A 62 year old truck driver presents to your clinic complaining of worsening lower back pain. Pain is accompanied by numbness in perineum and describes pain as “sharp and burning.” Pain seems to be worse in the left buttock. Pain starts in the mid-buttock and radiates to the left leg as well as down the lateral aspect of the leg toward the dorsum of foot. Patellar DTR are 1+ on the left and 2 + on right. The pedal, posterior tibialis are equal in both lower extremities. Which of the following is the most appropriate next step?

Which of the following is NOT one of the criteria of the Ottowa knee rules predicting the need to obtain knee radiographs?  

Which of the following are potential complications of gastroesophageal reflux disease?  

A 36 year old female presents to your office with a 2 day history of lower abdominal pain that has progressively worsened. She notes some vaginal spotting but no frank bleeding. Denies fever, chills, diarrhea, vaginal discharge or urinary symptoms. LMP was 5 weeks ago. Is married and has been trying to conceive for the past 6 months. Vital signs are stable. On exam, cervical os appears closed with a small amount of dark brownish-red blood in vaginal canal. No cervical motion tenderness. Does have left adnexal tenderness without obvious mass. What is the most appropriate initial test that should be performed to support your suspected diagnosis? 

For the above scenario, which of the following laboratory markers would be most helpful in supporting the diagnosis?

You are seeing a 24 year old female with a 2 day history of urinary frequency, urgency and dysuria. No hematuria. No fever, nausea or vomiting. No flank pain or abdominal pain. No new sexual partners. You obtain a urinalysis and micro urine looks like this:Bacteria: 3 plusWBC: 15-20RBC: 2Blood: noneNitrate: noneLeukocyte esterase: small amount What is the likely pathogen? What antibiotic will you prescribe? Please include Medication, route, dose, frequency and duration.

A patient you are evaluating has diarrhea and recently returned from a mission trip to Central America. Given your main differential diagnosis, which antibiotic may need to be prescribed if symptoms do not improve?

You are evaluating a 54 year old gentleman. He has been noticing a bulge in his midline every time he rises from bed in the morning. You inform him this is a ventral hernia, which is also known as an: 

A 21 year old male presents to the clinic after “twisting” left ankle after jogging. He tells you he believes his ankle “rolled in” at the time of injury. He is able to bear weight but is having pain doing so. On exam, there is minimal ecchymosis and swelling on the lateral side of the left ankle. No ligamentous laxity. What is the treatment of choice for this patient? 

A young adult comes to the student health center complaining of blood in urine along with abdominal pain. An initial priority in the diagnostic work up would include: