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During a new office visit your 70 year-old patient complains of being easily short of breath and is often tired.  He has been a smoker for 50 years.  On exam you hear decreased breath sounds bilaterally , hyperresonance and hypertrophied accessory muscles.  His hematocrit it elevated and his pulmonary function test shows increased total lung capacity with FEV1 of 60%.  His mMRC is 3. How would you treat him?

 A 42 year old female comes to your office complaining of bilateral wrist and PIP pain for the past several months but more in the last 3 weeks. She reports that it takes her over an hour in the morning for her hands and wrists to begin feeling better. She reports weight loss of 5 lbs over the last 2 months and feeling flu like. She has had low grade fevers on and off but hasn’t thought about it too much. She denies recent cough, congestion, runny nose or watery eyes. Given her history, all of the following would be appropriate test(s), except:

During the examination of a patient with a complaint of  frothy yellow green vaginal discharge, you observe flagella on wet mount and a vaginal PH of  6.0.  What should the NP include in the treatment plan?

A 23 year old male presents to the office for acne treatment. He indicates that he has had acne all of his life and has used benzoyl peroxide in the past but has not tried anything else. On exam, he has open and closed comedones, papules and postules. What would you recommend for him? 

A 32 year old female presents to the office for vision loss in one eye for one day but has resolved. She also notes facial weakness, numbness and dysarthia that followed. As you review her chart, you note that she was seen 2 months ago for numbness and tingling in the left side of her body which has since resolved. You are concerned about multiple sclerosis (MS). What testing would be suggestive of MS?

A 72 year old patient with diabetes, hypertension and high cholesterol presents to the office for a follow-up to his osteoarthritis knee pain. He started taking tylenol for the pain but reports that this has not been helpful. His current medications are insulin, losartan, asprin and simvastatin. His creatinine is 2.4 and A1c is 6.3%. His vital signs are all normal. All of the following would be acceptable treatment options except which?

All of the following are acceptable treatments for depression except:

The USPTF recommends which group of patient’s receive a low dose CT of the chest for lung cancer screening?

A 32 year old female presents to the office for complaints of dysuria, incomplete bladder emptying and blood in urine. On exam you note a fever of 101.4 and CVA tenderness. The remainder of her vitals and exam are stable. She is allergic to sulfa. Her urine is positive for blood, +leukocytes and +nitrates. How would you treat her?

A 26 year old male presents to the office for complaints of knee pain. He indicates that he has been running 4-5 miles daily for the past several months. He denies trauma/injury to the knee. He just noticed that it is achy and mildly swollen. On exam, you note tenderness over the patellar. The lachman, mcmurray, valgus/varus testing are all within normal limits. He has a negative anterior and posterior drawer sign. There is mild swelling around the patellar but no warmth or erythema. What is your recommendation for him?