Question 25 Jackie O. comes to the clinic today concerned of fatigue, weight gain and abnormal periods. She has no previous past medical history of any chronic illnesses. She does have family history of hypothyroidism in her mother.  You perform a physical exam which is normal. You then order laboratory tests with results as follow.  CBC – normal CMP – normal Vit D – normal TSH – 15 microunits/ml – high  (normal range is 0.4-4 microunits/ml) Free T4 – 0.8 mcg/dl – low  (normal range is 0.9-2.4 mcg/dl) You determine she is hypothyroid. Your next course of action is to:

Question 27 Use the case study below to answer this question and the next question Justin, age 37 fell off a ladder 24 hours ago. He presents with right shoulder pain. Imaging reveals no bony abnormalities. He has been taking ibuprofen 800mg every 8 hours since the injury for his pain, but reports this has not relieved the pain.  He has no red flags for neurological or vascular abnormalities but exhibits right shoulder pain with abduction and external rotation. He rates the pain as 8 on a scale of 1-10 and indicates that the pain is constant and interfering with his activities of daily living as well as sleep. He asks for something stronger than ibuprofen for his pain. You conclude that Justin is experiencing acute pain secondary to the musculoskeletal trauma based on history and physical. You decide to prescribe an opioid for his pain. Essential provider considerations consistent with current recommendations when beginning opioid therapy for acute pain should include: (Check all that apply)

Question 4: Henry P, age 72 years has been a smoker for 45 pack years. He was seen 2 weeks ago for increasing dyspnea with activity, chronic productive cough. Spirometry was completed and he returns today for follow up. Spirometry results show FEV 1 is 70% and FEV1/FVC is 68%. You recognize that this is consistent with mild to moderate Chronic Obstructive Pulmonary Disease. In addition to recommending smoking cessation, you begin first line therapy and start him him on:

Question 11:  A patient taking Lisinopril (an ACE inhibitor) would need to be monitored carefully if taking the following supplement (select one):

Question 24 Match the drug/drug class with potential serious side effect.

The following statement is/are true of Anti-Epileptic Drugs (AEDs): (Choose all that apply).

Question 31   BONUS Howard W. is a 55 year-old male with insulin dependent diabetes who weighs 170 pounds. He presents for his 3-month diabetes follow up appointment. A review of his blood glucose log reveals the following: Breakfast     Lunch     Dinner     Bedtime    3am     260 108 120 118 240 120 124 122 164 230 105 134 128 180 262 124 128 132 He reports that he awoke at 3 a.m. 2 nights in a row to use the bathroom, so he checked his blood sugars at that time also. His current regimen is 24 units long acting insulin lantus before bed, and regular insulin 8 units before breakfast, lunch and dinner. An appropriate first course of action to take in this patient would be to: Select one:

Patients on oral bisphosphonate therapy for osteoporosis should be instructed to:

BONUS QUESTION (OPTIONAL) Nancy, age 73 has developed a Urinary Tract Infection (UTI) and you elect to treat her with Ciprofloxacin (Fluoroquinolone) 250mg twice daily for 5 days. You note that she is also on medications for peptic ulcer disease including Famotidine (H2 receptor antagonist) and sucralfate (cytoprotective agent) daily. Best advice to the patient on administering these medications is: 

Sheila B. age 30 presents to the clinic with complaint of classic migraine headache, which she describes as moderately severe. She first developed migraines in her teen years and they have worsened as she has gotten older. She has been using ibuprofen, aspirin, acetaminophen and aspirin plus caffeine 2 to 3 times per week for the treatment of her headaches, but continues to experience them despite increasing therapy. The best course-of-action from the list below to manage Sheila’s headaches is: