Mr. Joynt is a 67-year-old carpenter complaining of morning stiffness and mild pain in his fingers and right knee upon awakening. He feels some relief after warming up. On exam, the nurse notices the presence of Herberden’s nodes on distal fingers. Which of the following conditions is most likely?

A 38-year-old male with a diagnosis of systemic sclerosis presents with complaints of shortness of breath and dry cough. On physical examination, you note diminished breath sounds in both lower lung fields and crackles on auscultation. His pulmonary function tests show a restrictive pattern.Which of the following is the most common pulmonary complication of systemic sclerosis?

A 20-year-old female presents with a complaint of neck fullness and a lump that she noticed. She denies pain, but her mother had thyroid cancer in her 60s. On physical exam, you palpate a firm, non-tender nodule in the right lobe of the thyroid. The patient is otherwise healthy with no symptoms of hyperthyroidism or hypothyroidism. You order a TSH and it is elevated. Which of the following is the next additional step in evaluating this patient?

A 42-year-old woman with a known history of Addison’s disease presents to the clinic for a routine follow-up. She has been on hydrocortisone 20 mg in the morning and 10 mg in the afternoon, as well as fludrocortisone 0.1 mg daily. She reports feeling generally well, but lately, she has noticed increased fatigue, weakness, and dizziness, especially when standing up. She is also experiencing nausea and a loss of appetite. On examination, her blood pressure is 90/60 mmHg, and she has mild dehydration.What is the most appropriate adjustment in her treatment?

Match the patient presentation to the appropriate diagnosis.

Match the patient presentation to the corresponding diagnosis.

A patient has chronic elbow pain associated with osteoarthritis.  What is included in management of this condition? (select all that apply)

A 62-year-old male with a history of type 2 diabetes and intravenous drug use presents to your primary care clinic with a gradual onset of severe low back pain over the past three weeks. He describes the pain as constant, worse at night, and not relieved by rest or position changes. He denies trauma but reports low-grade fevers, night sweats, and recent unintentional weight loss.On physical exam, he has localized tenderness over the lumbar spine, mild paraspinal muscle spasm, and limited range of motion due to pain. He denies bowel or bladder dysfunction but appears fatigued and uncomfortable. His temperature is 38.3°C (100.9°F), and his heart rate is 102 bpm.Which of the following is the most appropriate initial step in diagnosing this patient’s condition? (select all that apply)

A 58-year-old male presents with sudden, severe pain in his right big toe. The pain started overnight and has worsened throughout the day. The affected joint is red, swollen, and warm to the touch. He has a history of hypertension, stage 3 CKD, and hyperlipidemia, and is currently taking a diuretic (hydrochlorothiazide) and atorvastatin. His uric acid level is significantly elevated. Which of the following are appropriate patient education points for this patient regarding gout management and prevention? (Select 2 that apply)

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