A 42yo Asian male presents for follow-upof elevated blood pressure. He has no additional chronic medical problems andis otherwise asymptomatic. An exam is significant for BP of 162/95mmHg, but is otherwise unremarkable.

Labs:

•Sodium: 138 mEq/L (N135-145)

•Potassium:3.9 mEq/L (N3.5-5.5)

•FastingGlucose: 86 mg/dL

•BUN:14 mg/dL (N 10-20)

•Creatinine:0.6 mg/dL (N 0.6-1.3)

•Urinemicroalbumin: negative

According to the ACC/AHA 2017 guidelines,which one of the following would be the most appropriate medication to initiateat this time?

During rounds at the nursing home, you are informed that there are two residents on the unit with laboratory-confirmed influenza. According to CDC guidelines, who should receive chemoprophylaxis for influenza?

A 24yo female presents with a 2-dayhistory of mild to moderate pelvic pain. She has had two male sex partners in the last 6 months and uses oral contraceptives and sometimes condoms. A physical exam reveals a temp of 36.4oC (97.5oF) and moderate cervical motion and uterine tenderness. Urine HCG and UA are negative. Vaginal microscopy shows only WBCs.

The initiation of antibiotics for treatment of PID in this patient:

A 24yo patient wants to start the process of transitioning from female to male. He has been working with a psychiatrist who has confirmed the diagnosis of gender dysphoria.

Which one of the following would be the best initial treatment for this patient?

Based on American Cancer Society guidelines for cervical cancer screening, when should HPV DNA co-testing first be performed along with Papanicolaou testing?

Long-term proton pump inhibitor use is associated with an increased risk for:

An 87yo female comes to your office for an annual health maintenance visit. She appears cachectic and tells you that for the past 6 months she has had a decreased appetite and generalized muscle weakness. The patient is alert and oriented to person and place. She has a 10% weight loss, dry mucous membranes, and tenting of the skin on the extensor surface of her hands. While inflating the blood pressure cuff on her right arm, you observe carpopedal spasms.

Which one of the following is the most likely electrolyte disturbance?

A 24yo female presents to your office with a 3-month history of difficulty sleeping. She says that she struggles to fall asleep and wakes up multiple times at night at least three times a week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of the night trying to fall back asleep. Lately she has been feeling fatigued and having difficulty concentrating at work. You conduct a full history and physical exam and tell her to return in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping an average of 5 ½ hours per night.

Which one of the following would be the most appropriate recommendation?

A nonverbal 22yo male with intellectual disability is brought to your office by the staff of the group home where he lives. They report that the patient has been functioning at his baseline until this morning when he was found to have loud breathing. No other history is available at the time of this visit.

On exam he has a temp of 37.3oC (99.1oF), a BP of 124/82mmHg, a pulse of 100bpm, and a respiratory rate of 16/min. The patient appears to be in mild distress and a high-pitched whistling, crowing sound on inspiration is heard as you walk in the room.

Which one of the following would be the most appropriate next step for this patient?

A 16yo female presents with chronic acne on her nose, forehead, and chin consisting of a few comedones and a few mildly inflamed papules and pustules. She says it is minimally improved after 12 weeks of daily adapalene 0.1% gel. There are no scars or cysts. The patient would like to try to achieve better control.

Which one of the following would yourecommend at this time?

A 32-year-old female who is one of your longtime patients calls you because of a 24-hour history of painful urination with urinary frequency and urgency. She is otherwise healthy and does not have any fever, chills, back pain, or vaginal discharge. She uses an oral contraceptive pill and states that her last menstrual period was normal and occurred last week.

Which one of the following would be most appropriate at this time?

A 70-year-old female develops thrombocytopenia during a prolonged hospitalization for

endocarditis. Her current medications include scheduled unfractionated heparin injections for

venous thromboembolism prophylaxis. You suspect heparin-induced thrombocytopenia (HIT).

Assuming that her thrombocytopenia is caused by HIT, which one of the following is the most

likely complication?