Your next patient is a 62 year-old man with intermittent rig…

Your next patient is a 62 year-old man with intermittent right upper quadrant abdominal pain. His past medical history includes hypertension and GERD. He is afebrile and hemodynamically stable. An abdominal exam reveals a positive Murphy’s sign, the rest of his PE is unremarkable.  What is the best next step to confirm a diagnosis?

Your next patient is a 52-year-old female patient with a BMI…

Your next patient is a 52-year-old female patient with a BMI of 31.5. She drinks 1-2 alcoholic beverages/day, 2-4 cups of coffee/day and eats fatty foods 3x/week. She smokes ½ pack of cigarettes/day. Her medication list includes asa 325 mg PO every day and Advil PRN as needed for pain. She states that she has had frequent recurrent epigastric pain and burning sensation for the past few months.  She describes the pain as occurring mostly after meals and sometimes it wakes her up during the middle of the night.  She occasionally experiences regurgitation of a sour-tasting fluid. She denies dysphagia, weight loss, or blood in her stool.  PE findings were unremarkable. What is the most appropriate initial management for this patient?

Your next patient is a 50 year-old man who scheduled an appo…

Your next patient is a 50 year-old man who scheduled an appointment to evaluate low back pain. He PMHx includes hypertension.  On his PE the back pain is reproduced by lifting the right leg 45 degrees from the horizontal table while he is lying down. He has right posterior calf pain which radiates down to his foot while this maneuver is performed.  Which additional PE findings would help you confirm your diagnosis?

You are seeing an 17-year-old female for a health maintenanc…

You are seeing an 17-year-old female for a health maintenance exam. She is concerned about concentration and issues with anxiety.  She informs you that she was raped repeatedly at a college party during the previous semester. She attends the University of MN, Minneapolis campus as PSEO (post-secondary education option) as a senior in high school. She did not report this to anyone at that time the incident occurred.   She had been drinking alcohol that evening and was afraid to tell anyone. What action is the priority for this patient?