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?

A 19 year old female presents to the office for complaints of shortness of breath and wheezing. She indicates that she ishavign daily symptoms has awoken 3 times in the last week due to coughing.  She denies smoking and allergy symptoms. She has missed several days of work because she has not been feeling well. In the office she has wheezing and coughing, but otherwise everything else is normal on exam. She has normal vital signs and denies congestion, runny nose, fever/chills. What medication is the preferred choice for her?

A 23 year old female presents to the office complaining of vaginal discharge. She reports that she is sexually active with 1 partner for the past 2 years and uses condoms sometimes. She also takes a combination birth control pill. Based on your exam, you suspect she is infected with bacteria gardnerella vaginitis. All of the following are true for this condition except:

A 31 year old male presents to your office for a follow-up visit. He was seen 2 weeks ago for fatigue and a sore throat. He indicates that he has not gotten better since that time . He still has a fever and the fatigue has gotten worse. He has been gargling with salt water and using cepachol lozenges. You checked a rapid strep test and it was negative. He indicates that he is sexually active with men and has oral and anal sex. What additional testing(s) would be most appropriate for him at this time?

A 23 year old male presents to the office complaining of bloody stool. He reports that symptoms started about 1 week ago. He has crampy abdominal pain throughout the day. He denies fever, chills, nausea or vomiting. He reports that this is the 3rd time he has had these symptoms in the past 6 months. He denies constipation. He has not seen any relationship with his diarrhea to the food that he eats. He is sexually active with females only and has never had anal sex. On DRE you note occult blood and diffuse tenderness in the lower abdomen. You have completed baseline labs with CBC/CMP, ESR and CRP. You suspect that he has inflammatory bowel disease, what are your next steps in evaluation?