A 30-year-old woman presents with nasal congestion, clear rhinorrhea, and itchy eyes during springtime. She has no fever or systemic illness. Which treatment is first-line for allergic rhinitis? 

A 62-year-old man with diabetes and CAD is prescribed sildenafil for ED. Which concurrent medication is an absolute contraindication? 

A 62-year-old man presents with acute monoarticular pain, swelling, and redness in the left knee that began overnight. He reports a history of recurrent gout and is on allopurinol 200 mg daily with good adherence. He also takes furosemide for heart failure. Joint aspiration reveals needle-shaped, negatively birefringent crystals. Serum uric acid today is 6.8 mg/dL (previously >10). Which is the most appropriate management of this acute flare? 

A 67-year-old man hospitalized with COPD exacerbation is treated with high-dose IV steroids. The NP plans to taper steroids after recovery. Why is tapering required? 

A 42-year-old woman with systemic lupus erythematosus presents for follow-up. She has been taking hydroxychloroquine for the past 6 months with partial symptom relief. Labs today show persistent proteinuria and elevated anti-dsDNA titers. The NP considers escalating therapy. Which pharmacologic agent is the most appropriate next step? 

A 70-year-old woman with postmenopausal osteoporosis is unable to tolerate oral alendronate due to severe esophagitis despite appropriate administration (upright posture, fasting intake). Her history includes stage 3 chronic kidney disease (eGFR 45 mL/min) and prior vertebral compression fracture. She continues calcium and vitamin D supplementation. Which pharmacologic alternative is most appropriate for secondary fracture prevention? 

A 55-year-old woman presents with severe hot flashes and night sweats that significantly impair sleep. She has a past medical history of unprovoked deep vein thrombosis (DVT) at age 50, hypertension controlled on lisinopril, and obesity (BMI 32). She underwent a total abdominal hysterectomy for fibroids 8 years ago. She asks about starting hormone replacement therapy (HRT) because her sister found relief with oral estrogen. Her labs show normal renal and liver function. Which is the most appropriate evidence-based management for this patient’s vasomotor symptoms? 

A 22-year-old with moderate acne is prescribed topical tretinoin. What is the most important counseling point? 

A 28-year-old woman with HIV is on antiretroviral therapy and has an undetectable viral load. Her male partner is HIV-negative. Which strategy provides the most effective reduction in HIV transmission risk? 

A 40-year-old man asks for “antibiotics” for his cold symptoms, which include nasal congestion, sore throat, and rhinorrhea for 3 days. Exam: afebrile, lungs clear. What is the best management?