A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition?

Choice A reason: Warfarin should be held before surgery due to its anticoagulant properties. Continuing warfarin increases the risk of excessive bleeding during and after surgery. The patient's INR level is already elevated, indicating a higher risk of bleeding.

Choice B reason: Metformin should be held before surgery, especially for patients undergoing procedures that involve the use of contrast dye or anesthesia. Metformin can cause lactic acidosis in patients with renal impairment or when kidney function is affected by contrast agents or surgery.

Choice C reason: Lisinopril is an ACE inhibitor used to manage blood pressure. While some guidelines suggest holding ACE inhibitors before surgery due to the risk of intraoperative hypotension, this decision is often individualized based on the patient's condition and the type of surgery. It is not as universally indicated to be held as warfarin and metformin.

Choice A reason: Anorexia, nausea, and vomiting are not typical findings associated with Cushing syndrome. These symptoms can be related to other medical conditions but do not specifically indicate Cushing syndrome.

Choice B reason: Truncal obesity, thin extremities, and rounding of the face (moon face) are classic signs of Cushing syndrome. This condition leads to fat redistribution, resulting in increased fat around the trunk and face while the extremities appear thinner. The distinctive appearance of moon face is due to fat accumulation.

Choice C reason: Purplish streaks on the abdomen, also known as striae, are a common feature of Cushing syndrome. These stretch marks occur due to the excessive production of cortisol, which weakens the connective tissue, leading to skin changes.

Choice D reason: Hyperglycemia, or high blood sugar, is frequently seen in patients with Cushing syndrome. The excess cortisol increases glucose production and decreases insulin sensitivity, leading to elevated blood sugar levels.

Choice E reason: A bronzed appearance of the skin is not a typical finding of Cushing syndrome. This symptom is more commonly associated with Addison's disease, which involves adrenal insufficiency rather than excess cortisol production seen in Cushing syndrome.