A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one-day history of fever, projective cough with yellow sputum and increasing shortness of breath. He denies GI distress but states his appetite is not what it usually is. He has a history of hypertension, type 2 diabetes, and dyslipidemia at guideline-based goals. He is a former smoker, quitting about 10 years ago with approximately a 35-pack-year history and was diagnosed 5 years ago with COPD.  Clinical assessment confirms the diagnosis of community-acquired pneumonia, suitable for outpatient treatment.  Which of the following represents the most appropriate antimicrobial option?

A. Oral levofloxacin

B. Injectable ceftriaxone

C. Oral azithromycin

D. Oral amoxicillin
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A 9-year-old female presents for well child care with her parent. She is in the 4th grade, doing well academically, plays soccer on a local team, and reports, “I have 3 best friends”. Health history per parent and child reveals no concerns. On physical exam the clinician's notes the child is at about 40th percentile height and weight for age, and has breast budding and downy, straight, slightly pigmented pubic hair long the labia majora.

These physical findings are consistent with:

A. Precocious puberty

B. Early onset normative puberty

C. Age-appropriate pubertal findings

D. Concern for a GNrH producing lesion
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A 40-year-old computer programmer presents for a sick visit with the chief complaint of a two-day history of low back pain. He reports the pain started after many hour stretch of doing yard work. The pain is described as a dull constant ache, worse with activity, better with rest, across the lower back, without radiation to the legs. He denies leg weakness, tingling, or numbness, and states he had similar pain in the past after doing extensive lifting. In considering the diagnosis of lumbar sacral strain, which of the following would most likely be noted on clinical assessment in this patient?

A. Diminished to absent lower extremity DTRs

B. Patient report of new-onset difficulty with voiding.

C. Paraspinal muscle tenderness

D. Positive straight leg raise test
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A 22-year-old woman who is 20-weeks pregnant was treated for C. trachomatis 4 weeks ago with an appropriate antimicrobial. She presents today for a follow-up visit and reports she is currently without symptoms, that her partner was also treated,  “And we both took the medicine just as we were advised.” Which of the following represents next steps in this patient’s care?

Choose two that apply. 

A. Testing for C. trachomatis should be obtained at today’s visit.

B. A repeat of C. trachomatis testing should be conducted at 1 month postpartum.

C. Given she is without symptoms and her partner was also treated, no further C. trachomatis testing is advised. 

D. In the absence of new clinical findings, follow-up test is advised at around 28-32 weeks gestation. 

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A 55-year-old man with a BMI of 40%, with the chief complaint of low back pain for the past two weeks. He describes the pain as originating in the lumbar sacral region, with radiation across the left buttock associated with numbness and tingling sensation in his left leg. The pain is worse with sitting and somewhat better with standing. He denies lower extremity weakness or a change in bowel or bladder function. He states, “I've tried ice, heat and ibuprofen and these just take the edge off. I've had back pain like this in the past. Usually just lasts a couple of days and it's not that bad. I'm going to try that again and it's not this bad.” This history of present illness is most consistent with:

A. Lumbar Radiculopathy

B. Spinal Stenosis

C. Vertebral Fracture

D. Lumbar Sacral Strain
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A 45-year-old adult presents for a sick visit, with the chief complaint of three-day history of low back pain. Clinical assessment is consistent with lumbar sacral strain. Which of the following represents the most appropriate next step in this person's care?

A. Advised three days of bed rest on a firm surface.

B. Apply ice or heat to the affected area based on clinical response.

C. Refer to neurology for further advice.

D. Order a lumbar sacral x ray to help confirm the diagnosis.
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You see a 44-year-old woman with a 6-month history of increasing fatigue despite adequate opportunity for sleep and rest.  Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW as well as TSH within normal limits. You expect to find which of the following upon review of the patient’s health history?

A. Report that she has been consuming a plant-based diet since age 18

B. Report of menorrhagia

C. A history of alcohol use disorder

D. A diagnosis of rheumatoid arthritis
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A 48-year-old woman presents for follow up on T2DM and HTN. As part of today’s visit, routine labs are ordered. Which of the following is an appropriate form of electronic communication for sharing these  results  with the patient?

A. Private message through Facebook® or similar social media website with patient permission

B. Electronic fax or scan uploaded to the patient’s personal account for a third-party file sharing service (e.g., DropBox®)

C. Using encrypted email  or other messaging service that is part of the patient’s electronic medical record (EMR) system 

D. Text message using the patient’s personal mobile phone number
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A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one day history of fever, productive cough with yellow sputum and increasing shortness of breath. His vital signs are as follows, temp 99.8 °F (37.6 °C) , BP 140/85, heart rate 98 beats per minute, and respiratory rate 22 at rest period O2 saturation is 94% on room air. He has a history hypertension and type 2 diabetes, at guideline-based goals. He is a former smoker, quitting about 35 years ago with approximately a 25-pack year history. On physical exam, he has crackles in his right lower lung fields, no wheezing, and can speak in complete sentences. He answers questions appropriately, has moist mucous membranes, and reports voiding approximately 1 hour ago. He denies GI distress but states his appetite’s not what it usually is. He lives in a single-story home with his spouse and adult child, both of whom are with him for today's visit. His laboratory results include a mild leukocytosis and renal function is within normal limits. There is no evidence of anemia, and chest X-ray confirms a right lower lobe infiltrate consisted with pneumonia. Which of the following is the most appropriate treatment location for this patient? 

A. Intensive care unit

B. At home with careful follow up

C. Inpatient medical ward

D. Long-term care facility
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A 49-year-old woman with type 2 diabetes mellitus was started on a standard dose of an ARB daily 6 weeks ago for the management of hypertension. Today her blood pressure is 128/78 mm Hg, stating she is taking the medication without difficulty and is feeling well. The appropriate action at this time would be to:

A. Order a white blood cell count to assess for neutropenia.

B. Continue her current medication regimen. 

C. Add HCTZ to enhance HTN control.

D. Obtain a 12-lead ECG
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