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MR is a 24-year-old female being seen in clinic for a follow-up appointment related to migraines.  She has a history of headaches and migraines without aura for 6 years.  She complains that her symptoms worsened after graduating college and starting her first “real” job where her stress level has been significantly higher.  Approximately three months ago, her provider prescribed topiramate 25mg by mouth daily, with a schedule to titrate weekly until a goal dose of 100mg twice daily. She feels she tolerated this new medication quite well, but is now having a significant amount of spotting during the month, even a day or two of bleeding during the middle of her cycle and she doesn’t feel like having sex with her husband.  Today’s vital signs are: BP 122/72 HR 70 O2 94% RR 18.  She is 5’ 6” tall and weighs 228#.  Her current medications include topiramate 100mg twice daily, vitamin D 2,000 IU once daily, Aviane (ethinyl estradiol 20mcg/levonorgestrel 0.1mg) once daily, and sumatriptan 50mg at onset of migraine, may repeat x1 in 24-hour period.  What is your assessment of her current situation?

TT, a 25-year-old comes to clinic today for her annual well woman exam.  She has a history of migraine headaches x6 years and would like to discuss contraception today.  She reports that her migraines have been much better in the past year since she switched from topiramate to Aimovig.  She feels this is because she “hates taking pills and forgets to take them a lot – so much easier to do a shot once a month”.  She is married to her husband for 2 years and admits they are tired of using condoms.  She works full time as a high school science teacher and enjoys her job but looks forward to having kids in the next 3-5 years and staying home with them. Today’s vital signs are: BP 122/72 HR 70 O2 94% RR 18.  She is 5’ 4” tall and weighs 217#.  Which form of contraception would best meet TT’s needs today?

HG is a 43-year-old female who has a primary breast cancer, with brain metastases. She is receiving cisplatin and etoposide. While the nurse is giving the IV etoposide, the patient begins to complain of painful burning at the injection site. Which of the following is the antidote for extravasation with etoposide?

Which of the following medications contribute to electrolyte anomalies in TLS patients?

JF is a 47-year-old obese Asian male the clinic today because he is experiencing his 3rd gout flare over the past 12 months.  His physical exam is notable for bony growths (tophi) on his great toe and first metacarpal joints. His renal and hepatic function are within normal limits. PMH: obesity, uric acid kidney stones, HLA-B*5801 gene mutation Social history: does not smoke, drinks 6 beers every weekend No known drug allergies Current Medications             Ibuprofen 600 mg as needed for gout pain               Which of the following statements is correct?

All of the following are primary injury concerns when resistance training children EXCEPT:

Supervision is one of the top methods for minimizing injuries to children in the weightroom.

All of the following are rules to follow when resistance training children EXCEPT:

Sex hormone levels affect the rates at which we age.

Increases in which of the following during adolescence helps to help prevent osteoporosis later in life?