A 55 year old male with history of hypertension and hyperlipidemia presents to the office for shortness of breath and difficulty climbing a flight of stairs. On exam you note lower extremity b/l edema, crackles in the lungs and a PMI shift. An echo confirms heart failure with an EF of 45% and GFR of 43. Currently, this patient takes HCTZ and verapamil. What changes would you make to his medications?

A 65 year old male presents to the office complaining of shortness of breath for the past 3 months which has been getting worse. He indicates that he has no past medical history and takes no medications. He smokes 1 ppd for the past 43 years, but denies alcohol or drugs. On exam, you note distant breath sounds with very mild expiratory wheezing. His vital signs are all normal and you suspect COPD. What is/are the appropriate test(s) you would check if you wanted to diagnose COPD?

As part of the monitoring for a patient being treated for Rheumatoid Arthritis with methotrexate, which of the following should be considered?

You diagnose PUD caused by H.Pylori.  First line treatment for this patient is which of the following?

A 27 year old male presents to the office for follow-up to a rash. He has no significant past medical history except for Acne for which he is taking clindamyacin as he was allergic to tetracycline. His labs show a positive IgM for Borrelia with a positive Western Blot. Which of the following medications would be the best treatment?

A 56 year old white male presents to your office for new onset hypertension. His blood pressure is 160/92. He has no other medical problems, what is the best choice for him?

A 42 year old male with asthma also needs anthypertensive therapy. Which of the following should you avoid prescribing for him?

A 22 year old female presents to the office for vaginal discharge. She is sexually active and has had 4 partners in the last 3 months and 6 partners in the last year. She has an IUD and uses condoms occasionally. She reports the discharge has a foul odor to it and is yellowish. She complains of vaginal irritation and some discomfort with urination. On wet mount she has a positive whiff test, with motile flagella and no clue cells. What is your treatment plan for this patient?

A 35 year old female presents to the office complaining of daily headaches lasting about 2-3 hours after work for the past 2 months. She describes bilateral pain which is not aggravated by activity. She denies nausea, vomiting or sensitivity to light. She works as a social worker for the county and has been working a lot of overtime. Her vital signs and exam are normal. She is taking tylenol and ibuprofen with minimal symptomatic relief. What is the most likely diagnosis and treatment?

A 21 year old female presents to the office for vaginal discharge and itch for the past 3 days. She is sexually active and takes Ortho Tri Cyclen for her birth control. She does not use condoms. On exam you note thick white discharge and on microscopic exam you note budding yeast. What is her diagnosis and treatment plan?