A 17-year-old high school football player presents the Monday after a weekend game during which he attempted a tackle and caught his left ring finger on his opponent’s uniform. On examination he has mild swelling and tenderness over the volar aspect of the affected finger, and he is unable to actively flex the distal interphalangeal joint. Plain radiographs demonstrate no bony trauma.

Which one of the following management options would be most appropriate?

A 55-year-old male with a 10-pack-year history of smoking as a young adult sees you for follow-up after a recent hospitalization for community-acquired right lower lobe pneumonia. His symptoms resolved after standard antibiotic treatment.

Which one of the following should you recommend regarding follow-up radiography?

A 42-year-old female sees you for follow-up 6 weeks after starting treatment for Helicobacter pylori. She was diagnosed with the urea breath test. She completed her antibiotic regimen as prescribed and stopped her proton pump inhibitor (PPI) 2 weeks ago. She is symptom free.

Which one of the following is the recommended next step?

A 72-year-old female with a history of hypertension, previous stroke with no residual deficits, and mild cognitive impairment presents for an annual health maintenance examination. Her documented weight 6 months ago was 79 kg (174 lb) and her current weight is 73 kg (161 lb). She is sedentary and has not changed her diet.

Which one of the following is true about this patient’s condition?

A 27-year-old gravida 2 para 2 presents because of tenderness in her left lower breast, which she first noticed this morning. Three weeks ago she vaginally delivered an 8 lb 1 oz infant. She breastfed her first child for 10 months and initiated breastfeeding after this delivery without difficulty. Currently she is feeding her infant on cue about every 2–4 hours. On examination she has 4 cm of focal tenderness at 6 o’clock on the breast with no skin erythema. Her vital signs include a temperature of 37.0°C (98.6°F), a pulse rate of 84 beats/min, and a blood pressure of 118/72 mm Hg.

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

Since the United States began fortifying grains with folic acid, which one of the following birth defects has declined?

A 36-year-old male presents to the urgent care clinic 2 days after he fell on his outstretched arm while snow skiing. He waited until his return home to seek evaluation and treatment. On presentation to your clinic he reports pain located in the deltoid region that is exacerbated when lifting the arms overhead. The pain is so severe that it awakens him at night. Examination of the shoulder demonstrates weakness with external rotation, internal rotation, and abduction. The empty can and drop arm tests are positive. Initial shoulder radiographs are negative.

Based on the presentation and examination, which one of the following would be the most appropriate next step in management?

A 5-year-old female is brought to the emergency department by her parents after her temperature increases to 104°F. On examination she has noticeable inspiratory stridor. She is restless and drooling, and her voice is muffled. In spite of the nurse’s repeated efforts to get the child to lie back, the patient continues to sit forward in a sniffing position. Her parents indicate that they have declined vaccinations for the patient since leaving the hospital after delivery.

Which one of the following is the most important next step in management?

An 8-year-old female is brought to your office by her parents for follow-up 6 months after you recommended a DASH diet and 1 hour of physical play daily to address her BMI and blood pressure, which were both greater than the 95th percentile for her age and height. Her mother also has a history of obesity and hypertension. The patient otherwise has an unremarkable past medical history. Although she has lost 1.4 kg (3 lb) her blood pressure remains at 125/77 mm Hg. You diagnose stage 1 hypertension and recommend management with medication.

In addition to a CBC; electrolyte, BUN, and creatinine levels; a urinalysis; and a lipid panel, you recommend

A 62-year-old female sees you for follow-up of bilateral lower extremity edema that worsens throughout the day. A BNP level, TSH level, comprehensive metabolic panel, urinalysis, chest x-ray, EKG, and lower extremity venous ultrasound have all been normal.

Which one of the following diagnoses should you consider in this patient?

A 42-year-old female sees you for routine follow-up of adrenal insufficiency diagnosed 2 years ago. Today she reports a 2-month history of fatigue, decreased energy, difficulty concentrating, and nausea. She has also had an unintentional 5-lb weight loss over the past 3 months. She takes oral hydrocortisone, 10 mg in the morning and 5 mg in the afternoon. She is adherent to her medication regimen and has not had any illnesses in the past year.

Which one of the following would be the most appropriate initial step in the management of this patient’s adrenal insufficiency?

Which one of the following findings on a HINTS (head-impulse, nystagmus, test of skew) examination suggests a central etiology for a patient with vertigo?

A 32-year-old female sees you to request breast cancer screening after learning that her 45-year-old sister was diagnosed with breast cancer. She has no other known history of breast cancer. The patient does not have a family history of ovarian, tubal, or peritoneal cancers. Menarche occurred at 13 years of age and she has never been pregnant. On examination there is no nipple discharge or axillary lymphadenopathy and she has no palpable breast masses.

Based on U.S. Preventive Services Task Force guidelines, which one of the following should you recommend as the next step in evaluation?

An 80-year-old male who is taking furosemide (Lasix), 80 mg, for heart failure presents to the emergency department (ED) with a gradual onset of somnolence. He is found to be hyponatremic with a serum sodium level of 104 mEq/L (N 135–145).

You should order the administration of which one of the following?

A 45-year-old female presents for evaluation of a 3-month history of left knee pain. She commutes by bicycle and is now finding it painful to cycle or even walk. On examination she does not have any deformity, and there is normal range of motion of the hips and knees. She has bilateral knee crepitus, pain on flexion of the left knee, and point tenderness that is noted 2 cm proximal to the left lateral joint line while flexing the knee.

Which one of the following is the most likely diagnosis?

You see an expectant mother for a prenatal visit. She has heard of sudden infant death syndrome and asks for advice on sleeping arrangements. You tell her that infants should sleep

A 55-year-old female presents to your office because of a several-month history of progressively worsening fatigue, weakness, and unexplained weight loss. Physical examination findings are remarkable for hyperpigmentation of the skin and buccal mucosa. Initial laboratory studies reveal a low morning cortisol level.

Which one of the following is the most likely diagnosis?

A 65-year-old male presents to your office for a Welcome to Medicare visit. The whisper test is abnormal with both ears.In addition to difficulty hearing and participating in day-to-day conversation, the patient is at increased risk for which one of the following health problems due to his hearing loss?

A 32-year-old female presents with concerns regarding infertility. She has been married for 3 years and has been attempting to conceive for the past 18 months. She reports early menarche at age 10 and a long-standing history of dysmenorrhea and heavy bleeding. These symptoms improved when she was using oral contraceptive therapy in her 20s. Transvaginal ultrasound results are inconclusive.

Which one of the following would be the most appropriate next step in management?