A 36 year patient presents to clinic with acute onset of abdominal pain.  On abdominal exam, a maneuver is performed involving flexing the patient’s right hip to 90 degrees and internally rotating the righ hip by moving the knee inward or medially. The patient reports no abdominal pain with this movement. What physical exam maneuver was performed and what condition is less likely at this point?

A patient reports a decrease in the frequency of stools and asks about treatment for constipation. Which of the following criteria is NOT included in the Rome IV criteria for diagnosing constipation?

A 58-year-old patient presents to her primary care provider (you) to discuss her risk of cardiovascular disease.  Her family history ov CV disease includes her mother having a MI at the age of 66.  Her past medical history includes hypertension, hyperlipidemia and elevated BMI > 30.  She has never smoked tobacco and drinks a glass of white wine daily.   Her current medications include 5 mg of amlodipine PO daily, 10 mg of atorvastatin PO daily.  PE findings include HR 68 bpm, BP 128/68 mmHg, cardiovascular and pulmonary exam within normal limits.  A recent fasting lipid profile obtained 2 weeks ago revealed a total cholesterol of  220mg/dL, HDL of 45 mg/dL and a LDL of 175 mg/dL. :  Which of the following is the most appropriate management to lower her risk of cardiovascular disease?

Anaphylaxis can be a medical emergency. You are seeing a 45-year-old female patient who has a severe bee sting allergy. Which of the following statements would NOT routinely be included in patient education for anaphylaxis.

The development of hypertension is multifactorial. Your next patient is a 62 year old female who returns to clinic today to follow-up on her hypertension and diabetes.  You diagnosed her with hypertension 3 months ago. She has started a walking program 5 days/week for 30 minutes.  She has also made some changes to her diet, adding more vegetables and fruits and decreasing her carbohydrate intake. She quit smoking 3 months ago. Her BP today in clinic is 148/88 mmHg, HR 72 bpm, BMI is 32 kg/M2.  Her medications include metformin 500 mg BID, atorvastatin 20 mg daily, hydrochlorothiazide 12.5 mg daily. She takes her medications every day. Her latest A1C result is 6.6.  Her LDL was 88 and her BMP results were all within normal limits. Which of the following treatment option is the most appropriate for her?

Your next patient is a 19-year-old female with abdominal pain. She states the pain has been bothering her for the last week, and has progressively become worse. She denies nausea, vomiting, any episodes of diarrhea, or chest pain. She is sexually active with her boyfriend, and admits to having some pain during sex. She states she does not feel comfortable telling her boyfriend that she does not want to have sex. Her last menstrual period was two weeks ago. She reports no history of sexually transmitted infections, but says that she has not questioned her significant other because “he would be upset.” VS 37.1 C (98.7 F), BP 120/70 mmHg, HR 82 beats/minute, RR 18 breaths/minute.  PE:  The patient is visibly uncomfortable during the physical exam, which reveals a few bruises on her abdomen and lower back that are at different stages of healing. What is an appropriate technique for screening for intimate partner violence in this patient?

Acute pancreatitis is an inflammatory condition of the pancreas that may range in severity from mild to severe. There are many different causes of pancreatitis. Which of the following statements regarding the diagnosis of acute pancreatitis is false?

Your next patient is a 52-year-old woman with the diagnosis of type 2 diabetes. Her low-density lipoprotein (LDL) level is 160 gm/dL. According to the ACC/AHA Guideline criteria for “Treatment of Hyperlipidemia with Statin Therapy to Reduce Atherosclerotic Cardiovascular Risk”, what is your treatment recommendation to manage this patient?

Your next patient is a 34-year-old female with a “twisted ankle.” She stepped off a curb 3 days ago and came down “wrong”. She has had moderate pain, moderate swelling and it has been difficult to bear weight. She has slightly limited ROM and stability.  After reviewing the clinical guidelines, you know that:

What is the American Society of Anesthesiologists (ASA) recommendation for discontinuing herbal medications prior to a planned surgery?