A 45-year-old woman presents for a sick visit with a chief complaint of 2–3-day sudden onset right elbow swelling with pain, stating, “I’ve never had pain like this. It looks like I have a swollen ball hanging from my elbow”.  She denies recent or remote injury to the area, fever, pain in other joints or skin lesions, and does report recently spending an extensive period of time on her computer due to a major work project. Physical exam reveals an area of painful sac-like swelling behind the right elbow, slightly warm, without redness or evidence of trauma. Joint range of motion (ROM) elicits discomfort but is largely intact. This clinical presentation is most consistent with: 

A. Rheumatoid arthritis 

B. Tendonitis 

C. Olecranon bursitis

D. Septic arthritis

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A 37-year-old adult was diagnosed with dyspepsia with documented H. pylori infection. An appropriate course of antimicrobial and proton pump inhibitor (PPI) therapy was prescribed and completed approximately 4 weeks ago. The patient states that the presenting symptoms have resolved and, “My stomach feels much better.” Which of the following is the most appropriate next step in care?

A.  Serologic test for H. pylori antibodies should be checked today.

B. The patient should be referred to gastroenterology for biopsy via endoscopy.

C. No further testing is needed as the patient’s symptoms have resolved.

D. Urea breath test should be conducted to confirm H. pylori eradication.

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Sarah is a 75 year-old woman with a 40 year history of HTN and a 30 year history of T2DM and dyslipidemia who was recently diagnosed with stage 4 chronic kidney disease (CKD). Given this history, which of the following hemograms would be expected? 

A. Hb = 9.7 g/dL (12 to 14 g/dL); MCV = 69 fL (80 to 96 fL); RDW=18% (11.5-15%)

B. Hb = 7.2 g/dL (12 to 14 g/dL); MCV = 122 fL (80 to 96 fL); RDW= 18.1% (11.5-15%)

C. Hb = 9.4 g/dL (12 to 14 g/dL); MCV = 83 fL (80 to 96 fL);  RDW= 13% (11.5-15%)

D. Hb = 10.4 g/dL (12 to 14 g/dL); MCV = 82 fL (80 to 96 fL); RDW= 18% (11.5-15%)

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Which of the following is a MEC Category 4 (use represents unacceptable health risk) to the use of a CHC (combined hormonal contraception method such as combined oral contraception [COC])?

A.  Mother with a history of breast cancer.

B. Personal history of hepatitis A at age 10 years.

C. Presence of factor V Leiden mutation.

D. Cigarette smoking one pack per day in a 22-year-old.

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YouTube: https://www.youtube.com/watch?v=PI9_QBQGxFU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=20

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You see a  17-year-old  woman with a long-standing history  of eczema and allergic rhinitis. Today she presents with worsening symptoms of skin lesions with itch for the past 2 months, now affecting the antecubital fossa of both arms, stating, “I get like this every winter but I am much better during warm weather. “  She is otherwise healthy. The most important aspects of skin care for this scenario is:

A.Daily use of medium to higher potency topical corticosteroids.

B. Twice-daily application of an antifungal cream.

C. Use of a topical antibiotic until skin lesions are clear.

D. Maintaining skin lubrication.

E. The use of low to medium potency topical corticosteroids to treat layers. 

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A 72-year-old woman with severe COPD, who uses an inhaled LAMA/ LAMA daily on a set schedule and SABA via MDI as needed for symptom relief, presents with a 4-day history of URI symptoms, starting with sore throat and clear nasal discharge, without fever. She denies N, V, or other GI upset. She now reports a 2-day history of increasing shortness of breath and production of clear to white sputum. SaO2= 97% and she is no acute distress. In considering the diagnosis of COPD exacerbation, which of the following best describes the role of imaging in the evaluation of COPD exacerbation?

A. A chest x-ray should be ordered in COPD exacerbation in the patient with fever and/or low SaO2 to help rule out concomitant pneumonia.

B.  A chest x-ray should be ordered routinely in the evaluation of a person with COPD exacerbation.

C. Given the frequency of COPD exacerbations that typically occur in a person with COPD, chest x-ray use should be limited due to radiation exposure risk.

D. A thoracic ultrasound is the preferred imaging study to order in a COPD exacerbation.

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The NP is seeing a 65-year-old woman who is a former smoker, having quit at age 40, with a 20 pack-year cigarette smoking history, and has been diagnosed with community-acquired pneumonia (CAP). Which of the following is most often noted CAP finding in an adult who is deemed to be appropriate for outpatient treatment? 

A. Pleuritic chest pain

B. Dyspnea

C. Purulent sputum production

D. Cough

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A 27-year-old, otherwise well, woman complains of recurrent headache that occurs every 1‒2 weeks and lasts up to 24 hours. During headache, she reports sudden onset of unilateral pulsating pain, nearly always on the left side that is accompanied by photophobia, phonophobia and mild nausea without vomiting. Her first headache occurred when she was approximately 12-years-old.  Her neurological exam is within normal limits. What is this clinical scenario most consistent with?

A. Cluster headache 
B. Tension-type headache 
C. Intracranial lesion 
D. Migraine without aura

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When advising a patient on the use of emergency contraception (EC) with levonorgestrel (LNG), which of the following is correct?

A. If pregnancy does occur post LNG EC use, a teratogenic pattern in the offspring has been noted

B. EC LNG must be used within 12 hours after unprotected heterosexual vaginal intercourse to provide EC benefit. 

C. LNG EC’s use is limited due to a number of common contraindications. 

D. LNG EC use does not result in the interruption of an established pregnancy.

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The NP is caring for a 68 year-old man with a 20 year-history of  type 2 DM, HTN, dyslipidaemia, obesity (BMI=32 kg/m2) stage 3a CKD who is currently taking all of the following medications at optimized doses and with adherence, ACEI, thiazide diuretic, statin, and metformin. His current A1c= 8.2%. (NL= <5-6%)  and states he is feeling well. Which of the following should be considered as next step therapy?

A. A sulfonylurea

B. Basal insulin

C. A SGLT2- inhibitor 

D. No additional therapy as he is feeling well.

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