Jennifer Albertson iHuman Case Study and Best Guide 2025

Jennifer Albertson is a 65-year-old female presenting with trouble sleeping that started a couple of months ago and has progressed from intermittent to multiple times per week. In this comprehensive guide, we’ll walk you through how to approach her case, from initial history-taking through physical examination to the final diagnosis of hyperthyroidism with secondary insomnia. You’ll learn the key clinical reasoning steps, what the iHuman grading rubric expects, and a complete step-by-step solution to help you confidently navigate this complex endocrine case simulation.

Jennifer Albertson Ihuman Case Overview (Doorway Information)

Patient Overview: Jennifer Albertson is a 65-year-old Caucasian female presenting with a chief complaint of “trouble sleeping” that has been occurring over the past couple of months. She describes initial intermittent sleep disturbances that have now progressed to multiple times per week. The patient reports difficulty both falling asleep (tossing and turning for 1-2 hours) and staying asleep (waking at 2-3 AM with difficulty returning to sleep). She is a light sleeper who awakens easily with noise.

Key Background Information:

• Age/Gender: 65-year-old female
• Chief Complaint: Trouble sleeping
• Duration: Started couple of months ago, now multiple times weekly
• Sleep Characteristics: Difficulty falling asleep and staying asleep, light sleeper
• Associated Symptoms: Feelings of nervousness/jitteriness, weight loss despite increased appetite
• Significant History: Recently retired, enjoying retirement with friends
• Current Medications: To be determined during assessment
• Lifestyle: Recently retired, socially active with friends
• Physical Presentation: Height 165 cm (5’5″), Weight 126 lb (57.3 kg), appears anxious

The patient appears alert and cooperative but reports feeling nervous and jittery. Her presentation with sleep disturbances combined with nervousness, weight loss, and increased appetite suggests possible hyperthyroidism as an underlying cause, making this an excellent case for learning systematic endocrine assessment and differential diagnosis skills.

Jennifer Albertson (65 y/o female) – Insomnia Assessment

• CC: Trouble sleeping
• MSAP: Insomnia with difficulty falling asleep and staying asleep, progressive worsening from intermittent to multiple times weekly
• Associated nervousness, jitteriness, weight loss despite increased appetite
• History: Recently retired, socially active, denies depression/anxiety
• Presentation suggests secondary insomnia due to underlying medical condition

History Questions:

• How can I help you today?
• When did your sleep problems begin?
• Any other symptoms we should discuss?
• Do you have any allergies?
• Are you taking any OTC or herbal medications?
• Any new or recent changes in medications?
• Can you describe your sleep difficulty in detail?
• How long does it take you to fall asleep?
• Do you wake up during the night? If so, when?
• How long does it take to fall back asleep?
• What makes your sleep problems better or worse?
• Have you been nervous, anxious or worried about something?
• Do you awaken frequently from sleep?
• Does your insomnia come and go or is it constant?
• If you wake in the middle of the night, are you able to fall asleep again?
• Have you noticed any changes in your weight recently?
• How is your appetite? Any recent changes?
• Any change in the frequency of your bowel movements?
• Do you have any heart palpitations or rapid heartbeat?
• Do you feel more sensitive to heat than usual?
• Do you have any tremors or shaking of your hands?
• Do you experience: fatigue, difficulty concentrating, mood changes?
• Do you have any neck swelling or throat discomfort?
• How has your energy level been lately?
• Tell me about your retirement and recent life changes
• Do you drink alcohol or caffeine? How much and when?
• Do you have any family history of thyroid problems?

Physical Exam:

• Vitals: pulse, BP, respirations, temperature
• Examine skin and hair texture
• Neck: palpate thyroid gland
• Neck: auscultate for thyroid bruits
• Eyes: examine for exophthalmos, lid lag
• Cardiovascular:
  • Assess heart rate and rhythm
  • Auscultate heart sounds
• Neurologic:
  • Assess for tremor
  • Deep tendon reflexes
  • Mental status assessment
• Extremities: inspect nails and skin changes
• General: assess for anxiety, nervousness

Assessment note: J.A. is a 65-year-old female presenting with 2-month history of progressive insomnia, difficulty falling asleep and staying asleep. Associated symptoms include nervousness/jitteriness, weight loss despite increased appetite, and loose bowel movements. Recently retired and enjoying social activities. Physical exam notable for possible thyroid enlargement and signs of hyperthyroidism. Sleep disturbances appear to be secondary to underlying endocrine dysfunction.

Diagnostic Tests: TSH, Free T4, Free T3, Complete metabolic panel, CBC with differential, Sleep study consideration

Diagnosis: Hyperthyroidism with secondary insomnia

Plan:

• Comprehensive thyroid function testing (TSH, Free T4, Free T3)
• Consider thyroid ultrasound if enlargement detected
• Sleep hygiene education
• Discuss thyroid treatment options (antithyroid medications, radioactive iodine, surgery)
• Cardiology evaluation if tachycardia present
• Follow-up in 2-3 weeks for test results
• Patient education about hyperthyroidism and sleep relationship

Jennifer Albertson SOAP Note

Patient: Jennifer Albertson Subjective Data

CC: 65-year-old female presents with “trouble sleeping”

HPI: 65-year-old female presents today with complaints of sleep disturbances that began a couple of months ago and have progressively worsened from intermittent to multiple times per week. The patient describes difficulty both falling asleep, taking 1-2 hours of tossing and turning, and staying asleep, typically waking around 2-3 AM with difficulty returning to sleep. She reports being a light sleeper who awakens easily with environmental noise. The patient also reports feeling nervous and jittery but denies knowing why, stating “maybe it’s the sleep problems.” She reports weight loss despite having an increased appetite, stating she feels “hungry all the time.” She also notes loose, soft bowel movements that sometimes border on diarrhea consistency. The patient denies depression or anxiety and states that life is good, enjoying retirement with friends.

Medications: Current medications to be clarified during assessment

Allergies: (medication, environmental, food) Allergies to be assessed

PMH: Medical history to be elicited, particularly thyroid disorders, cardiac conditions, psychiatric history

LNMP/OB History (if indicated): Post-menopausal female, obstetric history to be obtained if relevant

PSH: Surgical history to be documented

Sexual History (if indicated): Deferred for this visit unless relevant

Hospitalizations: Previous hospitalizations to be assessed

Health Maintenance: Preventive care history to be obtained

Immunizations: Immunization status to be updated

Family History: Family history of thyroid disorders, sleep disorders, cardiac disease, psychiatric conditions to be elicited

Substances (Tobacco, alcohol, illicit drugs, caffeine): Smoking history, alcohol consumption, caffeine intake patterns to be assessed for impact on sleep

Home environment: Lives independently, social support system with friends

Employment type: Recently retired, previously worked (occupation to be specified)

Diet: Appetite increased, eating habits to be assessed

Sleep: Current primary concern – difficulty falling asleep and staying asleep, light sleeper

Exercise: Activity level and exercise habits to be assessed

Safety: Safety assessment regarding nervousness and potential hyperthyroid symptoms

Objective Data

ROS: (Perform an appropriate ROS based on the C/C and HPI; documented in i-Human assignment; performed in final focused exam)

General: Patient appears alert and cooperative but reports feeling nervous and jittery. No acute distress noted but appears anxious about sleep problems and overall symptoms.

Skin, Hair and Nails: Assess for skin texture changes, hair thinning, nail changes consistent with thyroid disorders. Check for warm, moist skin or brittle nails.

HEENT: Examine eyes for exophthalmos, lid lag, or other signs of Graves’ ophthalmopathy. Assess for neck masses or thyroid enlargement.

NECK: Careful palpation of thyroid gland for enlargement, nodules, or tenderness. Auscultate for thyroid bruits if enlargement detected.

Thorax and Lungs: Respiratory assessment for any signs of dyspnea or respiratory compromise related to hyperthyroidism.

Cardiovascular: Heart rate and rhythm assessment, looking for tachycardia, palpitations, or irregular rhythms. Blood pressure assessment for hypertension.

Peripheral Vascular: Assess peripheral pulses and circulation status.

Abdomen: Assess for hyperactive bowel sounds consistent with loose stools. Rule out other gastrointestinal pathology.

Genitourinary: Deferred unless relevant to case.

Metabolic/Hematologic: Assess for signs of hyperthyroidism including weight loss, heat intolerance, excessive energy alternating with fatigue.

Psychiatric: Mental status examination focusing on anxiety, nervousness, mood changes, but patient denies depression or anxiety disorders.

Musculoskeletal: Assess for muscle weakness or wasting that can occur with hyperthyroidism.

Neurologic: Assess for tremor (particularly fine tremor of hands), hyperreflexia, restlessness, and cognitive effects of sleep deprivation.

Vital Signs: Temperature: Normal, Pulse: Potentially elevated, BP: Monitor for elevation, Respirations: Normal Height: 165 cm (5’5″), Weight: 126 lb (57.3 kg)

Assessment

General: 65-year-old female in no acute distress but appearing anxious and reporting subjective nervousness. Alert and oriented with appropriate affect for clinical situation.

Skin, Hair and Nails: Skin warm and possibly moist if hyperthyroid. Hair texture and nail changes to be assessed for thyroid-related changes.

HEENT: Eye examination for thyroid-related changes. Thyroid palpation may reveal enlargement or nodularity.

NECK: Full range of motion, assess for thyroid enlargement, tenderness, or nodules.

Thorax and Lungs: Respiratory examination within normal limits unless complications present.

Cardiovascular: Heart rate may be elevated (tachycardia) if hyperthyroid. Regular rhythm expected unless atrial fibrillation develops.

Peripheral Vascular: Peripheral circulation assessment, checking for signs of hyperdynamic circulation.

Abdomen: May have hyperactive bowel sounds consistent with loose stools reported in history.

Psychiatric: Anxious affect but denies depression. Nervousness and jitteriness may be related to hyperthyroidism rather than primary anxiety disorder.

Musculoskeletal: Assess for proximal muscle weakness or thyroid-related myopathy.

Neurologic: Fine tremor may be present. Hyperreflexia possible with hyperthyroidism. Sleep deprivation effects on cognition.

Differential Diagnoses

Hyperthyroidism with Secondary Insomnia: The patient’s presentation with insomnia, nervousness, weight loss despite increased appetite, loose stools, and jitteriness strongly suggests hyperthyroidism. Hyperthyroidism commonly causes sleep disturbances due to increased metabolic rate and sympathetic nervous system activation.

Primary Insomnia: Could be considered given the sleep complaints, but the associated symptoms of weight loss, increased appetite, nervousness, and loose stools suggest a secondary cause rather than primary sleep disorder.

Anxiety Disorder: The nervousness and sleep disturbances could suggest an anxiety disorder, but the patient denies anxiety and the associated physical symptoms (weight loss despite increased appetite, loose stools) point toward an organic cause.

Adjustment Disorder with Insomnia: Recent retirement could be a stressor causing adjustment issues and sleep problems, but again the associated physical symptoms suggest an underlying medical condition.

Caffeine-Induced Sleep Disorder: Excessive caffeine intake could cause insomnia and nervousness, but would not typically cause weight loss with increased appetite or loose stools.

Most Likely Diagnosis: Hyperthyroidism (likely Graves’ disease or toxic multinodular goiter) with secondary insomnia. The constellation of symptoms including insomnia, nervousness, weight loss despite increased appetite, loose stools, and possible thyroid enlargement strongly supports this diagnosis. Sleep disturbances are common in hyperthyroidism due to increased metabolic rate and catecholamine sensitivity.

Plan

Health Promotion: (appropriate screening, disease prevention, and health promotion according to the patient’s age, gender, and identified risk factors…not diagnosis specific)

✓ Cardiovascular Health – Blood pressure monitoring, lipid screening, and cardiac evaluation if tachycardia present due to hyperthyroid effects on heart.

✓ Bone Health – Bone density screening as hyperthyroidism can accelerate bone loss, especially important in post-menopausal women.

✓ Cancer Screening – Age-appropriate mammography, colonoscopy, cervical cancer screening if applicable.

Screening

✓ Thyroid Function – Complete thyroid function panel including TSH, Free T4, Free T3, and consider thyroid antibodies.

✓ Cardiac Screening – ECG if tachycardia present, echocardiogram if indicated.

✓ Bone Density – DEXA scan given hyperthyroid risk for osteoporosis.

Immunizations

✓ Age-appropriate vaccines – Annual influenza, COVID-19, pneumococcal as indicated ✓ Shingles vaccine – Recommended for adults over 60

Complete Step-by-Step Guide to Writing the Jennifer Albertson iHuman Case Study

Completing the Jennifer Albertson iHuman case requires a systematic approach that recognizes insomnia as a presenting symptom while identifying the underlying endocrine pathology. This comprehensive guide will walk you through each section of the simulation, providing specific strategies and key points to ensure you achieve the required 70% score.

Step 1: Pre-Case Preparation and Initial Approach

Before diving into the case, review the doorway information and formulate your initial clinical approach for a sleep disorder presentation in an older adult.

Key Information to Note:

• 65-year-old female with “trouble sleeping”
• Progressive worsening over couple of months
• Consider both primary sleep disorders and secondary causes

Initial Clinical Mindset: Approach this case with a broad differential for insomnia in older adults. While primary sleep disorders are common, the combination of sleep disturbances with other systemic symptoms should raise suspicion for underlying medical conditions, particularly endocrine disorders.

Step 2: Conducting the History of Present Illness (HPI)

The HPI is crucial for distinguishing primary from secondary insomnia. Use the OLDCARTS method systematically:

Onset: Ask about timing and progression

• Key points to elicit: Started couple of months ago, initially intermittent, now multiple times weekly

Location: Sleep disturbance patterns

• Target response: Difficulty both falling asleep and staying asleep

Duration: How long sleep episodes and awakenings last

• Important detail: Takes 1-2 hours to fall asleep, wakes around 2-3 AM

Character: Detailed description of sleep problems

• Critical descriptor: Light sleeper, tosses and turns, awakens with noise

Aggravating factors: What makes sleep worse

• Essential findings: Environmental noise, possibly stress or anxiety

Relieving factors: What helps with sleep

• Key response: Limited relief, seeking medical help for sleep aids

Timing/Treatment: Pattern and attempted interventions

• Important pattern: Progressive worsening, no effective treatments tried

Severity: Impact on daily functioning

• Typical response: Significant distress, affecting quality of life

Associated Symptoms:

• Ask specifically about: nervousness, weight changes, appetite, bowel movements, heart palpitations
• Key finding: Nervousness, weight loss despite increased appetite, loose stools

Step 3: Review of Systems (ROS)

Conduct a thorough ROS focusing on endocrine and sleep-related systems:

Endocrine:

• Heat/cold intolerance, excessive sweating
• Weight changes, appetite changes
• Energy levels, fatigue patterns
• Hair and skin changes

Cardiovascular:

• Palpitations, chest pain, exercise tolerance
• Blood pressure changes
• Shortness of breath

Gastrointestinal:

• Bowel movement changes, consistency
• Nausea, abdominal pain
• Appetite and eating patterns

Neuropsychiatric:

• Anxiety, depression, mood changes
• Concentration difficulties
• Tremor, restlessness

Step 4: Past Medical History, Social History, and Family History

Past Medical History:

• Previous thyroid disorders, cardiac conditions
• History of anxiety or depression
• Previous sleep studies or sleep disorders
• Medications that could affect sleep

Family History:

• Family history of thyroid disease (critical for Graves’ disease)
• Autoimmune disorders
• Sleep disorders, psychiatric conditions

Social History:

• Recent life changes (retirement – significant stressor)
• Caffeine and alcohol consumption patterns
• Exercise habits and timing
• Sleep hygiene practices
• Social support system

Step 5: Physical Examination Strategy

Perform a comprehensive examination with focus on thyroid and cardiovascular systems:

Vital Signs:

• Expected findings: Possible tachycardia, elevated blood pressure, normal temperature

Thyroid Examination:

• Inspection: Look for visible thyroid enlargement, neck masses
• Palpation: Carefully examine thyroid for size, consistency, nodules
• Auscultation: Listen for thyroid bruits if enlargement present

Cardiovascular Examination:

• Heart rate and rhythm assessment
• Blood pressure in both arms
• Heart sounds for murmurs or extra sounds
• Signs of heart failure if severe hyperthyroidism

Neurologic Examination:

• Fine tremor assessment (especially hands)
• Deep tendon reflexes (often hyperreflexic in hyperthyroidism)
• Mental status and anxiety level

Additional Key Exams:

• Eye examination: Look for lid lag, exophthalmos
• Skin and hair: Assess texture, moisture, warmth
• Nail examination: Look for thyroid-related changes

Step 6: Developing Differential Diagnoses

Propose appropriate differentials with rationales:

Primary Considerations:

Hyperthyroidism with Secondary Insomnia

• Supporting evidence: Weight loss with increased appetite, nervousness, loose stools, sleep disturbances
• High-probability diagnosis given constellation of symptoms

Primary Insomnia/Sleep Disorder

• Supporting evidence: Sleep complaints, age-related changes
• Less likely given associated systemic symptoms

Secondary Considerations:

• Anxiety Disorder: Could explain nervousness and insomnia, but physical symptoms suggest organic cause
• Adjustment Disorder: Recent retirement could be stressor, but systemic symptoms point elsewhere
• Caffeine-Induced Sleep Disorder: Less likely to cause weight loss and loose stools

Step 7: Diagnostic Test Interpretation

Order and interpret appropriate tests:

Essential Tests:

• TSH: Will be suppressed in hyperthyroidism
• Free T4 and Free T3: Elevated in hyperthyroidism
• Complete metabolic panel: Assess for electrolyte abnormalities
• CBC: Look for signs of hyperthyroid effects

Additional Tests:

• Thyroid antibodies: If Graves’ disease suspected
• ECG: Assess for tachycardia or atrial fibrillation
• Sleep study: Consider if thyroid function normal

Step 8: Final Diagnosis and Most Significant Active Problem (MSAP)

Primary Diagnosis: Hyperthyroidism with Secondary Insomnia

Justification:

• Classical presentation with insomnia, nervousness, weight loss despite increased appetite
• Loose stools and jitteriness consistent with hyperthyroidism
• Sleep disturbances are common manifestation of hyperthyroid state

MSAP Selection: Choose “Hyperthyroidism” as your Most Significant Active Problem, as treating the underlying condition will resolve the insomnia.

Step 9: Comprehensive Management Plan

Develop an immediate and long-term treatment approach:

Immediate Management:

• Thyroid function testing to confirm diagnosis
• Symptom management for sleep and anxiety
• Cardiovascular assessment if tachycardia present

Pharmacological Interventions:

• Antithyroid medications: Methimazole or propylthiouracil
• Beta-blockers: For symptomatic relief of tachycardia and nervousness
• Short-term sleep aids: If necessary while treating underlying condition

Long-term Management:

• Discussion of treatment options: medications, radioactive iodine, surgery
• Regular monitoring of thyroid function
• Cardiovascular follow-up
• Sleep hygiene education

Follow-up Plan:

• Return in 2-3 weeks for test results
• Endocrinology referral for definitive management
• Sleep study if insomnia persists after thyroid treatment
• Patient education about hyperthyroidism and treatment options

Step 10: Documentation and Submission Tips

Writing Your Summary:

• Create a concise 350-word summary linking insomnia to underlying hyperthyroidism
• Include how you systematically evaluated secondary causes of insomnia
• Cite specific assessment findings and planned diagnostic tests
• Use appropriate endocrine terminology

Key Documentation Elements:

• Assessment Statement: Connect sleep symptoms to systemic findings
• Clinical Reasoning: Explain approach to secondary insomnia evaluation
• Evidence Correlation: Link physical findings to hyperthyroid diagnosis
• Management Rationale: Justify treating underlying condition vs. symptom management

Final Submission Checklist:

• ✓ Complete sleep history with systematic assessment
• ✓ Comprehensive endocrine-focused physical exam
• ✓ Appropriate differential diagnoses including secondary causes
• ✓ Correct identification of hyperthyroidism as underlying cause
• ✓ Evidence-based management plan addressing both conditions
• ✓ Professional documentation with proper medical terminology

Jennifer Albertson iHuman Case Summary

Grading Criteria:

The Jennifer Albertson iHuman case evaluates your ability to recognize secondary causes of insomnia and diagnose hyperthyroidism in older adults. Here’s what you need to focus on to maximize your score:

(1) History Taking (Critical Points):

You must ask targeted questions about sleep patterns AND associated systemic symptoms. Essential questions include: detailed sleep history (falling asleep, staying asleep, sleep quality), weight changes despite appetite, bowel movement changes, nervousness/anxiety symptoms, heat intolerance, and palpitations. Don’t miss asking about: recent life changes (retirement), family history of thyroid disease, caffeine intake, and medication history. The rubric rewards students who systematically evaluate both primary and secondary causes of insomnia.

(2) Physical Examination (Endocrine Focus):

Prioritize thyroid and cardiovascular examination. Must-do components: complete vital signs (noting tachycardia), thyroid palpation and auscultation, cardiovascular assessment, neurologic examination for tremor and reflexes, and eye examination for thyroid-related changes. Pro tip: The rubric awards significant points for proper thyroid examination technique and recognition of hyperthyroid signs beyond just sleep complaints.

(3) Differential Diagnosis (Secondary Causes):

You need to consider both primary sleep disorders and secondary medical causes. Expected differentials include: hyperthyroidism with secondary insomnia (primary consideration), primary insomnia, anxiety disorder, and adjustment disorder with insomnia. Scoring secret: The rubric heavily weighs your ability to recognize that systemic symptoms suggest secondary rather than primary insomnia.

(4) Final Diagnosis & MSAP:

You must correctly identify hyperthyroidism as the underlying cause of secondary insomnia. Justification should cite the constellation of symptoms: insomnia, weight loss with increased appetite, loose stools, nervousness, and possible thyroid enlargement.

(5) Management Plan (Comprehensive Approach):

The rubric expects management of both the underlying thyroid condition and symptomatic sleep support. High-scoring responses mention: thyroid function testing (TSH, Free T4, Free T3), antithyroid medication options, beta-blocker for symptomatic relief, endocrinology referral, and sleep hygiene education while treating underlying condition.

(6) Patient Communication:

Demonstrate understanding of the connection between thyroid function and sleep. Bonus points for: explaining how hyperthyroidism causes insomnia, discussing treatment timeline expectations, and providing reassurance that sleep should improve with thyroid treatment.

Example of a High-Scoring Clinical Summary

Here’s how a top-performing student might document this case:

Patient Summary – Jennifer Albertson

Situation: 65-year-old female presenting with progressive insomnia over 2 months, associated with systemic symptoms suggestive of hyperthyroidism.

Background: Recently retired, otherwise healthy appearing female with new onset sleep disturbances. Associated symptoms include nervousness, weight loss despite increased appetite, loose bowel movements, and jitteriness. Denies primary anxiety or depression.

Assessment: Physical examination notable for possible thyroid enlargement and signs consistent with hyperthyroid state. Sleep disturbances appear secondary to underlying endocrine dysfunction rather than primary sleep disorder. Primary Diagnosis: Hyperthyroidism with secondary insomnia.

Recommendation:

• Immediate thyroid function testing (TSH, Free T4, Free T3)
• Consider thyroid antibodies if Graves’ disease suspected
• Symptom management with beta-blocker for tachycardia and nervousness
• Sleep hygiene education and short-term sleep support if needed
• Endocrinology referral for definitive thyroid management
• Discussion of treatment options (antithyroid medications, radioactive iodine, surgery)
• Follow-up in 2-3 weeks to review test results and adjust treatment plan
• Patient education about hyperthyroidism-insomnia connection

Patient Education Provided: Explained the relationship between thyroid function and sleep disturbances, discussed that treating the underlying thyroid condition should improve sleep quality, reviewed warning signs requiring immediate medical attention, and provided reassurance about treatment effectiveness for hyperthyroidism.

Conclusion

By following this comprehensive approach to the Jennifer Albertson case, you’ll demonstrate the clinical reasoning skills needed to evaluate insomnia in older adults systematically. Remember, success in endocrine cases requires looking beyond the presenting complaint: gather detailed history about associated systemic symptoms, perform focused endocrine physical examination, consider secondary causes of common symptoms, and develop comprehensive treatment plans addressing underlying pathology. The key is recognizing that this iHuman simulation tests your ability to connect seemingly unrelated symptoms to underlying endocrine dysfunction – be thorough, think systematically, and always consider secondary causes of insomnia in older adults. With this guide, you’re well-prepared to excel in this challenging but educational case simulation.

Frequently Asked Questions

What is the correct diagnosis for Jennifer Albertson’s sleep problems?

Jennifer Albertson’s primary diagnosis is hyperthyroidism with secondary insomnia. The key distinguishing features include the combination of sleep disturbances with systemic symptoms such as weight loss despite increased appetite, loose bowel movements, nervousness, and jitteriness. Students often focus solely on the insomnia complaint, but the associated symptoms strongly suggest an underlying endocrine disorder causing the sleep problems rather than a primary sleep disorder.

What are the critical physical exam components I need to perform to score well?

Essential physical exam elements include complete vital signs (particularly noting any tachycardia), comprehensive thyroid examination (inspection, palpation, and auscultation if enlarged), cardiovascular assessment, neurologic examination for tremor and hyperreflexia, and eye examination for thyroid-related changes like lid lag. Many students miss points by not performing a thorough thyroid examination or failing to assess for the neurologic signs of hyperthyroidism such as fine tremor and hyperactive reflexes.

How do I pass the Jennifer Albertson case and meet the 70% requirement?

Success requires recognizing that this presents as insomnia but is actually a case of secondary sleep disorder due to hyperthyroidism. Focus on systematic history-taking that explores both sleep patterns and associated systemic symptoms, perform a comprehensive endocrine-focused physical examination, propose appropriate differential diagnoses that include secondary causes of insomnia, and develop a management plan that addresses the underlying thyroid condition rather than just treating insomnia symptomatically.

What diagnostic tests should I order and why?

The essential diagnostic workup should include thyroid function tests (TSH, Free T4, Free T3) as the primary investigations to confirm hyperthyroidism. Additional tests to consider include thyroid antibodies if Graves’ disease is suspected, ECG if tachycardia is present, complete metabolic panel, and CBC to assess for hyperthyroid effects on other systems. Students often forget that sleep studies are not the first-line investigation when systemic symptoms suggest a secondary cause of insomnia – focus on identifying and testing for the underlying medical condition first.