A 37 year old male presents to the office for follow-up to his major depression. He has a past medical history of reflux and he smokes 1ppd. He was seen about 6 weeks ago and started on Paroxetine 20mg daily. He indicates that it seemed like it was working, but he stopped because he was having sexual side effects. What recommendations would you provide to him?

A 42 year old female presents with intermittent right upper quadrant pain over the past several weeks which is worse after eating fried foods.  On exam, she has positive bowel sounds and the abdomen is soft.  When palpating deeply on the right upper quadrant during deep inspiration, the patient complains of severe sharp pain.  This describes which of the following?

A 73 year old male presents to the office for follow-up to his systolic CHF. You are explaining to his family that he has New York Heart Association stage III heart disease? What is the most accurate list of medications that he should be taken?

A patient is given metroniazole for treatment of an STI. You advise the patient of the following:

A 35 year old male presents to the office for complaints of a headache. He describes the headaches as one sided, pulsating and lasting for about 1-2 hours. He notes that his eye sometimes waters with the headache. He denies nausea, vomiting, fever, chills, photophobia or phonophobia. What is considered first line treatment for this headache?

A 57 year old male presents to the office for a physical and lab review. You note that his blood pressure is 180/90. He indicates that he has been very stressed out lately and that he has been having daily headaches. A repeat blood pressure in the office shows the patient continues to be elevated at 182/96. His last office visit showed his blood pressure to be 150/88 and at that time you counseled him on diet, exercise and weight loss. His most recent labs show elevated creatinine at 2.0 with a decrease in GFR to 55. His urine dipstick is negative for ketone, glucose and bilirubin but positive for protein. What is the most appropriate next step for him?

Tara is a 52 year old woman that presents to your office with bilateral weakness that started in her legs. The onset was rapid and followed with pain, numbness, and tingling. At first she thought her legs were asleep, but the feeling persisted.  When you ask about other symptoms, she mentions before the weakness started she had a fever, cough, and sore throat, with some mild nausea. During your physical exam you note absent reflexes, with sensation still intact, and strength 3/5 in legs bilaterally with 5/5 in arms. What is you leading diagnosis?  

Debbie is a 35 year old female that presents to the clinic with weakness and numbness of the left arm which started about 2 weeks ago. When discussing her review of systems, she also notes that about 2 months ago she had an episode of diplopia which lasted about 24-36 hours about 4 months ago. She says something similar happened about a year ago and lasted for several weeks and is worried this could be a stroke. Based on this presentation, what is the most likely diagnosis and most likely treatment?   

A 64 year old woman presents to the office with concerns regarding her “joint problem”. She does not recall the name of her condition, but reports that she has had several flares in her big toe over the past 2 years.  A doctor once told her it causes crystals to get stuck in her joints and this causes pain, swelling, and redness. She has a significant past medical history for HTN, hyperlipidemia, and asthma. She takes the following medications: hydrochlorothiazide, simvastatin, aspirin, and prn albuterol. As her PCP you include all of the following in your plan for her “joint problem” (choose all that apply) :

A 37 year old female presents to the office for evaluation. She reports feelings of hopelesness, depressed mood, decreased appetite and sleep. Her employer indicated that she needed to get help because she is not completing her tasks at work and has been calling in sick too much. She feels fatigued and has trouble concentrating. She reports that she has been feeling this way for the last 4 weeks. She did not seek help because 2 months ago she was feeling great. She went out gambling with her friends, participated in a group cocaine party and staying up all night. What is her likely diagnosis and treatment plan?