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A 65 year old female presents with a past medical history of hypertension and hyperlipidmeia presents to the office for complaints of knee pain for the past several months. She denies recent trauma or injury to the knee. She notes that it is painful to walk more than 1/2 mile and she is getting fatigued much sooner. She notes some swelling in the knee as well. On exam, you note that she has mild swelling over the medial joint with crepitus. There is no warmth or redness. She has good range of motion, but it is painful for her to internally rotate the knee. You advise her the best treatment for her right now is:

A 39 year old African American male presents to the office for routine physical. He was seen 2 months ago and his blood pressure was 152/86. Today his blood pressure is 155/82 and he has no other medical problems. What is the best treatment for him?

A 43 year old white male presents to the office for follow-up to hypertension. He has been taking HCTZ 25 mg for 3months. His blood pressure in the office today is 150/80 in the office. What do you recommend? 

A 64 year old male presents to the office for follow-up. He has a history of an diabetes, hypertension and heart failure.  He takes losartan, atorvastatin, carvedilol, nitroglycerin, glucophage and aspirin. He reports that he is having sexual dysfunction. You reply this is most likely due to:

A 62 year old female with a history of hypertension presents to the office for follow-up after feeling short of breath. Her CXR shows congestion without any evidence of pneumonia or COPD.  Her echocardiogram shows an EF of 45% and EKG shows LVH.  She reports that she is out of breath after walking up 1 flight of stairs. She has no allergies. What are the appropriate medications for this patient?

A 35 year old female presents to the office complaining of daily headaches lasting about 2-3 hours after work for the past 2 months. She describes bilateral pain which is not aggravated by activity. She denies nausea, vomiting or sensitivity to light. She works as a social worker for the county and has been working a lot of overtime. Her vital signs and exam are normal. She is taking tylenol and ibuprofen with minimal symptomatic relief. What is the most likely diagnosis and treatment?

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?