A 54 year old African American male with a history of asthma and seasonal allergies presents to the office with complaints of severe itching on his hands. He notes this has been going on for the past several weeks and it is driving him crazy. He works as a pilot and feels like the itching it getting in the way of his job.  He has used some over the counter anti-itch lotions but they do not seem to be helping him. On examination you note dry, flaky skin, that has erythematous papules with lichenification. There is no drainage or signs of infection. How would you treat this patient?

A patient comes into the office for his diabetes. You advise the patient that you are going to start him on liraglutide and explain to this patient the medication works by the following:

A 13 year old male presents to your office for a rash that is itchy on his hands, inside his elbows and behind his knees. The rash is not painful, only itchy. It is erythematous, with areas of excoriation but no discharge around the area.   What is the most appropriate treatment and patient education?

A 37 year old female presents to the office for feelings of l dizziness and palpitations. She reports some weight loss and increased bowel movements. She has a past medical history of gerd and take protonix. She drinks 2-3 glasses of wine a week but denies smoking and drug abuse. On exam, you note the following: T: 98.8, HR 133, RR 12, BP 140/88; BMI 27 HEENT: Normal Cephalic head, sclerae and conjunctiva normal, mild protusion of the globes bilaterally, Tympanic Membrane is reflexive and clear, thyroid is normal CVS: S1 and S2, tachycardic no murmurs, rubs or gallops Lung: Clear bilaterally, no rales, rhonchi or wheezing Abdomen: soft, non-tender/non-distended and normal bowel sounds Extremities;no edema, normal sensation  The following are her fasting lab results:  Glucose 110 Electrolytes- normal WBC 6,000 Free T4- 2.3 ng/dL (Normal 0.7-1.5 ng/dL) T3- 0.9 ng/dL (Normal 0.2-0.5ng/dL) TSH 0.02mIU/L  (Normal 0.3-4.5 mIU/L)  What is the next best step for this patient?  

A 29 year old female with no past medical history presents to your office for a headache. She indicates that she has had a headache almost every day for the past several months. It comes and goes but can last for several hours and sometimes all day. It starts in her neck and shoulders and feels like a tightening pressure on both sides of her head.  She denies fevers, chills. She  denies nausea, vomiting, photophobia. She reports starting a new job about 6 months ago. She also notes her grandmother passed away 6 weeks ago. She denies alcohol and smoking.  She has been taking extra strength tylenol but nothing else because she is allergic to aspirin and nsaids.  What is the best treatment for her headaches?

A 23 year old male presents to your office for green sinus drainage for the past 5 days. He complains of severe congestion, runny nose, watery/itchy eyes, mild cough and a stuffy nose. He denies any past medical history except for smoking. His vital signs are as follows: T 98.6, HR 88, RR 13, BP 114/70, Pulse Ox 100% on RA. On exam, you note there is bilateral injected conjunctiva, PERRLA, EOMI. He has green thin mucus in the posterior pharynx but no edema or erythema. His nasal turbinates are pale and boggy but non-tender. The remainder of his exam is normal.  He reports that he must get rid of these symptoms because he has a work presentation and does not have time to be sick. Currently, he has not taken any medication for his symptoms. He denies any medication allergies. What would you recommend and/or prescribe?

A 46 year old male presents to the office as a new patient. He reports that he has a history of  Diabetes Type 2 for the past 5 years. His last A1c was 6.4  and it has never been above 7.2. His LDL is 169 and his urine test showed a small amount of protein. His GFR is 59 and his creatinine is normal. His blood pressure is 150/90. What medications should he be taking based on this information?

A  38 year old man with HIV presents with a chief complaint of a painful rash that started on his left flank yesterday. On exam you note linear vesicular lesions to  his posterior thorax, with prominent erythema, that does not cross the midline. What is the most likely diagnosis and the most appropriate treatment?

The initial treatment for a symptomatic patient with a TSH of 7.3 ( 0.3-4.5) and free T4 0.5 (0.7-1.5) would be:

Más verbos irregulares Complete the following sentences with the correct preterit form of a verb from the word bank. You may use each verb only once. decir hacer poder poner querer venir traer La semana pasada Graciela y Lupita una torta de chocolate a mi casa para la fiesta de cumpleaños. Nosotros muchas cosas el fin de semana pasado. Ellos a las ocho de la noche. ¿Dónde tú los libros? ¿Qué te Margarita por teléfono anoche? El profesor explicar bien la lección. Anoche yo no probar la comida exótica.