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
The general survey includes assessing every patient for signs of distress.
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