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2766 Medicine

A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is two times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/mL (normal 0.9-2.4) and an elevated thyroid-stimulating hormone (TSH) at 22 microU/mL (normal 0.4-4). What is the likely course of her illness?

APermanent hypothyroidism requiring lifelong replacement therapy
BEventual hyperthyroidism requiring methimazole therapy
CRecovery with euthyroidism
DInfertility
Medicine
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2769 Medicine

A 46-year-old smoker presents in an ED with a sharp ,left sided chest pain. The pain is not focal. On physical examination , there is no specific finding .Pain is neither aggravated nor relived with change of postural change and with inspiration. On an ECG , anterior ST elevation can be seen.What shall be the next step in management ?

AActivation of the primary angioplastyteam
BAwait troponin tests and give analgesia
CNon-steroidal anti-inflammatory analgesia
DUrgent bedside echo to rule out a regional wall motion abnormality
Medicine
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