Amara is an 8-year-old whose parents have brought her to the clinic today with a 3 week history of runny nose, sneezing, congestion, and itchy nose and throat. Her parents also state that she has developed a white crease across the bridge of her nose (see photo). Her parents say the nasal symptoms have worsened since she started playing softball this spring. They said she did the same thing at this time last year. Which of the following pharmacologic interventions is most appropriate for this child at this time?

A 23-year-old female comes to your office to discuss birth control options. Her history includes migraine headaches with aura while on combination oral contraceptives in the past. She does not want to become pregnant and has no current future plan for pregancy. Which of the following birth control options would be the best choice for her?

A 24-year-old preschool teacher presents complaining of waking the last three mornings with her right eye matted shut. She says it has been terribly red for almost three days, it feels dry and like it has a foreign body in it. Upon physical exam you note redness, dryness of the eye and the surrounding skin, and purulent discharge (see photo). The patient has no signs of an upper respiratory infection. She says that three kids in her preschool class have all had the same problem. Based on the probable differential diagnosis, which of the following would be the appropriate treatment and priority patient teaching?

Jamie is a 39-year-old woman who presents to the health department today for a routine PAP and pelvic exam. The patient does not use condoms and has had 3 sexual partners this year. She has an IUD in place for birth control. Physical examination reveals a firm, round, small painless chancre to the genitalia (see photo). Regional lymphadenopathy is also noted. The patient has no drug allergies. Given the clinical presentation and laboratory findings, which of the following is the most likely pharmacologic management for this patient?  

Mrs. Henderson, age 54, asks why she needs progesterone in addition to her estrogen for hormone replacement. Women who have an intact uterus need to add progesterone to their prescribed estrogen because progesterone:

Buck, a 47-year-old man, presented to the primary care clinic with severe right toe pain. He says he has been feeling “fine,” but cannot bear weight on the right leg due to the pain, which he rated as a 5/10  on a 0-10 numeric pain scale. Mr. Buck denies any trauma or previous injury to the toe.  His past medical history includes hypertension, type 2 DM, chronic alcoholism, and kidney stones. Physical exam shows a temperature of 100.6. The right big toe is swollen, warm, red, and tender. The rest of the physical exam is WNL. Labs are as follows: ESR= 124mm WBC count= 7,400 Random blood sugar= 139 Creatinine= 1.6mg/dl Serum calcium, phosphorus, LFT, electrolytes, and lipid profile were normal Serum uric acid= 6.5 mg/dl What does the FNP appropriately prescribe for pain at this time?

Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis, and is most consistent with lateral epicondylitis is:

Randell is a 38-year-old male who is 5 feet 8 inches tall and weighs 191 pounds. He reports that he has had intermittent heartburn for several months and takes antacids with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflex disease (GERD) is the cause of his pain?

A young woman complains to the FNP that she is experiencing headaches, irritability, decreased appetite, and fatigue about 1 week before menses. Appropriate initial management includes which of the following?

Gary, a 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The fundoscopic exam demonstrates cupping of the optic disc. There is no identified opacification of the lens. The nurse practitioner suspects which differential diagnosis?