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?

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?

A patient reports a sudden onset of sore throat, fever, malaise, and cough. The APRN notes mild erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the most likely cause of these symptoms?

According to the ACC/AHA Guideline criteria for “Treatment of Hyperlipidemia with Statin Therapy to Reduce Atherosclerotic Cardiovascular Risk” which of the following patient categories would NOT be included in the guidelines for primary prevention.

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?