36-year-old woman comes to the physician for a routine health examination

36-year-old woman comes to the physician for a routine health examination. She has no complaints or previous

medical problems and takes no medications. She does not use tobacco, alcohol, or illicit drugs. Her menstrual

cycles are regular. The patient is an architect at a local construction firm. She has had no exposure to excessive

radiation in the past. Her family history is negative for thyroid problems. Her temperature is 36. 7° C (98° F), blood

pressure is 130/80 mm Hg, pulse is 80/min, and respirations are 16/min. Examination of the neck shows a 2x2 cm,

discrete, nontender, firm, and mobile nodule in the left thyroid lobe without cervical lymphadenopathy. The

remainder of the examination is within normal limits. Which of the following is the most appropriate initial step in

evaluation of this patient?

  • O A. Computed tomography scan of the neck
  • O B. Fine-needle aspiration biopsy
  • O C. Measurement of thyroid-stimulating hormone and thyroid ultrasound
  • 0 D. Radionuclide scan
  • O E. Serum anti-thyroid peroxidase antibodies and thyroglobulin

0 voters

43-year-old man is being evaluated for erectile dysfunction, which has been progressive over the past year. He

has no other symptoms except some fatigue that he attributes to his intense work schedule. The patient drinks 1-2

beers every day after work and has a 20-pack-year smoking history. He does not use recreational drugs or take

over-the-counter medications. Vital signs are normal. BMI is 29 kg/m2• Skin examination shows brownish skin

pigmentation, most pronounced over the face and both arms. The abdomen is soft and nontender without

organomegaly. Cardiopulmonary examination shows no abnormalities, and there is no peripheral edema.

Laboratory results are as follows:

Hemoglobin 14 g/dL

Platelets 200,000/mm3

Leukocytes 7,500/mm3

Blood urea nitrogen 14 mg/dL

Creatinine 0.8 mg/dL

Fasting glucose 130 mg/dL

Aspartate aminotransferase 78 U/L

Alanine aminotransferase 80 U/L

If untreated, this patient is at increased risk for developing which of the following complications?

  • 0 A. Gastric adenocarcinoma
  • 0 B. Hepatocellular carcinoma
  • 0 C. Hypotensive crisis
  • 0 D. Nephrotic syndrome
  • 0 E. Pancreatic cancer
  • 0 F. Skin cancer

0 voters