Which of the following is an appropriate nonpharmacologic intervention for gout?

Kern, 72-year-old male presented at the hospital complaining of severe pain in his left leg, shortness of breath, and pleuritic type chest pain following a long drive from Connecticut to Florida with minimal stopping. The patient had a history of pulmonary embolism, degenerative joint disease, and previously was a chronic smoker. His vital signs were: temperature 38.4 °C, pulse 98 bpm, respiratory rate 20 breaths per minute, and blood pressure 138/90 mm Hg. Basic metabolic panel and complete blood count values were within the normal range. Kern is  diagnosed with a new DVT. Kern is given an appropriate loading dose (bolus) of heparin (Half-Life ≈ 1.5 hrs) and started on a heparin infusion at an initial rate of 18 units/kg/hr. Six hours after starting the initial infusion, Kern’s aPTT is 37 seconds. (Institution-specific therapeutic range is 46-70 seconds). What should be done?

HP is a 73 yo female who brought to the ED with altered mental status, but is unable to reliably describe any other symptoms. Urinalysis would demonstrate cloudy colored urine, (+) for  RBCs, WBCs, nitrites as well as leukocyte esterases.  Her culture shows >100,000 bacteria in the urine.  TRUE or FALSE:  You would treat this patient for a urinary tract infection (UTI).  

The use of metoprolol (Lopressor* / Toprol XL*), a cardioselective (also known as β1 selective) beta blocker, is absolutely contraindicated in patients with COPD (or asthma) despite any possible compelling indications (e.g. stable heart failure or IHD).

Angela is a 79yo Caucasian female with a history of heart failure with reduced ejection fraction (HFrEF) and hypertension.  Her BP is 142/76 and heart rate is 73 bpm.  Medications include carvedilol (Coreg*) 25mg twice daily, lisinopril (Zestril*) 40 mg daily, Empagliflozin (Jardiance*) 10mg daily and furosemide (Lasix*) 40 mg daily. She has been fairly compliant with the recommended lifestyle modifications.  Angela returns to your clinic 2 months later with a new complaint of a dry cough.  Her lungs are clear, weight and labs are unchanged, and she has no other symptoms.  Which of the following is most appropriate?

Tess is a 55yo African American female with a PMH of HTN, DM and hyperlipidemia.  She weighs 175 lbs and is 5’4″. She sometimes eats processed foods and admits to having trouble with portion control. She does not exercise regularly and she does not smoke.  Her mother had a MI at the age of 70.  Her fasting lipid profile shows TC 200 [

Mr. Damone, a 59 year old man, presents to the emergency department with crushing chest discomfort. An ECG indicates a small transmural left ventricular free wall infarction. The patient is given several drugs, for both immediate management of ischemia and for long term prevention of a subsequent MI. Which of the following drugs would provide immediate relief of the symptoms of myocardial ischemia, but has no long term effects on mortality (i.e. reducing the risk of sudden cardiac death or ventricular dysfunction)?

John is a 57yo Caucasian male who presents for a routine visit for his hyperlipidemia.  His PMH includes hyperlipidemia and hypertension.  He has no family history of heart disease.  He is a current smoker (1 PPD x 45 years).  He currently takes quinapril (Accupril*) 20mg daily.  Vitals include BP 165/90 x 2, HR 84, EKG shows normal sinus rhythm.  Weight 210 lbs, ht 5’10”.  Fasting labs include K 5.1 , Cr 1.1 [

Which of the following is the recommended daily calcium and vitamin D intake for a 76 yo woman?

Lynette is a 68 yo female who presents to your clinic for a follow up appointment after her recent heart failure diagnosis.  She complains of weakness, loss of appetite, and she is seeing a blue/green halo.  Her daughter comments that she has appeared confused over the past day or so.  Which medication may be causing these side effects?