Family Medicine COMAT || Questions and 100% Accurate Answers.

B (although treatment with methimazole, proylthiouracil, radioactive iodine, and surgical removal of the thyroid gland are plausible treatments for Grave's disease, methimazole is recommnded as a first line agent over propylthiouracil due to potential hepatotoxicity) correct answers A 56-year-old female complains of palpitations and an unintentional 20 lb weight loss in the past six months. History reveals that her menstrual periods stopped approximately 7 years ago. Vital signs include a blood pressure of 135/85 and a heart rate of 110. Physical examination reveals a non-tender enlarged thyroid gland without nodules. Structural examination reveals tissue texture changes at T2 associated with an upper thoracic flexion hump. Laboratory studies reveal the following TSH: 0.05 free T3: 380 free T4: 22 A thyroid stimulating immunoglobulin test is positive. The most appropriate initial management is A. levothyroxine B. methimazole C. proylthiouracil D. radioactive iodine ablation E. thyroidectomy D (the most likely diagnosis is onychomycosis - microscopic evaluation is the best first step to make the diagnosis) (A; bacterial infection is less likely than fungal) (B; Sabouraud's agar is used to grow fungal specimens - culture results usually return after weeks, a microscopic evaluation would be faster - culturing would be indicated if the initial KOH prep shows absent fungi) (C; this procedure stains fungal cell walls and helps in visualization - however, while this test is more sensitive, it is more expensive) (E; empiric treatment is not recommended due to side effects - additionally, treatment usually lasts 3 months, not 1, due to the slow growing nature of toenails) correct answers A 66-year old female complains that the nail of her right great toe is discolored and brittle. She states that she first noticed it 4 months ago during a pedicure. Physical examination reveals the right great toenail to be yellowed, thickened, and has white subungual debris. The most appropriate modality to confirm the most likely diagnosis is A. bacterial culture of nail clippings B. culture of toenail scrapings on Sabouraud's medium C. histopathologic examination of nail clippings under periodic acid-Schiff stain D. microscopic evaluation of toenail scrapings using KOH prep E. one month terbinafine to confirm resolution