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?

A 45-year-old female present to the clinic for her wellness exam. She mentions since she turned 41 she has been experiencing difficulty in reading, especially menus at restaurants. The nurse practitioner determines that this patient should be screened for:

You are caring for Cathy, a 14-year-old with suspected appendicitis. Clinical findings most consistent with appendiceal rupture include all of the following except:

A NP student asks her preceptor what is the gold standard when diagnosing patients with otitis media. The preceptor’s best response would be: