A young adult female presents to your office with acute onset of shortness of breath.  Her history reveals recent long distance air travel. She denies a history of asthma, is a non smoker and is currently taking melatonin for sleep and oral contraceptives which she has been taking for 8 years without any problems. Assuming you had access to all stat labs and diagnostic studies, what is the next best step for this patient?

The USPTF recommends which group of patient’s receive a low dose CT of the chest for lung cancer screening?

A 14 year old male presents to the office for cough, congestion and fever. He reports that he has had symptoms for the past 6 days and he seems to be getting worse. On exam you note fever of 101.2, RR 16, HR 102 and BP is 140/92. His heart sounds are normal, lung sounds show rales on the right upper lung. He has no significant past medical history. What would you treat him with? 

A 48 yr old post menopausal Asian woman presents to the office for a physical. She has blood pressure readings of 146-152/90-94 documented over 2 months on three separate occasions. She has no other medical conditions. Her  ECG and creatinine are normal and she has no proteinuria.  She has mild trace lower extremity edema bilateral.  Clinical findings in today’s office visit are BP 145/92, HR 62, BMI 26, RRR, S1, S2, no S3, S4 or murmur, point of maximal impulse at fifth intercostal space, mid-clavicular line.  Which of the following represents the best treatment for her high blood pressure?

The NP suspects that the patient has primary syphilis because

A 55 year old male presents to the office for concerns about chest pain which has been going for the past 6 months. He reports that it occurs when he is playing on a recreational basketball team. He notes that when he rests, the pain goes away. He has a history of hypertension and hyperlidipemia and takes valsartan, HCTZ and rosuvastatin. On exam today, his vital signs show BP 149/90. You are planning to order a stress test for him, but want to treat his discomfort. What medication would you use for him?

A 62 yo female who presents with pain in her hands and fingers that is getting worse.  She denies any trauma or other musculoskeletal complaints.  She is overweight (BMI 30.5) and has hypertension which is controlled by medication.  On exam you observe bilateral Heberden and Bouchard nodes.  This finding would most likely by seen in?

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?