A 68 year old patient with a history of type 2 diabetes is diagnosed with hypertension.  Which medication should the patient be started on first line?

Another patient presents to the clinic post bar fight and is noted to have swelling around the right orbit. The patient is conscious but unable to see out of the right eye. You mechanically manipulate the eyelid and determine an open globe rupture. What is your initial treatment? 

An adult patient reports occasional anal bleeding with defecation and pruritis. On examination the nurse practitioner notes non-thrombosed external hemorrhoids around the anal orifice as the patient is bearing down. The hemorrhoids are not actively bleeding. Patient is afebrile and does not have any other associated symptoms and physical exam is otherwise unremarkable. What is the initial treatment for symptoms?

What is your treatment based on your differential? 

A patient presents to the clinic post bar fight and is noted to have facial trauma. The patient is conscious but blood appears in the nose and mouth. What is the most important factor to consider in this patient? 

You are concerned that a patient has a UTI, what symptoms would support this suspicion? 

This patient has a history of GERD and reports that he has been taking 600mg of Ibuprofen PO TID since this back pain has started 3 days ago. He states that his GERD symptoms have worsened since taking the Ibuprofen. He has tried Acetaminophen as well, which has not helped with the pain. You advise the patient to stop the Ibuprofen due to the GI side effects. What do you advise for alternative treatment?

This patient has a history of GERD and reports that he has been taking 600mg of Ibuprofen PO TID since this back pain has started 3 days ago. He states that his GERD symptoms have worsened since taking the Ibuprofen. He has tried Acetaminophen as well, which has not helped with the pain. You advise the patient to stop the Ibuprofen due to the GI side effects. What do you advise for alternative treatment?

 A patient presents with known osteoarthritis and has been taking NSAIDs. There is a strong suspicion for peptic ulcer disease. What is the most effective initial step in treating this patient’s peptic ulcer disease?

What is your differential?