A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months.
On physical exam, the clinician notices a sinus bradycardia, muscular stiffness, coarse, dry hair, and a delay in relaxation in deep tendon reflexes (DTRs). Which of the following tests should be ordered next?
a. Serum calcium
b. Thyroid-stimulating hormone (TSH)
c. Electrolytes
d. Urine specific gravity
Question 2
A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of my feet feel like they are on fire. He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left heel.
Which of the following would be an appropriate treatment?
a. Tricyclic antidepressants
b. Capsacin cream
c. Vitamin B12 injections
d. Insulin
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