Another patient presents to the clinic post bar fight and is noted to have swelling around the right orbit. The patient is conscious but unable to see out of the right eye. You mechanically manipulate the eyelid and determine an open globe rupture. What is your initial treatment? 

What is your top differential diagnosis for this patient?

What diagnostic tests would you consider for your top differential? 

A 45 year old male construction worker presents to the clinic with complaints of right middle finger pain and swelling. The patient does not recall any significant trauma to the finger, however he does have a small skin tear/laceration to the plantar aspect of the right middle finger on assessment. On exam the patient holds the affected finger in slight flexion, there is uniform palmar swelling, tenderness along the flexor tendon sheath and pain with passive extension of the affected finger. What is your diagnosis and treatment for this patient?

This patient has a history of GERD and reports that he has been taking 600mg of Ibuprofen PO TID since this back pain has started 3 days ago. He states that his GERD symptoms have worsened since taking the Ibuprofen. He has tried Acetaminophen as well, which has not helped with the pain. You advise the patient to stop the Ibuprofen due to the GI side effects. What do you advise for alternative treatment?

An adult patient with nonspecific, non-radicular, acute low back pain has not had any relief with Ibuprofen 800 mg TID since onset of pain two days ago. Patient denies injury or recent surgery and has no red flag findings. Which one of the following medications would be the best addition to this medication as second-line therapy? 

An adult patient presents with an acute injury to the left 4th toe after stubbing the toe. On physical exam there is localized swelling, ecchymosis and tenderness to palpation to the left 4th toe. Patient’s vascular and neurological exam of the foot/lower extremity is within normal limits. X Ray of the left 4th toe reveals a non-displaced fracture. What will be a component of your treatment plan?

Match the following definition with the appropriate burn 

In this scenario what questions in the review of systems are most important to ask to rule in or out red flag signs/symptoms? (Select all that apply)

A patient presents to your office with complaints of depression that has been ongoing for several months. They mention little interest in their normal activities, fatigue, depressed mood, and feeling immense guilt. The patient’s significant other also states “they have had moments where they are full of energy, can’t relax, up all night long cleaning and reorganizing, talking to family members on the phone non-stop, and having distractibility for a couple of days”. Select all of the symptoms that apply for diagnosis of bipolar II