The Thyroid Puzzle

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

A 55-year-old woman presents with fatigue, weight gain, and constipation. TSH is 12 mIU/L, free T4 low-normal. (8 points)

1. Most likely diagnosis? (1 point)
   1. Subclinical hypothyroidism
   2. Overt hypothyroidism
   3. Hyperthyroidism
   4. Euthyroid sick syndrome
   5. Thyroid nodule

   Answer: B

2. Best initial management? (1 point)
   1. Observation only
   2. Start levothyroxine
   3. Methimazole
   4. Radioactive iodine
   5. High-dose iodine supplementation

   Answer: B

3. Which factor increases levothyroxine requirements? (1 point)
   1. Pregnancy
   2. Sedentary lifestyle
   3. Vitamin D supplementation
   4. Aging
   5. High-fibre diet

   Answer: A

4. Which medications interfere with levothyroxine absorption? Select all that apply. (4 points)
   1. Calcium
   2. Iron
   3. Bisphosphonates
   4. Proton pump inhibitors
   5. Metformin

   Answer: A, B, C, D

5. Target TSH after treatment? (1 point)
   1. <0.1 mIU/L
   2. Within normal range for age
   3. >10 mIU/L
   4. Suppressed below normal
   5. No need to monitor

   Answer: B

The Case of the Persistent Cough

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

SAMP

A 48-year-old non-smoking woman presents with an 8-month history of chronic cough. She notes it started at the same time she was diagnosed with hypertension and started on medication. There has been no fever, weight loss, or hemoptysis. She reports occasional heartburn and seasonal allergies. Medications: ramipril, cetirizine PRN. Chest X-ray is normal. (7 points)

1. Most likely diagnosis? (1 point)
   1. ACE-inhibitor-related cough
   2. Non-asthmatic eosinophilic bronchitis
   3. Cough-variant asthma
   4. Gastroesophageal reflux disease (GERD)
   5. Upper-airway cough syndrome (UACS)

   Answer: A

2. Next best step in management? (1 point)
   1. Methacholine challenge test
   2. Switch ramipril to an ARB
   3. Start high-dose ICS
   4. Start PPI trial
   5. Order sinus CT

   Answer: B

3. Which feature least supports cough-variant asthma? (1 point)
   1. Normal spirometry
   2. Response to bronchodilators
   3. Positive methacholine challenge
   4. Eosinophilia in sputum
   5. No history of wheeze

   Answer: A

4. Which is true regarding chronic cough work-up? Select all that apply. (3 points)
   1. ACE inhibitors can cause cough months after initiation
   2. GERD-related cough requires daily heartburn to be likely
   3. Normal chest X-ray rules out chronic sinusitis
   4. UACS can present without rhinorrhea
   5. Trial therapies are acceptable diagnostic tools

   Answer: A, D, E

5. Which medication is least likely to help ACE-I cough? (1 point)
   1. ARB substitution
   2. Inhaled corticosteroid
   3. Cough suppressants
   4. Switching to another ACE-I
   5. Discontinuing ACE-I

   Answer: D

Under Pressure: Recognizing and Managing Eustachian Tube Dysfunction in Primary Care

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

Just a reminder… pay attention to the questions. Here are our general tips one more time:

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A Lifelong Journey: Managing Adult Cerebral Palsy

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Just a reminder… pay attention to the questions. Here are our general tips one more time:

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High Stakes: The Rising Potency of Cannabis and Its Mental Health Risks

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Just a reminder… pay attention to the questions. Here are our general tips one more time:

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GLP-1 RAs and Reproductive Health: Balancing Benefits, Risks, and Timing

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Just a reminder… pay attention to the questions. Here are our general tips one more time:

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The Hidden Deficiency: Copper’s Crucial Role in Blood, Brain, and Beyond

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Just a reminder… pay attention to the questions. Here are our general tips one more time:

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Iron Matters: Managing NAID and IDA in Women

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Just a reminder… pay attention to the questions. Here are our general tips one more time:

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Boost or Bust? A Clinical Look at Testosterone Supplements

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Just a reminder… pay attention to the questions. Here are our general tips one more time:

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Dengue Danger: Know the Facts to Beat the Bite

We are excited to see so many of you join our FMEP courses. Several of you have requested we continue to post more practice SAMPs, so here you go!

Just a reminder… pay attention to the questions. Here are our general tips one more time:

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