A 39 year old male presents to the office for shortness of breath and wheezing.  He indicates that he takes medium dose budesonide and formoterol but his symptoms are still not controlled. You have ruled out infection with a CBC and a CXR and he has been taken prednisone that he received from an Urgent Care office. He has an appointment with a Pulmonologist in one month. What is the next best step (according to GINA guideline) that can also be used to help control his symptoms?

A 48 yr old post menopausal Asian woman presents to the office for a physical. She has blood pressure readings of 146-152/90-94 documented over 2 months on three separate occasions. She has no other medical conditions. Her  ECG and creatinine are normal and she has no proteinuria.  She has mild trace lower extremity edema bilateral.  Clinical findings in today’s office visit are BP 145/92, HR 62, BMI 26, RRR, S1, S2, no S3, S4 or murmur, point of maximal impulse at fifth intercostal space, mid-clavicular line.  Which of the following represents the best treatment for her high blood pressure?

A 42 year old male with asthma also needs anthypertensive therapy. Which of the following should you avoid prescribing for him?

A patient is given metroniazole for treatment of an STI. You advise the patient of the following:

Which of the following is a true statement regarding kidney stones?

During a new office visit your 70 year-old patient complains of being easily short of breath and is often tired.  He has been a smoker for 50 years.  On exam you hear decreased breath sounds bilaterally , hyperresonance and hypertrophied accessory muscles.  His hematocrit it elevated and his pulmonary function test shows increased total lung capacity with FEV1 of 60%.  His mMRC is 3. How would you treat him?

A 45 year old female with significant past medical history of fibromyalgia, chronic pain, high cholesterol and hypertension comes into the office for depression. She currently takes HCTZ 25mg, Lisinopril 20mg and atorvastatin 40mg and tylenol 500mg daily. After your assessment, you determine she would benefit from treatment of her depression. What is the best medication choice for her?

A 27 year old new married patient comes to your office for elevated blood pressure. She notes that she was seen at a health fair and her blood pressure was 160/85 so they told her to come to the office. She has a long family history of hypertension in her mother, father, brother and grandparents. She is planning to get pregnant in the next year and wants to know what would be the best blood pressure medication to use. Which of the following shows evidence of being the safest for a pregnant patient?

Side effects of SSRI’s include the following: nausea, vomiting, GI upset and sexual dysfunction.

A 57 year old male presents to the office for a physical and lab review. You note that his blood pressure is 180/90. He indicates that he has been very stressed out lately and that he has been having daily headaches. A repeat blood pressure in the office shows the patient continues to be elevated at 182/96. His last office visit showed his blood pressure to be 150/88 and at that time you counseled him on diet, exercise and weight loss. His most recent labs show elevated creatinine at 2.0 with a decrease in GFR to 55. His urine dipstick is negative for ketone, glucose and bilirubin but positive for protein. What is the most appropriate next step for him?