NMS Q&A Family Medicine

Thyroid Diseases 20515 A previously healthy 35-year-old man complains ofpainful neck for the past 2 weeks, along with malaiseand night sweats. In addition, he notes increased nervousnessand irritability. He manifests a sinus tachycardiaat 108 beats per minute. He denies treatmentfor cancer and human immunodeficiency virus(HIV) disease and risk factors for HIV. The thyroid isdiffusely palpable and mildly tender. The eyes exhibita mild stare, but exophthalmos is not present. TheTSH level is 0.2 IU/mL (0.4 to 4.8) and the FT 4 levelis 3 ng/dL (0.9 to 2.1). A radioactive iodine (RAI)uptake and scan shows a very low uptake. Which ofthe following is the diagnosis?(A) Graves disease(B) Riedel struma(C) Hashimoto thyroiditis(D) Ludwig angina(E) Subacute thyroiditis16 Which of the following is the most reasonable therapeuticapproach for the patient in Question 15, at thepresent time?(A) Institute methimazole treatment as 30 mg dailyby mouth(B) Start propylthiouracil 300 mg daily(C) Start propranolol 20 mg daily131(D) Treat with I(E) Consult and arrange for subtotal thyroidectomy17 A 45-year-old female has completed treatment forsubacute thyroiditis for 3 months. Now, however, shecomplains of decreasing energy and increased sleeprequirements. Her skin is dry and the eyes mildly“puffy” compared with her former appearance, evenbefore the acute phase of the recent illness. Each ofthe following statements regarding this developmentis true except for which one?(A) The patient’s case has evolved into hypothyroidism.(B) Treatment of this condition will remain in placefor life.(C) This complication occurs in nearly one-half ofpatients.(D) The patient may, at a later date, develophyperthyroidism.(E) A significant proportion of patients with thiscondition will have persistent elevations ofantithyroid peroxidase antibodies18 A 35-year-old woman enters your office complainingof a 20-lb (9-kg) involuntary weight loss over a periodof 4 months. At 5 ft, 4 in. (1.63 m), she weighs 110 lb(50 kg), down from her usually stable weight of 130 lb(59 kg). Her skin is moist and velvety in texture. Hersclerae are visible above her corneae and she showsan asymmetrical ocular proptosis. Her thyroid glandis diffusely palpable and non-nodular. She is at riskfor each of the following diseases, except whichone?(A) Alopecia areata(B) Diabetes mellitus type 1(C) Vitiligo(D) Coronary atherosclerosis(E) Adrenal insufficiency19 For a 37-year-old woman with Graves disease, whichof the following is the least favored choice of treatmentfor this woman, assuming she wants no morechildren and is not pregnant?(A) Methimazole(B) Propylthiouracil(C) I 131 therapy(D) Thyroidectomy(E) Short-term propranolol20 A 45-year-old white man complains of weight lossfor several weeks and his wife complains that he oftensets the heating system down, a change from his priorcomfort zone in which the two had always had agreement.He has lost weight from his usual 185 lb(84 kg) at 5 ft, 10 in. (1.78 m) to 165 lb (74.7 kg) overthe past 3 months. His wife reminds him that whilethey were living in another city several years ago, hewas diagnosed as having a goiter, which was treatedwith thyroid hormone, but his prescription lapsedafter they had moved and he had not sought furthertreatment. His thyroid gland is enlarged and palpablynodular in both lobes. Examination of his eyes externallyis normal. This entity is preceded by which ofthe following conditions?(A) Single “cold” thyroid nodule(B) Single “hot” thyroid nodule(C) Autoimmune thyroiditis(D) Nontoxic multinodular goiter(E) Factitious hyperthyroidism21 Regarding the patient in Question 20, which of thefollowing is the most likely treatment of choice?(A) Respective surgery(B) I 131 therapy(C) Propylthiouracil(D) Methimazole(E) Propranolol