Which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection?

Ms. Gloria Briggs continued – see below her subjective and objective data points. Gloria is now taking a B-blocker in addition to her other medications. What other steps might be used to treat her stage C/class II HF?   Ms. Gloria Briggs works as a librarian and presents with a 6-week history of fatigue and increasing shortness of breath. She believes that these symptoms are related to recent renovations at the library, which have reactivated her asthma; however, her nebulizer and inhaler have not relieved her symptoms. Gloria reports that her dyspnea is worse with ordinary activity and lying flat, but she is comfortable sitting. She has not experienced chest pain. She complains of her legs swelling and shoes “pinching.” She can no longer take her brisk lunchtime walk and has gained weight. Her history includes hypertension, type 2 diabetes (T2DM), and dyslipidemia; she is a nondrinker and quit smoking 7 years ago. Physical examination: o   Height: 5 ft 6 in; weight: 165 lb (body mass index : 26.6 kg/m2) o   Blood pressure (treated): 140/92 mm Hg o   Heart rate: 116 bpm; respiratory rate: 22; temperature: 98.4°F o   1+ pitting edema ankles; S3 heart sound; bilateral rales at lung bases o   Mild cardiomegaly

Mr. James is a 43-year-old African American male who you just diagnosed with hypertension.  As part of his diagnostic work-up you are ordering the following except for

Describe how a PSK9 inhibitor work.  

Which is TRUE concerning Obstructive Sleep Apnea (OSA)?

Mr.  Peter Miller has a hx of HF and recently was started on Entresto (sacubitril/valsartan).   The patient followed the instructions to discontinue Lisinopril.   He calls the office and reports that he is feeling a “little” short of breath, especially when he is walking up the one-flight of stairs to his bedroom.  He also gained 3 lbs since he was seen last in the office 3 weeks ago.  The NP orders lab and wonders what lab to order – a BNP or a NT-pro-BNP?   Answer the following questions: 1.  Which lab test should the NP order? 2.  Explain the rationale for the correct lab order.  

John H presents to your office for his “regular physical.” He is 48 years old. In the office his initial blood pressure is 154/88 mmHg. It falls to 142/88 mmHg after ten minutes. Record review shows that his BP was 142/78 mmHg last year. His weight is 265 lbs, height 5’9″. His heart rate was 88 and regular. He has no previous diagnosis of hypertension. Which of the following tests would NOT be appropriate at this time per JNC8?

Mrs. Jones calls your office stating that she is tired and has swollen feet. You work her into your schedule immediately. She is a 72-year-old woman with a history of hypertension. She does not take daily diuretics but has Lasix at home “just in case”. She took one this morning. It is not on your medication list, and you don’t know the strength. Her blood pressure in the office is 160/82 mmHg and her weight is up 12 pounds since you saw her a month ago. Her last echocardiogram was 3 months ago and demonstrated an ejection fraction of 55%. Her primary complaints are tiredness and a cough for the past week. On exam you note jugular venous distention of about 6 cm, and she has pulsatile hepato-jugular reflux, clear lung sounds in all fields, and an irregular heart rate at 100. No S4 or S3. Abdomen is soft, but a little distended you think. She has 2(+) dependent edema to almost her knees, bilaterally. Based on the assessment and findings noted above, which of the following diagnostic tests will help you decide how to treat Mrs. Jones? Select all correct answers. 

Which anti-depressant is the preferred option for depression post-MI?

Ms. Jones is a 76-year-old woman with long-standing, poorly controlled hypertension.  When evaluating her for hypertensive target organ damage you look for evidence of: