Faye Davis-Pierce, 21 years old, is visiting her college clinic for the first time. She reports fatigue and a
weight gain of about 9 kg (20 lb) over the past 3 months. She is also concerned because her hair has been
falling out. Her temperature is 36.8?C (98?F) orally, pulse 64 beats/min, respirations 12 breaths/min, and
BP 98/66 mm Hg. Her height is 1.72 m (5 ft 8 in.), her weight is 94 kg (208 lb), and her body mass index is
31.6 (obese). Faye?s current medications include an oral contraceptive and a multivitamin. Upon
assessment the following were observed; Cranium is normocephalic, atraumatic. Hair blondish and
slightly dry. Skin dry and intact. Trachea midline. Skin color slightly pale, appears puffy. Wears glasses for
near vision. Reads menu and hears sentences accurately. Thyroid gland palpable and enlarged,
symmetrical, smooth, rubbery, and nontender. No lumps or masses. No bruit over thyroid. The patient
states, ?I?ve just been feeling really tired. I?ve had some weight gain and I?ve been really cold.? Symptoms
are related to low thyroid. Need for teaching about new prescription for thyroid replacement medication.
Teaching plan were provided about new thyroid replacement medication. Provide materials on nutrition
for healthy food choices. Suggest calorie limitation of 1,500 per day, including foods that she likes and can
eat. Consult with a dietician on written materials. Also state exercise plan of yoga and walking daily.
Continue on oral contraceptive and multivitamin daily. See back in clinic in 1 month. Provide contact
information for questions. Assess college stressors at next visit.
Initial subjective and objective data collection is complete. Tests of Faye?s thyroid levels reveal an elevated
TSH and low T3 and T4 , indicating hypothyroidism.

What is Auscultation of the case below?