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A 76-year-old woman with hand and knee osteoarthritis presents to the clinic with increased pain of the affected joints for the past month. She has been applying topical capsaicin cream 0.025% TID PRN for over 2 months with minimal relief. Which of the following is the most appropriate step up in therapy?

Sheila, age 78, presents to your primary care clinic with symptoms of waking up during the night while coughing, an S3 heart sound, pulmonary crackles (rales) that do not clear with coughing, and peripheral edema. The diagnostic work-up for her would include all of the following except:

Mr. Smith, age 70 is being seen for evaluation of symptoms of BPH. In evaluating Mr. Smith’s history and physical the NP understands that:

A 16-year-old male presents to the clinic with whitish-yellow penile discharge and some anal itching and pain with defecation. What is the NP’s best course of action?

Most of the body’s iron is obtained from:

Mr. Henry, a 61-year-old with a history of MI (at age 50) and hypertension is being seen for fatigue and decreased exercise tolerance. He complains of mild SOB and pain in his legs when walking even short distances.  Blood Pressures:  Right arm:   138/88                     Left arm: 142/86 Ankle: 90 systolic Based on the calculated ABI, the NP’s recommendation is:

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Your 52-year-old female patient is being seen for a follow-up on hypothyroidism and weight management. She was prescribed levothyroxine (Synthroid) 75mcg daily one year ago. Her last TSH result 3 months ago was 4.8. Today the patient’s TSH is 8.8 mU/L. What is the NP’s conclusion?

The most common clinical manifestation of systemic anaphylaxis is:

A.R., age 59, is a postmenopausal woman, who presents to your office complaining of vaginal dryness. She has been sexually active with a new partner and says penetration is very painful. She has tried OTC lubricants but has not found one that works. PMH: controlled hypertension. After examination and wet prep, you diagnose her with atrophic vaginitis. Which of the following is true about best practice treatment options?