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 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?

The patient with an acute anterior cruciate ligament (ACL) injury may recall hearing a “pop” when the injury occurred. What maneuver would you include during a physical examination to assess the anterior cruciate ligament (ACL)?

Your next patient has been diagnosed with Vitamin B12 deficiency. Which of the following conditions is NOT associated with vitamin B12 deficiency?

 You can include a reference from the National Sleep Foundation on tips for good sleep hygiene in your after visit summary.   When educating your patients regarding good sleep hygiene include the following information:

The next 3 questions pertain to this patient.Your next patient is a 26-year old female patient who presents to clinic for a health maintenance exam.  A CBC is obtained with the following results: Complete Blood Count Results  CBC Value Reference Range WBC 5.5 4-11 X 103/ul RBC 4.33 4.0-5 X106/uL Hgb 10.5 12.0-16 g/dL HCT 30.3 36-46% MCV 71 80-100 fl MCH 24.2 28-34 pg MCHC 28.6 32-36 g/dL RDW 15.4 12-14.6% PLT 258 150-450 X 103 u/l  What type of anemia does this patient have?

Group A Streptococcus (GAS) infection is the leading bacterial cause of tonsillopharyngitis in adults and children worldwide.  Which of the following statements regarding GAS in NOT true?

 There is a reference to Healthy People 2030 the Buttaro textbook. What is NOT a goal of the Healthy People initiative?

The next two questions are related to this patient.Your next patient is a 68-year-old female patient who presents to clinic for a health maintenance exam. A CBC is obtained with the following results: Complete Blood Count Results Value Reference Range WBC 6.5 4-11 x103/µL RBC 4.25 4.0-5 x 106/ µL Hgb 10.6  12.0-16 g/dL HCT 30.4       36-46% MCV 72.0    80-100fl MCH 24.2 28-34 pg MCHC 31.6    32-36g/dL RDW 15.4    12-14.6% PLT 260    150-450103/µL While reviewing this patient’s chart you note that her hemoglobin was 10.8 last year and ferrous sulfate was prescribed, although patient indicates she did not take it. No other work up was done at that time. She is asymptomatic. Given the patient’s age and lack of symptoms, you are suspicious that the anemia is due to a chronic underlying problem. The most common cause for this presenting anemia is:

Intractable dizziness can be complicated to evaluate in the older adult.  Always concerned about fall risk, fracture and/or head injury.  This population may multiple medications and have numerous specialists prescribing their medications.  It is your job as a primary care provider to look at all of their medications  What medications are NOT generally problematic and can be used safely without caution for the older patient population?