A 28‑year‑old male non‑smoker with no chronic health problems presents with a 10‑day history of persistent cough that's worse at night, stating, "I started with a head cold about two weeks ago. The cold moved into my chest." He reports mild chest discomfort with deep cough, rare production of small amounts of clear to white sputum, and feels tired because, "the cough keeps waking me up." He denies sore throat, fever, ear pain, shortness of breath, or GI symptoms. Objective temp 97.6, heart rate 72, respiratory rate 18, BP 112 over 68, SpO2 is 99%, no acute distress, mild pharyngeal redness, no lymphadenopathy, chest without crackles, occasional dry cough, abdominal exam is within normal limits.

Which of the following is the most appropriate next step?

A. Prescribe one week of oral amoxicillin.

B. Order a chest x-ray

C. Prescribe a five-day course of azithromycin

D. Provide advice about symptomatic care

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A 36 year old woman presents with a three month history of unintended weight loss, sensation of increased anxiety, heat intolerance, and reports, "I feel like my heart is going to beat right out of my chest." In addition, she reports a two-month history of increased frequency and looseness of stools. Physical exam reveals 3-4 plus Achilles and patella reflex response, mild exophthalmosis, bilateral fine tremor, and a diffusely enlarged non-tender thyroid. Heart rate 115 beats per minute at rest without murmur or other cardiac abnormalities.

Considering thyroid disorder as her working diagnosis, which of the following would be her anticipated lab results?

A. Elevated TSH with normal limit free T4

B. Low TSH with elevated free T4

C. Elevated TSH with a low free T4

D. Normal limit TSH

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A 62 year old man with a 60 pack year cigarette smoking history presents with a chief complaint of progressive dyspnea on exertion and a chronic productive cough over the past eight years. Significant contributing history include two episodes of being seen in urgent care in the past year for "bronchitis" and being told he should follow up with primary care.

When considering the diagnosis of COPD, which of the following is the most important diagnostic parameter?

A. patient report of progressive dyspnea and chronic productive cough

B. 60-pack year cigarette smoking history

C. FEV1 to FEC ratio of less than 0.7 post bronchodilator

D. FEV1 of less than 50 % of predicted

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