A 28-year-old woman presents with a two month history of fatigue, sleeping much more than usual but still being fatigued when she awakens.  She tells you she could care less about her work and only shows up “because I have to pay the bills”.  She finds it hard to be at work as she is unable to make even the most straightforward of decisions.  She also has no desire to go out with her husband and expresses feeling very guilty as she doesn’t even want to have sex.  She tells you that she has no specific plan of harming herself, but feels as if her family would be “better off without me”.   According to the American College of Physicians (ACP) Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder, what treatment options should be considered?  Please select all that apply.

Fran is a 47-year-old in your practice that you see annually for her women’s health exam as well as diabetes, hypertension, and hyperlipidemia.   She is a 1 ppd smoker x 20 years and has a number of medication intolerance’s. You are a bit concerned to hear she is preparing for an extended trip to the Amazon River Basin to perform research on a plant species she has been studying for the past 7 years (she has a PhD in agriculture sciences).  She will be camping at a remote research site.  She is quite concerned regarding travelers diarrhea. What would you advise her? Please select all responses that apply.

Which are included in the Rome IV criteria used to diagnose irritable bowel syndrome? Select all that apply.

Paul is a 62-year-old who presents with complaints of a gnawing, mid epigastric pain that is worsened by eating. This description is most likely indicative of:

You suspect your patient has acute pancreatitis, what should you include in your treatment plan?  Please select all that apply.

Which is associated with peptic ulcer disease? Select all that apply.

Anita is a 37-year-old who presents as a new admission physical from a local assisted living facility that cares for a lot of mentally ill adults. She has told the staff and yourself that she has been taking alprazolam 1 mg at least QID for the last several months (she obtained illicitly).  The staff would like to discontinue this medication.  What’s your best plan?

Kaitlyn is a 20-year-old college student who presents for evaluation of inability to quit crying.  She is accompanied by her Mom who has driven to campus to pick her up and take her home due to her concerns. Kaitlyn tells you that two weeks ago her professor in her film class had the group watch a film that “was really really scary”.   She states she is sleeping well, feels rested when she gets up, is still going to class and has been able to concentrate on her studies, “the only thing I can’t seem to do is quit crying and I haven’t been able to write my review paper for the film we watched”.  She wakes up crying each morning and will start to cry for no reason during class, “I don’t feel sad”.  You note that Kaitlyn appears Asian and her mother appears Caucasian. As part of the history, you find that she was raised in an orphanage in China until the age of 5, when she was adopted by her.  She has a very difficult time in recounting this history.  What is your working diagnosis? 

Frances is a 92-year-old woman you see at the nursing home.  She has multiple co-morbidities including diabetes, CAD, congestive heart failure, COPD, and  hyperlipidemia,  She was recently hospitalized with pneumonia, and in part of the work up a chest CT was performed that captured, the upper part of her abdomen and showed a large gallstone in her gallbladder.  She is asymptomatic for cholecystitis or dysfunction, but she and her family are concerned that this will create a problem if it is left untreated.  The surgeon has expressed concern about her ability to survive a surgery to remove the gallbladder.  What would you advise? 

List and describe one strategy that might enhance discourse in your classroom. How will this affect vocabulary growth?