Family Medicine Thyroid Disease Clinical Vignettes

Listen to the podcast for why each multiple choice answer is right or wrong!

1. A 38-year-old woman has a developed a solid and quite firm thyroid mass that is approximately 1 cm diameter by palpation. She does not have any hoarseness, difficulty breathing or swallowing, or symptoms of thyroid disease. She no history of radiation, cancer, or familial history of thyroid disease. You order a Thyroid panel that includes TSH, Free T3 and T4. What would you do next?

A Fine-needle aspiration biopsy of the nodule 
B Observation to see if the nodule increases in size 
C Radioactive iodine uptake test (RAIU) 
D Resection of the nodule 
E Soft tissue neck ultrasound

2. You’ve been treating a 35-year-old female patient for thyroid disease and she comes back for a yearly exam. Her meds are significant for 100 ugm of levothyroxine once daily. Blood pressure is 124/84, pulse 72 bpm, respirations 13 bpm, and she is afebrile. Her physical examination is normal. Since you’re a PA who’s on top of your game, you’ve already had her come a week ago to draw her yearly physical labs that include a thyroid panel and you discuss the following results with her: Her TSH level is 11.5 uIU/mL (normal 0.4 to 5.0 uIU/mL). What is your next step in her treatment?

A Draw a free T3 and free T4. 
B Decrease levothyroxine to 88 ugm daily and recheck her TSH in 4 to 6 weeks to adjust if necessary. 
C Increase her levothyroxine to 112 ugm daily and recheck her TSH in 4 to 6 weeks to adjust if necessary. 
D Since she is asymptomatic no adjustment to levo is necessary. Recheck levels in 6 months to increase her levothyroxine dose. 

3. 24-year-old woman presents to your office with symptoms of heart palpitations, sore neck, and excessive sweating when other people say its cold. She has no significant history of surgery or medical conditions and is not on any medications. In office, her BP = 124/68, pulse = 110 beats per minute, respirations = 18 per minute, and temperature = 101 o F orally. Upon exam, her thyroid is mildly enlarged without nodules, and severely tender. RAIU is depressed. No local erythema or heat is noted. What is the most likely diagnosis in this patient?

A Thyroid abscess 
B Papillary thyroid cancer 
C Hashimoto's thyroiditis 
D Graves' disease 
E Subacute thyroiditis

Answers

1. E Soft tissue neck ultrasound
2. C Increase her levothyroxine to 112 ugm daily and recheck her TSH in 4 to 6 weeks to adjust if necessary. 
3. E Subacute thyroiditis

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Pediatric Cardiology Clinical Vignettes

Listen to the podcast for why each multiple choice answer is right or wrong!

1. A 9 YO boy presents to your clinic with widened pulse pressure, paradoxical splitting of S2 and a continuous machinery-type murmur that is heard best in the 2nd left intercostal space and widely transmitted over the precordium. No cyanosis present. What is the most likely diagnosis?

A. Ventricular septal defect.
B. Atrial septal defect.
C. Coarctation of Aorta
D. Patent Ductus Arteriosus.

2. A 15-year-old man presents after fainting while playing a basketball game. The patient states he was shooting when he felt lightheaded and subsequently passed out. On presentation, he is asymptomatic and has completely normal vital signs. Using your stethoscope, you hear a crescendo-decrescendo murmur at the left sternal border. What diagnosis should be suspected in this patient?

A. Still's murmur
B. Eisenmenger's syndrome
C. Hypertrophic cardiomyopathy
D. Venous hum

3. It’s your 3rd week at your pediatric rotation and a 8-year-old girl is brought in by his mom for strange behavior. She’s had intermittent fevers at night for the past week and reports L knees, bilateral ankle and R elbows joint pain and swelling. As she’s sitting on your exam table, her hands are writing uncontrollably and she maintains she can’t control them. On exam, a diastolic murmur is noted at the right upper sternal border. Which of the following diagnoses is most consistent with her symptoms?

A. Acute Rheumatic Fever
B. Pulmonic stenosis
C. Aortic stenosis
D. Tetralogy of Fallot

Answers

1. D. Patent ductus arteriosus
2. C. Hypertrophic cardiomyopathy
3. A. Acute Rheumatic Fever

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Pediatric Dermatology Clinical Vignettes

High yield clinical vignettes for pediatric dermatology, covering topics from Rubeola to Scarlet Fever to Tinea capitis, so you can ACE your EOR exams. I cover all answers including the incorrect ones for more learning in less time. Listen to the podcast for why each multiple choice answer is right or wrong! 

#1 A 2 year old boy presents with a 3 day history of rhinorrhea, conjunctivitis, barky cough, and a fever of 102 degrees. On physical examination you appreciate cervical lymphadenopathy, an erythematous throat most likely from the cough, and while you’re inspecting the mouth, you see a number of 1-3 mm white and gray elevations in the back of the cheek. Otherwise he has normal heart and breath sounds. This presentation is most consistent with: 

A. Roseola

B. Rubeola

C. Rubella

D. streptococcal pharyngitis

#2 A 5 year old boy presents with a 2 day history of fever and runny nose. His father states that he woke up this morning with rosy cheeks, and sure enough he’s sitting on your exam table with rosy cheeks. Physical exam reveals a light reticular rash over the extensor surfaces. Which of the following is the most likely diagnosis? 

A. Scarlet fever

B. Erythema infectiosum

C. Varicella

D. Epstein-Barr virus

#3 A 6-year-old boy presents with a fever for the past week. His mother states that over the course of the week, he has been getting worse. You take a look at the boy and doesn’t look very good. He has a 38.5C fever, bilateral conjunctival injection, a macular, erythematous rash on his abdomen and arms and a beefy red tongue. Which of the following is the most likely diagnosis? 

A Herpes simplex 1 

B Hand Foot and Mouth disease

C Tinea capitis

D Kawasaki disease

Answers

#1 B. Rubeola

#2 B. Erythema infectiosum

#3 D. Kawasaki disease

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