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A 47 year old overweight female with type 2 diabetes presents to the office with right upper abdominal pain.   She has had it before but it went away.  This time it has been going on for about 4 hours.  She notes the pain is worse when she eats fried foods. She denies fever, diarrhea, constipation or change in bowel habits.  On exam, she has a positive Murhphy’s sign. Which test is considered most sensitive for confirming her diagnosis?

Debbie is a 35 year old female that presents to the clinic with weakness and numbness of the left arm which started about 2 weeks ago. When discussing her review of systems, she also notes that about 2 months ago she had an episode of diplopia which lasted about 24-36 hours about 4 months ago. She says something similar happened about a year ago and lasted for several weeks and is worried this could be a stroke. Based on this presentation, what is the most likely diagnosis and most likely treatment?   

A 36 year old African American male presents to the office for routine follow-up for hypertension. He reports changes to his diet and is taking his HCTZ 25 mg daily. His blood pressure is 155/87. What is your recommendation for him today?

A 73 year old male presents to the office for follow-up to his systolic CHF. You are explaining to his family that he has New York Heart Association stage III heart disease? What is the most accurate list of medications that he should be taken?

A 37 year old female presents to the office for evaluation. She reports feelings of hopelesness, depressed mood, decreased appetite and sleep. Her employer indicated that she needed to get help because she is not completing her tasks at work and has been calling in sick too much. She feels fatigued and has trouble concentrating. She reports that she has been feeling this way for the last 4 weeks. She did not seek help because 2 months ago she was feeling great. She went out gambling with her friends, participated in a group cocaine party and staying up all night. What is her likely diagnosis and treatment plan?

Which of the following is considered a clinical red flag for a patient who presents with back pain?

A 23 year old male presents to the office complaining of bloody stool. He reports that symptoms started about 1 week ago. He has crampy abdominal pain throughout the day. He denies fever, chills, nausea or vomiting. He reports that this is the 3rd time he has had these symptoms in the past 6 months. He denies constipation. He has not seen any relationship with his diarrhea to the food that he eats. He is sexually active with females only and has never had anal sex. On DRE you note occult blood and diffuse tenderness in the lower abdomen. You have completed baseline labs with CBC/CMP, ESR and CRP. You suspect that he has inflammatory bowel disease, what are your next steps in evaluation?

A 25 year old male presents to the office for malaise, sore throat and fever. He reports that his symptoms started about 3 days ago. On exam, you note submental and submandibular adenopathy and bilateral exudates on the tonsils with an erythematous posterior pharynx. His temperature is 101.4 and the remainder of his vitals are normal. He denies cough, congestion or oral sex. His mono test is negative.  What is the best treatment plan for him? 

A 28 year old male presents to the office for complaints of a rash on the palms of his hands and the soles of his feet. He reports it started about 1 week ago and he has used hydrocortisone on it without any resolution. He reports that he has felt tired and weak and has had a fever of 101.4 on and off for the past week. He denies headaches, chills, neck pain, nausea, vomiting or diarrhea. He denies smoking, etoh and drugs. He is sexually active with 2 other male partners in the past 1 month and 6 in the past year. He notes that he did have a lesion on his penis a 3-4 weeks ago which has resolved. On exam, you note some tender adenopathy in the inguinal nodes as well as bilateral supraclavicular nodes. He appears tired and in the office he has a temperature of 100.2. He has negative Brudinski and Kernig signs. What is his likely diagnosis and treatment plan?

  A 59 year old male presents to your office as a new patient. He indicates that he has a history of hypertension and high cholesterol. He reports that he was admitted to the hospital about a year ago for some crushing chest pain and shortness of breath “alot of stuff went on, but I don’t really remember it all”. He reports that he was in the ICU for a few days and had a stent placed. He will get you his old records for further review. He indicates that he takes a combination medication called Prinzide (lisinopril/HCTZ), atorvastatin and an aspirin. You check an EKG and it shows q waves and LVH. His vital signs are T: 98.6, HR 92, RR 16, BP 150/92. What other medication should he be started on before he leaves the office?