Author: Anonymous

A patient is unable to wrinkle the forehead, tightly close the eye, or smile on the left side. Facial sensation is intact.Which cranial nerve is primarily affected?

A 72-year-old woman presents to your primary care office with a 4-week history of progressively worsening bilateral shoulder and hip pain. She reports morning stiffness lasting nearly 90 minutes and says she now requires assistance getting out of bed and lifting her arms to comb her hair. She denies recent trauma, fever, or joint swelling. Physical examination demonstrates limited active range of motion due to pain but no muscle weakness. Laboratory studies reveal an ESR of 88 mm/hr and an elevated CRP.Which diagnosis is most likely?

A 58-year-old woman presents with a 1-year history of urinary urgency accompanied by involuntary urine leakage before she is able to reach the bathroom. She reports urinary frequency every 2 hours during the day and awakens three to four times each night to void. She occasionally loses urine when she hears running water or inserts the key into her front door after returning home. She denies dysuria, fever, hematuria, or recurrent urinary tract infections. Physical examination is unremarkable. Urinalysis is normal, and her post-void residual volume is 30 mL.Which of the following is the most likely diagnosis?

A 46-year-old carpenter presents with progressively worsening pain over the lateral aspect of his dominant elbow for the past 3 months. He denies trauma but reports spending most of his workday using screwdrivers, hammers, and power drills. The pain worsens when lifting objects with his palm facing downward and when shaking hands. On examination, there is point tenderness over the lateral epicondyle. Pain is reproduced with resisted wrist extension, while elbow range of motion is full without swelling or erythema. Sensation is intact throughout the upper extremity.What is the most appropriate initial management for this patient?

A family nurse practitioner evaluates two patients during the same morning clinic session.Patient 1: A 70-year-old man reports gradually worsening bilateral knee pain over the past 6 years that is aggravated by gardening and climbing stairs. Morning stiffness lasts approximately 15 minutes and improves with movement. Physical examination reveals crepitus, bony enlargement of the DIP joints, and decreased range of motion without warmth or synovitis. ESR and CRP are within normal limits.Patient 2: A 46-year-old woman presents with progressively worsening bilateral hand pain, fatigue, and morning stiffness lasting nearly 2 hours. Examination demonstrates symmetric swelling and tenderness of the MCP and PIP joints with decreased grip strength. Laboratory studies reveal an elevated ESR, elevated CRP, and a positive anti-cyclic citrullinated peptide (anti-CCP) antibody.Which of the following is the best evidence-based management plan for these two patients?

A 34-year-old otherwise healthy woman presents to your primary care office with a 2-day history of dysuria, urinary urgency, and urinary frequency that has progressed to fever, chills, nausea, and left-sided flank pain. She reports mild nausea but has been able to tolerate oral fluids and medications. She denies vomiting, pregnancy, diabetes, or a history of recurrent urinary tract infections.Vital signs are as follows:Temperature: 100.8°F (38.2°C)Blood pressure: 118/72 mmHgHeart rate: 92 bpmRespiratory rate: 16 breaths/minOxygen saturation: 99% on room airPhysical examination demonstrates left costovertebral angle tenderness. Urinalysis reveals positive nitrites, positive leukocyte esterase, pyuria, bacteriuria, and WBC casts. A urine culture is obtained before initiating treatment. Based on the patient’s presentation, which of the following is the most appropriate next step for treatment plan?

A 46-year-old man experiences his first generalized tonic-clonic seizure. He returns to baseline within 30 minutes, and the neurologic examination is normal.Which diagnostic studies are most appropriate?

An 83-year-old nursing home resident develops sudden confusion over the past 24 hours. Staff report fluctuating alertness and poor attention. She was functioning at baseline two days earlier but now has fever, dysuria, and urinary frequency.Which diagnosis is most likely?

A 40-year-old patient presents with spontaneous epistaxis and widespread petechiae. Platelet count is 17,000/mm³.Which patient education should the nurse practitioner provide while awaiting hematology consultation?

A 52-year-old woman presents with progressively worsening fatigue over the past six months. She reports becoming short of breath when climbing one flight of stairs and has noticed brittle fingernails and increasing difficulty completing her daily walks. She has a history of heavy menstrual bleeding but has not seen a gynecologist in several years.Physical examination reveals conjunctival pallor. Cardiac examination demonstrates a soft systolic flow murmur. No lymphadenopathy or splenomegaly is noted.Laboratory results are:Hemoglobin 8.8 g/dLHematocrit 28%MCV 71 fLMCH 22 pgRDW 19%Platelets 415,000/mm³Which additional laboratory study would best confirm the suspected diagnosis?