESR is 120 mm/hr. Which of the following is the most appropriate next step in management?

The medical term “hepatitis” refers to: