A 80-year-old male with no previously diagnosed medical conditions presents to your office with complaints of chest pain and shortness of breath with exertion. He does not drink alcohol or use other illegal substances but has smoked 1/2 pack per day for 45 years. On physical exam, you note a systolic murmur that was not documented in his last visit 10 years ago. At which location can this murmur likely be auscultated the loudest?

A 72-year-old man with a history of chronic renal failure presents to your primary care office with weakness and bone pain in his legs and hips. Radiograph of the lower extremity demonstrates pseudofractures. Screening laboratory tests reveal low vitamin D, low calcium, low phosphate, and increased parathyroid hormone. Which of the following is the best initial treatment for this patient’s condition?

A 67-year-old man with a past medical history of type 1 diabetes mellitus, hypertension, and hyperlipidemia presents to the clinic office with fatigue and generalized body aches. His medications include insulin detemir, amlodipine, and rosuvastatin. He reports normal urine output and denies any urinary frequency or urgency problems. His in-office urine dipstick is positive for blood. Urinalysis is negative for eosinophils, proteins, white blood cells, red blood cells, or casts. Basal metabolic panel reveals a creatinine level of 2.9 mg/dL; it was previously 0.8 mg/dL. Which of the following is the most likely cause of his acute kidney injury?

A 60-year-old woman with a past medical history of obesity, type 2 diabetes mellitus, and remote history of myocardial infarction, presents with extreme pain when putting on her socks and shoes for the past 3 months. Both of her feet feel like they are burning, and the pain is keeping her up at night. The patient's current medications include losartan and metformin. On laboratory analysis, her hemoglobin A_1C is 9.8%. The patient denies any trauma to the lower extremities or open sores. On examination, her feet are clean, dry, and without ulceration. She has decreased sensation to pinprick and vibration. On further conversation, the patient reports that she is having a hard time managing her diabetes due to depression after the death of her long-term partner. Which of the following would be most appropriate for the initial management of this patient's symptoms?

A 36-year-old pregnant female at 9 weeks gestation with blood type A- antibody-negative presents to your office. She has read information about alloimmunization and wants to know more about the scenarios in which she would receive Rho(D) immune globulin (RhoGam). Which of the following scenarios would require RhoGam administration?

A 69-year old female is admitted to the intensive care unit on mechanical ventilation with noted bilateral pneumonia and multiorgan failure. Pertinent lab values are noted in the table below. 

 LabResult: Calcium11.3 mg/dL (high) and Parathyroid hormone 12.6 pg/mL (low)

Which of the following choices best describes the physiologic response of low parathyroid hormone levels?

A 16-year-old boy presents to your office with the chief complaint of a "rash." He is currently being treated with prednisone, vincristine, and doxorubicin for remission induction for acute lymphocytic leukemia. He denies any other medications. On physical examination, he is afebrile and normotensive. He has small scattered ecchymosis on the inside of his mouth and on his trunk. He denies recent trauma. He denies headache, epistaxis, or hematuria. His physical examination is otherwise normal. Which of the following is the next best step in the management of this patient?

A 10-year-old boy is brought to the pediatrician's office by his mother. He has been experiencing back pain for several months, and his mother complains that he has "poor posture." On examination, you note that his shoulders are anterior compared to the pelvis. A radiograph of the spine is taken and shows wedge-shaped vertebrae in the thoracic spine. Which of the following is the most likely diagnosis?

An 8-year-old boy presents with bilateral eye irritation with tearing for the past 2 days. He denies any photophobia, foreign body, or change in vision. He has had a scratchy throat and runny nose for the last 5 days. On examination, he has normal pupillary reaction and bulbar and palpebral conjunctival erythema with serous discharge. His vision is 20/20 bilaterally.Which of the following treatments would be indicated for this patient?

A 61-year-old male with no pertinent past medical history presents to the emergency room after accidentally choking on a cashew at a bar. The only symptom the patient has at this time is a dry, persistent cough. He denies loss of consciousness, wheezing, tachypnea, palpitations, fever, chills, and hemoptysis. Upon physical examination, there is no visible foreign body in the oropharyngeal region. His lung exam is clear to auscultation bilaterally without diminished breath sounds. Vital signs include temperature 98.9 degrees Fahrenheit, heart rate 87 beats per minute, respiratory rate 17 breaths per minute, oxygen saturation 93% on room air. Which is the most likely location of the foreign body?