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You are seeing Mr. Green, a 67 year old male, for the first time. He has had Type 2 diabetes for the past 16 years.  Although he has been on insulin for 2 years, he does not maintain optimal control, as his A1C remains 8-9 most of the time.  You see on his chart was prescribed an ACE inhibitor 2 year ago, after being found to have microalbuminuria.  This was likely done as Mr. G is at risk for:

*Lilly Scott, a 68 year-old patient of yours, has peripheral arterial insufficiency.  She complains of leg pain during rest.  You educate her to do the following to help with that pain:

Mr. Hadley has cognitive impairment.  He had a PET scan as part of his workup that showed amyloid deposits in his brain.  This leads you to believe his diagnosis is:

**  When evaluating your patient’s understanding of finasteride (5 alpha reductase inhibitor), which of the following statements about this medication needs further education?

You are seeing a 24 y/o female who comes in the clinic with complaint of abdominal pain. Which of the following added information would cause you to suspect an emergent condition?

Larry Baxter, 59 y/o patient presents to the clinic with general complaints of fever, chills, low back pain, accompanied with urinary frequency, urgency and dysuria.  Last night he had to get up several times to urinate.  Overall he just doesn’t feel well.  When performing a prostate examination, you note a tender, warm prostate. What do you suspect?

Morris is in a new relationship and is not sure whether his erectile dysfunction is caused by stress or is organic. What is the least invasive test could you suggest to determine if he has the ability to have an erection?

You want to slow the progression of a CKD in one of your patients, according to the NIDDK, which of the following are recommended?

*When is antiretroviral medication therapy to be started on all patients diagnosed with HIV?

When listening to heart sounds, the nurse practitioner knows if they are hearing a harsh systolic murmur usually crescendo-decrescendo pattern. Heard best: Second right intercostal space (RICS) near apex. Radiation: To carotids.  Which valve is likely causing the murmur?