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Which of the following arteries accounts for approximately 50% of occlusive coronary lesions?

True or false: taking antibiotics causes bacteria to mutate to become antibiotic resistant.

Which of the following represents “survival of the fittest” in the context of evolution?  (Not everyday language)  Choose all that apply.

Select the correct answer: The primary care nurse practitioner is evaluating a 28-year-old adult who presented for follow-up evaluation for headaches. The patient reports a history of migraine since adolescence and would like to attempt pregnancy in the near future.  The patient consistently experiences visual changes and nausea within the hour preceding each headache.  The patient has maintained a headache diary which shows headaches coinciding with menses and additionally occurring on 4 other days during the course of the month. The patient has been previously treated with internasal sumatriptan (Imitrex) which has not been completely effective in relieving symptoms. Appropriate preventative migraine management for this patient may include daily prescription of which of these medications?

The diagram below represents what type of selection? Disruptive Selection.png

Select the correct answer: A young adult with a 2-year-history of type 1 diabetes managed with insulin pump therapy presents for a wellness exam.  During the course of the exam, the patient reports symptoms of abdominal discomfort that is associated with bloating for the past 6-12  months. The symptoms are accompanied by  increased flatulence.  Stools have an oily appearance. The patient has not noted bloody stools. The patient also reports blister-like skin lesions that are itchy on the hands, arms, and abdomen. The patient experienced an unintentional weight loss of 10 pounds over the past 2 months and feels constantly fatigued.  Physical exam reveals a thin, frail-looking adult. Abdominal distention is noted on exam and slightly hyperactive bowel sounds. The abdomen has generalized tenderness. Herpatic-like lesions are noted on her hands, arms and abdomen. Lab findings show a evidence of a hypochromic, microcytic anemia.  While addressing dietary considerations associated with diabetes, what other clinical recommendations should be provided to this patient?

Heterozygous advantage allows the harmful sickle cell allele to remain in the human population instead of being selected against. (That allele causes sickle cell disease.)  Which of the following genotypes represents an individual that will not have sickle cell disease and also will will have a better chance of surviving if exposed to Malaria? H = the dominant sickle cell allele (not mutated) h = the recessive sickle cell allele (mutant allele that can cause sickle cell disease)

Select the correct answer: A middle-aged adult presents to a primary care nurse practitioner with an acute onset of several episodes of vertigo and tinnitus, associated with new-onset of hearing loss in the right ear. The initial episode lasted 2 hours and a subsequent episode recurred one week later. The patient’s physical exam in the office is unremarkable. Which of the following diagnostics should be incorporated into the work-up of this patient? 

Select the correct answer: During an annual wellness exam, a 68-year-old adult informs a primary care nurse practitioner of a recent onset of headaches which began several months prior to the visit. The patient states the headaches are increasing in frequency and severity. The patient has experienced episodes of balance disturbances during this time resulting several near falls. The patient has a prior history of migraine headache as a young adult, but reports no migraine days since completing menopause at 52-years-of-age.   Which of the following should be integrated into the management plan for this patient? 

Select the correct answer:    A 64-year-old adult with a 2-month history of hypertension presents for a follow-up visit. The patient has a 5-year history of type 2 diabetes. The patient-provided home blood pressure log show systolic values of 116-128 mmHg and diastolic values of 68-78 mm/Hg. The patient confirms taking medications as prescribed but has noted a persistent cough since starting medications to treat hypertension. Past medical history is positive for 5-year history of type 2 diabetes.    The patient reports no allergies to medications.  Current prescribed medications are:  Hydrochlorothiazide (Diuril) 12.5mg po daily Quinapril (Accupril) 10 mg po daily Metformin (Glucophage) 1000mg daily Dulaglutide (Trulicity) 0.75 mg subcutaneously weekly Labs: drawn 1  week age: chemistry pane within normal limits; A1C 6.3%   Vitals: B/P 142/88, pulse 68 beats/min; respiration 14; weight 143 lb; height 60 inches; BMI 27.9 kg/m2.  Physical exam is within normal limits.   Which of the following interventions is priority for this patient?