A 17 yo male presents for follow up on a “fainting” episode that occurred during football practice at the end of a running exercise. He states, “I do not know what happened. We finished a set of running sprints and next thing I knew, I was on the ground.” He denies injury from the event and history of prior episodes. His physical examination reveals a crescendo-decrescendo systolic murmur heart best at the apex, increasing in intensity with position change from supine to standing position.

This most likely represents:

A. Mitral regurgitation

B. Physiologic murmur

C. Hypertrophic cardiomyopathy

D. Aortic stenosis

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A 40 year-old accountant presents for advice on measles prevention. He reports disembarking from an airplane approximately 40 hours ago, and now being notified that one of the passengers on the plane has been diagnosed with measles today. He denies any chronic health problems, states he received “all the shots I should have” when he was a child. However, he is unable to produce documentation of childhood vaccinations.

Which of the following represents the most appropriate action?

A. This is an example of a low risk rubeola exposure without need for specific prophylactic action.

B. Obtain rubeola IgG titers and provide appropriate prophylaxis based on results.

C. Administer a single dose of MMR vaccine now with advice to contact the practice if there are concerning signs and symptoms.

D. Order a dose of immunoglobulin and arrange for MMR vaccination update.

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YouTube: https://www.youtube.com/watch?v=C-y2Ihr76nY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=122

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A nurse practitioner receives a message from a neighbor, a 35-year-old woman who is asking for a prescription to treat a “urine infection”. The neighbor states she's had this condition occur in the past and does quite well if she gets on an antimicrobial quickly. The neighbor also mentions that she's going out of town on a business trip the next day and is unable to contact her personal healthcare provider nor get to urgent care.

The NP considers the following in prescribing a medication to her neighbor.

A. Given this is a request for a prescription that is not a controlled substance, the NP can provide the prescription as long as the patient can advise on what antimicrobials she has taken in the past.

B. Providing this prescription would be a violation of federal law.

C. In suspected UTI, an antimicrobial prescription should not be initiated until urine culture results are available.

D. Since the NP does not have a patient provider relationship established with her neighbor, the request for an antimicrobial should be declined.

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YouTube: https://www.youtube.com/watch?v=G1IN08Ioh74&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=121

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