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A patient presents to the clinic with abdominal pain, nausea, urinary frequency, urinary urgency, and generalized malaise. On physical exam you note positive costovertebral angle tenderness. After urinalysis you note RBCs and small calcium oxalate crystals on microscopy. What is your top differential diagnosis? 

A 7 year old boy is brought into the clinic due to acute new onset of limping. The onset was insidious without injury to the affected let. There is pain and limitation of motion to the right hip. The patient is afebrile and generally well appearing besides this limp. Labs are unremarkable for any abnormality. This may be indicative of which of the following condition?

How are you going to treat and educate this patient based on your differential? 

When evaluating a female of child bearing age with abdominal pain what is the simplest diagnostic test to assess for red flag/ do not miss diagnosis? 

For this patient, what is (are) your most important diagnostic test(s)? 

Based on the PHQ9 results below, what is your initial treatment plan?

An adult patient presents with an acute injury to the left 4th toe after stubbing the toe. On physical exam there is localized swelling, ecchymosis and tenderness to palpation to the left 4th toe. Patient’s vascular and neurological exam of the foot/lower extremity is within normal limits. X Ray of the left 4th toe reveals a non-displaced fracture. What will be a component of your treatment plan?

A patient presents to your office with complaints of depression that has been ongoing for several months. They mention little interest in their normal activities, fatigue, depressed mood, and feeling immense guilt. The patient’s significant other also states “they have had moments where they are full of energy, can’t relax, up all night long cleaning and reorganizing, talking to family members on the phone non-stop, and having distractibility for a couple of days”. Select all of the symptoms that apply for diagnosis of bipolar II

A 36-year-old female was working on her deck 2 hours ago when her thumb got caught between two planks of wood. She is reporting severe persistent pain in the left thumb nail and states it seems to be getting worse. On exam the patient’s thumb nail has black/purplish discoloration underneath the intact nail. She maintains normal AROM, and is neurovascularly intact. There is a XR negative for fracture. Based on her exam, what is your diagnosis and what would you recommend? 

A 28 year old patient presents to the clinic with acute pain to their lateral ankle following a misstep while hiking on uneven terrain causing internal rotation of the ankle. She reports immediate onset of pain, swelling, and difficulty bearing weight on the affected ankle. On physical exam she has bone tenderness over the lateral malleolus on the right ankle.  She is able to take 4-5 steps in the exam room today on the affected ankle. According to the Ottawa Ankle Rules, what is the next best action for this patient?