A 44-year-old male patient with the diagnosis of pre-diabetes is seeing you for a pre-op evaluation for an anal fissure repair.  According to the American Diabetes Pre-Operative Guidelines, patients who are taking metformin (an oral diabetes medication) should:

Orthostatic hypotension is the second most common cause of syncope and more commonly affects older adults. Orthostatic hypotension is commonly seen in outpatient clinics. During the HPI and ROS careful attention should be paid to symptoms that may reveal the underlying cause.  Which question is less important to ask a patient that you are concerned may have orthostatic hypotension?

Cholelithiasis (gallstones) are caused by hardened deposits of bile and increased cholesterol secretions. Some people are more prone to the development of cholelithiasis (gallstones) than other people.  Which of the following is NOT considered a common risk factor for cholelithiasis (gallstone) formation?

Hepatitis is an inflammation of the liver and can be caused by alcohol consumption, autoimmune disease, malnutrition, metabolic defects, medications, nonalcoholic fatty liver disease (NAFLD) and viruses. Six hepatitis viruses are responsible for causing acute hepatitis (A, B, C, D, E and G). Only three of the six cause chronic hepatitis (B, C and D). Which form of hepatitis is spread rapidly via the fecal-oral route?

There are numerous noninvasive ways to evaluate a patient with symptoms of cardiovascular disease.  Which of the following statements is a true statement?

Orthostatic hypotension is defined as a drop of at least 20 mmHg in systolic BP with a change in position from lying to standing. Which of the following is NOT considered a common symptom of orthostatic hypotension?

The development of hypertension is multifactorial. Your next patient is a 62 year old female who returns to clinic today to follow-up on her hypertension and diabetes.  You diagnosed her with hypertension 3 months ago. She has started a walking program 5 days/week for 30 minutes.  She has also made some changes to her diet, adding more vegetables and fruits and decreasing her carbohydrate intake. She quit smoking 3 months ago. Her BP today in clinic is 148/88 mmHg, HR 72 bpm, BMI is 32 kg/M2.  Her medications include metformin 500 mg BID, atorvastatin 20 mg daily, hydrochlorothiazide 12.5 mg daily. She takes her medications every day. Her latest A1C result is 6.6.  Her LDL was 88 and her BMP results were all within normal limits. Which of the following treatment option is the most appropriate for her?

You are seeing an 17-year-old female for a health maintenance exam. She is concerned about concentration and issues with anxiety.  She informs you that she was raped repeatedly at a college party during the previous semester. She attends the University of MN, Minneapolis campus as PSEO (post-secondary education option) as a senior in high school. She did not report this to anyone at that time the incident occurred.   She had been drinking alcohol that evening and was afraid to tell anyone. What action is the priority for this patient?

Cardiac disease is the number one cause of death in the United States. Patient and family education to prevent coronary disease is an important role of the primary care provider. It is also important that APRNs recognize the signs and symptoms of a myocardial infarction when the patient is presenting in the primary care setting, and to immediately call 911. Which of the following in NOT a common sign or symptom of a myocardial infarction?

Your next patient is a 62 year-old man with intermittent right upper quadrant abdominal pain. His past medical history includes hypertension and GERD. He is afebrile and hemodynamically stable. An abdominal exam reveals a positive Murphy’s sign, the rest of his PE is unremarkable.  What is the best next step to confirm a diagnosis?