A 62-year-old woman presents with a 2-year history of knee pain; it has been getting worse. She reports the pain is bilateral, but it is worse on her left side. She describes the pain as deep and “achy”; it is located in the front and back of her knees. Her pain increases after long days on her feet, and it is somewhat relieved with over-the-counter pain relievers and rest. She denies other joint problems. The patient denies trauma to her knees. She has no known other chronic medical conditions, and she takes no regular medications. She has never had surgery. She works in food service for the local school district. On physical exam, her BMI is 42. The other vital signs are normal. Both knees exhibit crepitus and some decreased range of motion in flexion and extension. No erythema, edema, or warmth is noted in the joints. The remainder of her examination is normal.An X-ray is obtained, and it shows narrowed joint spaces and some subchondral sclerosis.   Which of the following conditions is the most likely diagnosis for this patient?

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 36-year-old female presents to her primary care physician for evaluation of bilateral nipple discharge. She has observed a milky discharge coming from her nipples for the past month. She has felt fatigued lately and has experienced decreased libido. She also reports headaches that typically resolve by the middle of the day and a 5-pound weight gain this past month. Vital signs include: T: 99.5°F (37.5°C), BP 132/76 mmHg, pulse is 60/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, auscultation of the heart and lungs is within normal limits. A neurological exam reveals cranial nerves II-XII as grossly intact. Which of the following conditions is the most likely diagnosis?

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

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?

A 52-year-old woman with no significant past medical history presents to your office complaining of fatigue, constipation, cold intolerance, and weight gain. She is presently on no medications. Her physical examination is notable for a dull facial expression, periorbital swelling, and coarse, dry skin. There is no thyromegaly. The most likely cause of this woman’s symptoms is:

A 56-year-old male presents for a follow up visit in your office. He is a known diabetic and hypertensive for 6 years. He has no complaints today and is up-to-date in the management of his conditions. He is not allergic to any medications. His medications include metformin, hydrochlorothiazide, aspirin, and acetaminophen for occasional headaches. He had just read about renal complications of diabetes mellitus and he would like to know what test could be done to evaluate him for diabetic nephropathy. His laboratory values are shown in the table. Serum glucose 129 mg/dl Sodium 144mmol/L Potassium 5.0mmol/L Chloride 110mmol/L Bicarbonate 22mmol/L BUN 15mg/dL Creatinine 1.1mg/dL Hemoglobin A1C 8.9%   Which of the following tests is the most appropriate intervention for this patient?

Multiple endocrine neoplasia type I (MEN1) is characterized by the combination of parathyroid tumors, pancreatic islet cell tumors, and anterior pituitary tumors.

The differential diagnosis of Cushing’s syndrome includes which of the following conditions?