42. The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane’s description of her injury. Which of the following clues in Diane’s examination or history would alert the clinician to the need for obtaining radiographs?

A 50-year-old man presents to the clinic for a preoperative surgical evaluation. He is required to hold anticoagulation prior to surgery and was asked to hold his apixaban (Eliquis) for 2–3 days before surgery. What is the pharmacokinetic parameter that best explains the need for holding apixaban (Eliquis) for 2–3 days?

A 78-year-old man presents to the clinic for a routine follow-up. He has a history of type 2 diabetes mellitus, hypertension, and depression. His medication list includes amitriptyline (Elavil) 50 mg daily, chlorthalidone (Hygroton) 25 mg daily, glipizide (Glucotrol) 2.5 mg daily, and metformin (Glucophage) 500 mg BID. Which medication should you consider removing according to the Beers criteria?

Undiagnosed diabetes may present as:

93.  Pharmacologic intervention for patients with depression should:

27. Which illness should definitely be treated with an antibiotic in any age individual? 

A 41-year-old woman presents with acute-onset right-sided facial weakness. She reports weakness to the right side of her face that started this morning upon awakening. She has a history of Lyme Disease. Her vital signs are normal. On physical examination, she has a right-sided facial droop when asked to smile, and she is unable to raise the right eyebrow or completely close her right eye. Her pupils are equal, round, and reactive to light, and there is no gaze palsy present. Sensation is intact to both sides of her face, and her tongue is midline. Examination of her arms and legs reveals no focal weakness or sensory deficit, and shoulder shrug and head turn are equal bilaterally. Based on the history and physical examination, which of the following is the most likely diagnosis?

You are auscultating the heart of a 75-year-old woman and hear a murmur at the 2nd intercostal space on the right sternal border. Which heart valve is most likely affected?

83. The mother of a 3-year-old tells the NP that she suspects her child has ADHD because he often ignores her and has difficulty following directions “just like his father.” Which test is FIRST priority?

The chest x-ray of an older adult shows an area of consolidation in the right lower lobe. Which condition is most likely?