A 28-year-old man presents to an urgent care clinic with approximately 12 hours of abdominal pain accompanied by “feeling warm” with T to 100.4 degree F (38 d C) at home and mild nausea without vomit. He reports that the discomfort began with a feeling of “heartburn that did not get better with taking an antacid like it usually does”. During the past 6 hours, the pain has become more intense and has moved more to the lower right side of his abdomen, stating, “It’s hard to show you exactly where it hurts.” Walking makes the discomfort worse, and rest makes it somewhat better. He also reports little appetite and denies contact with individuals with similar symptom. He reports having two small soft stools earlier today. He denies dysuria, penile discharge, or scrotal pain.

Physical examination is unremarkable except for localized tenderness at McBurney's point with mild involuntary guarding. Genital exam WNL Vital signs: T 100.4°F (38°C), HR 96 beats/min, BP 122/76 mmHg.

This clinical presentation is most suggestive of:

A. Viral gastroenteritis

B. Acute appendicitis

C. Acute diverticulitis

D. Testicular torsion

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A 78-year-old woman with hypertension controlled with hydrochlorothiazide started taking carbamazepine for trigeminal neuralgia approximately 3 weeks ago. She presents today saying, “I’ve been feeling oddly for the past week.”

Laboratory results are

•Na⁺ 131 mEq/L (normal 135–145 mEq/L)

•K⁺ 3.8 mEq/L (normal 3.5–5.0 mEq/L)

•Cl⁻ 100 mEq/L (normal 98–106 mEq/L)

•HCO₃⁻ 25 mEq/L (normal 22–29 mEq/L)

•Creatinine 0.9 mg/dL (approximately normal 0.6–1.3 mg/dL)

•eGFR 65 mL/min/1.73 m² (≥60 mL/min/1.73 m² generally considered preserved for medication/lab interpretation in this context) (Stage 3A CKD

Given her lab results, which of the following are the most likely clinical findings in this patient?

A. Mild fatigue, difficulty concentrating, intermittent nausea, and mild unsteadiness when walking

B. Marked confusion, repeated vomiting, seizures, and decreased level of consciousnes

C. Muscle weakness, muscle cramps, constipation, and palpitations

D. Perioral and fingertip tingling, painful muscle spasms, and carpopedal spasm

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A 78-year-old woman who is taking a thiazide diuretic with lisinopril for the treatment of hypertension is started on a therapeutic dose of an SSRI due to a new diagnosis of major depressive disorder. Which of the following is a potential drug induced electrolyte disorder in an older adult taking these medications?

A. Hypokalemia

B. Hyperkalemia

C. Hyponatremia

D. Hypercalcemia

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An 81-year-old woman with a 30-year history of hypertension and dyslipidemia, both at treatment goal, presents with a 1-week history of a new-onset headache. She states, “I’ve never had a headache like this before in my life.”

She has a history of migraine without aura beginning in her early teens, with only rare episodes since her early 50s. At age 60, she had herpes zoster ophthalmicus, which resolved without visual changes or neurologic sequelae.

Her current symptoms include right-sided scalp tenderness that worsens when she brushes her hair, unusual fatigue, and pain in the right jaw that develops with chewing and is promptly relieved when she stops moving her jaw. She is drinking fluids without difficulty but is eating less because chewing precipitates the jaw pain. She denies dysphagia, fever, diarrhea, constipation, or visual changes. She reports mild nausea associated with the headache.

Physical examination is at her previous baseline except for right-sided scalp tenderness and a thickened, tender right temporal artery area. Vital signs are unremarkable except for BP 155/82 mm Hg.

Which diagnosis best explains this patient's current clinical presentation?

A. A. Giant cell arteritis

B. Headache secondary to elevated blood pressure

C. Migraine without aura

D. Trigeminal neuralgia

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An 81-year-old woman with a 30 year hx of HTN and dyslipidemia, all at treatment goal, presents with a 1-week history of a new onset left sided headache, scalp tenderness and jaw claudication. Suspecting giant cell arteritis, the clinician orders which of the two following tests?

A. Temporal artery ultrasonography

B. C-reactive protein

C. MRI of the brain

D. Carotid artery ultrasound.

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A healthy 30-year-old at 33 weeks' gestation presents for routine prenatal care in late September in the northeast USA. She's not previously received any vaccines. And about the past ten years and states, "I heard there are shots to protect the baby from RSV. My niece had this when she was a month old and got very sick".

Which of the following is the best response?

A. Recommend a single dose of an FDA approved RSV vaccine as soon as possible.

B. The maternal RSV vaccine is recommended with each pregnancy, preferably given in the first trimester.

C. Given that her baby will be born outside of the typical RSV season, the use of maternal RSV vaccine is not recommended.

D. The maternal RSV vaccine is given to provide protection to the mother but not the baby.

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A 12-year-old male presents with his father for a routine Whelchel visit. The father asked to speak to you privately, as he's concerned that his son is, quote, showing some body changes. Close quote during the visit, the child is alert, interactive with physical exam findings consistent with Tanner's Stage three sexual maturation. He remains on his growth curve for height and weight.

When discussing these findings with the father, which of the following is the most accurate statement?

A. These findings are normal for his age.

B. This is an unusual finding in a 12-year-old.

C. This signals he is likely nearly his adult height.

D. He just started puberty changes.

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A seven year old with a diagnosis of asthma since age to present with his parents for a new patient visit. He has cough, wheezing and shortness of breath 4 to 5 days per week and awakens with asthma symptoms about once weekly. His parents states when he's playing soccer, sometimes he needs to stop running because of his cough. So last visit with his prior PCP was about seven months ago when he was prescribed, according to his parents quote, "a pill to take every day to help control his cough". His last dose of this medication was about two months ago because the medication had no refills.

He's currently using albuterol as needed. Two puffs, about 3 to 4 times a day. About. Five days per week to help control his cough and shortness of breath. The medication, per his parent quote, "works pretty well most times". The child is currently feeling well without evidence of acute asthma exacerbation. He is alert oriented, talkative, and able to demonstrate adequate inhaler technique. Peak expiratory flow rate is approximately 60% a predictor.

Which of the following is an appropriate preferred treatment option for this child?

A. Continue current therapy as it is providing adequate symptom control.

B. They begin low dose ICS formoterol therapy, as maintenance and reliever therapy or marked therapy.

C. Begin daily montelukast albuterol as needed.

D. Begin nebulizer budesonide twice daily with nebulizer albuterol as needed.

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