Episodes
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A 72-year-old woman with a 20-year history of hypertension and dyslipidemia-- both at EBP goals with appropriate drug therapy, as well as a remote history of peptic ulcer disease-- presents for follow up. She is a nonsmoker, drinks about 1- 2 glasses of wine per week and denies the use of other substances. Her daily routine includes a 2- 3 mile walk and she denies history of acute coronary syndrome or other ASCVD related conditions. She mentions that one of her friends takes an aspirin a day to “prevent a heart attack or a stroke”, and further states, “I live alone, and I need to maintain my independence.” According to the latest recommendations from US Preventative Services Task Force, which of the following is the most appropriate advice regarding low dose aspirin use in this patient?
A. Start low dose aspirin therapy 81 mg daily as the vascular benefits outweigh the risk.
B. Best evidence for primary prevention of ASCBT event is with higher dose aspirin at 325 mg a day.
C. The risks associated with aspirin therapy in this patient outweigh the potential benefits.
D. Start aspirin therapy only if the patient has a family history of heart disease and 1st degree relatives.
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A 57-year-old man presents for a routine physical exam during history taking. He reports that he drinks approximately 7-to-8 12-ounce beers nightly and denies other substance use, including tobacco. His physical examination is unremarkable except for mild pharyngeal erythema without exudate. In consideration of his health history, which of the following lab results would be anticipated?
A. Elevated platelets
B. Macrocytosis
C. Lymphocytosis
D. Elevated sed rate
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Missing episodes?
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Which of the following are the most common features of skin changes noted in areas of the feet affected by tinea pedis?
A. Widely distributed with consistently raised with areas of hyperpigmentation.
B. Localized to the dorsal aspect with central clearing and a raised border
C. Involving plantar crusting and interdigital fissures
D. Remains stable in size over time with lateral lichenification.
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Mrs. Martinez is a 64-year-old woman with 10 year-history of type 2 diabetes mellitus, HTN, and dyslipidemia. Her current medications include metformin, an SGLT-2 inhibitor, statin, ARB and thiazide diuretic. She is at EBP-advised goals including recent A1c=6.9%. Today, she reports she is feeling well. Her history and physical examination are unremarkable. She mentions that, for the past year, in addition to her prescribed medications, she drinks a special tea blend that her sister makes, taking this each day to help “draw out the sugar” in her blood. She states, “I feel much better when I take it.” Your most appropriate response is:
A. “I don’t believe the tea is helpful in controlling your blood sugar.”
B. "Please stop using the tea until I can look into its contents."
C. "Homemade teas might interact with your medicines”
D. “Tell me more about how the tea draws out the sugar.”
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A 76-year-old woman with presbycusis presents for a follow-up visit on HTN and dyslipidemia, treated with an ARB, thiazide diuretic and a statin, and at treatment goal. Which of the following is she likely to report?
A. Occasional difficulty with speech discrimination
B. Need to use her prescription eyeglasses to read
C. Altered sense of smell
D. Diminished sense of touch
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A 24-year-old adult, assigned female at birth, presents to your practice chief complaint of bilateral lower abdominal pain for the past three days, worsening over this time frame. She describes the pain as a heavy pressure like feeling, accompanied by intermittent fever , mild dysuria, yellow vaginal discharge, as well as nausea without vomiting nausea without vomiting. She is tolerating fluids well and has a markedly decreased appetite. Additional history of present illness includes recent LMP, ending about three days ago with normal timing and normal flow, she is sexually active with two male partners, and describes that the last episode of coitus six days ago was painful for deep pelvic discomfort. The physical exam reveals a temp of 100.4 Fahrenheit, rest of vital signs within normal limits, mild lower abdominal discomfort to light and deep palpation without rebound, yellow vaginal discharge and cervical motion tenderness without palpable pelvic mass. This clinical presentation is most consistent with:
A. Acute Appendicitis
B. Pelvic Inflammatory Disease
C. Ovarian Cyst
D. Ectopic Pregnancy
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A 14 yo presents with a 4 h history of sudden onset LLQ abdominal and scrotal pain, described as a pulling, burning sensation. He denies vomiting, diarrhea or constipation, and reports mild nausea and is taking fluids without difficulty. HPI is negative for recent trauma to the region, dysuria, penile discharge, genital lesions or fever. He reports milder, similar episodes during the past 3 months, “that just went away.” Physical exam reveals loss of the cremasteric reflex, negative Blumberg sign and a high riding left testicle.
A. Testicular Neoplasia
B. Acute Epididymitis
C. Incarcerated Inguinal Hernia
D. Testicular Torsion
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A 24-year-old woman presents to your practice with a diagnosis of pelvic inflammatory disease, suitable for outpatient treatment. Which of the following is recommended? Chose two that apply.
A. A single dose of IM ceftriaxone
B. A two-week course of oral doxycycline and oral metronidazole
C. A five-day course of oral azithromycin with a one-week course of oral ciprofloxacin
D. A single dose of IM penicillin
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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, 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.Visit fhea.com to learn more!
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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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Esteban is an 18-month-old child who presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations and has no drug allergies, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6 °F (39.2 °C), with father stating, “This is how he acted a few months ago when he had an ear infection.” Physical exam confirms the diagnosis of bilateral AOM. When prescribing an antimicrobial for this child, which of the following represents the first-line treatment option?
A. Oral azithromycin
B. Oral cefpodoxime
C. IM ceftriaxone
D. Oral amoxicillin
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An 18-month-old toddler, Estaban, presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6°F (39.2°C), with the father stating, “This is how he acted a few months ago when he had an ear infection.” Which of the two following findings are most suggestive in the diagnosis of acute otitis media in a toddler?
A. Bulging tympanic membrane
B. Cough
C. Evidence of ear discomfort
D. Bilateral cervical lymphadenopathy
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