The nurse practitioner sees a six week old with her parents for an urgent care visit. The family is of southeast Asian ancestry. They voiced concern about “dark spots” over her lower back and buttocks that have developed over the past three weeks. The child was born after a full term pregnancy, went home with parents in 24 hours, has had an appropriate weight gain, and is meeting developmental milestones. On physical exam, the infant appears in no acute distress, and has blue to blue gray spots ...
Mar 11, 2024•16 min•Season 1Ep. 59
A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of breath, chest pain or visual changes. He states, “ I just came in today for a v...
Mar 04, 2024•13 min•Season 1Ep. 58
A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of breath, chest pain or visual changes. He states, “ I just came in today for a v...
Feb 26, 2024•12 min•Season 1Ep. 57
A 12-month-old is seen for well child care. He has been walking solo since age 11 months, and now waves “bye-bye”, searches for an item under a blanket as well as using “mama” and “dada” specifically. His physical examination is within normal limits. Laboratory evaluation reveals a mild microcytic hypochromic anemia with an elevated RDW. The NP considers which of the following two are the most likely contributing causes of this anemia. A. Vitamin B 12 deficiency B. Plumbism C. Iron deficiency D....
Feb 19, 2024•14 min•Season 1Ep. 56
Ariel is a 7 month old infant, born at 40 weeks gestation, with Apgar scores of 9 and 10. The baby is up-to-date for well child care and immunizations and has had 2 minor episodic illnesses at aged 4 and 6 months with full recovery. Ariel rolled tummy to back, started to purposely bring hands together, and babble at around age 4 months, and has had a social smile since age 2 months. Ariel is the youngest of three children, and today, parents mention that they are concerned that, “She’s not sitti...
Feb 12, 2024•12 min•Season 1Ep. 55
A 22-year-old woman presents with a chief complaint of a 4-day history of mild dysuria, described as, “It burns a bit when I urinate.” She denies fever, GI upset, urinary urgency and frequency. About 1 month ago, she entered a relationship with a male partner who is currently without symptoms. Clinical assessment reveals a friable cervix covered by a thick yellow discharge. Suprapubic, CVA and cervical motion tenderness are absent. UA is positive for leukocytes and negative for nitrites, and mic...
Feb 05, 2024•10 min•Season 1Ep. 54
Which of the following applies when considering issues in clinical testing in a target disease? A. A false negative result identifies a person with the target disease B. A true positive result identifies a person with the target disease. C. A true negative result allows for the patient and clinician to discuss treatment options for the target disease. D. A false positive result supports a patient and clinician to discussion on the impact of the target disease on the patient’s overall health. ---...
Jan 29, 2024•7 min•Season 1Ep. 53
A 68-year-old woman presents for follow-up at her primary care provider with a chief complaint of “another urine infection”, stating she was seen 4 days ago at urgent care with new onset dysuria and urinary frequency. A review of her clinical record reveals that she has had 3 symptomatic, culture-confirmed UTIs in the past 8 months. She is currently on day 4 of 5 of the antimicrobial prescribed and is without symptoms. Her concomitant health issues include HTN and dyslipidemia, both at treatment...
Jan 22, 2024•10 min•Season 1Ep. 52
A 28 year-old woman presents with a 2-day history of urinary frequency, urgency and dysuria, stating, “This feels like when I had a urine infection 4 years ago.” She denies fever or GI upset and otherwise feels well. In consideration of the diagnosis of lower UTI/cystitis, a urinalysis is ordered. Which of the following is the most sensitive and specific finding for UTI caused by a Gram-negative organism? A. Positive leukocyte esterase B. Presence of bacteriuria C. Proteinuria D. Positive nitrit...
Jan 15, 2024•9 min•Season 1Ep. 51
Which of the following examples represents a potential medical malpractice scenario? A. A 25-year-old who is being treated for acute otitis media, reports penicillin allergy to the healthcare provider. An amoxicillin prescription is advised. The patient takes prescribed amoxicillin without adverse reaction. B. A 40-year-old patient with acute bacterial sinusitis reports to his healthcare provider that his symptoms have not improved after 2 days of a dose-appropriate prescription for amox with cl...
Jan 08, 2024•11 min•Season 1Ep. 50
A 67-year-old man with a five-year history of heart failure with reduced ejection fraction presented to the ER approximately 7 days ago with worsening shortness of breath, and new onset orthopnea. He was hospitalized for two days, with medications adjusted, and states at that time his symptoms were significantly improved. The nurse practitioner now sees him in follow up. The patient states today that, “For the past day, I feel just like I did the day I was admitted to the hospital. I might even ...
Jan 01, 2024•12 min•Season 1Ep. 49
A 14-month-old is brought into the clinic for a well-child visit. Born at 39.5 weeks gestation, he has been healthy and is up-to-date with immunizations. The child started to walk at age 12 months and the parents note that “his feet look a little crooked when he stands and sometimes he will trip when he is trying to run because they curve in.” The NP notes a mild inward curvature of the front half of the foot bilaterally, with an intoeing positioning when he stands. The feet are flexible and the...
Dec 18, 2023•12 min•Season 1Ep. 48
A 68-year-old with atrial fibrillation is taking warfarin as part of therapy for the prevention of thromboembolic event. His goal INR is 2-3, which is checked monthly and has been within acceptable range for the past 6 months. Today he presents with an INR=3.8. He denies bleeding events and reports, “I am taking my medicine just like I was told.” The NP considers that: A. The INR should be repeated today. B. A single dose of injectable vitamin K should be ordered. C. His health history should be...
Dec 11, 2023•11 min•Season 1Ep. 47
A 35-year-old woman presents for a well-woman exam. She is without complaint, with BMI=22, and reports that she runs about 28 miles per week, 4-5 miles with each run, and has excellent exercise tolerance. She states, “I am in great health.” On physical examination, the NP notes a faint mid-systolic click followed by a grade 2/6 mid- to late-systolic murmur, best heard at the apex. No other abnormalities are noted. These findings are most suggestive of A. aortic stenosis B. mitral stenosis C. mit...
Dec 04, 2023•12 min•Season 1Ep. 46
A 28-year-old woman who is breastfeeding her healthy 3-month-old term infant presents with a 48-hour history of generalized body aches, intermittent fever to 101.2 F, and localized pain on the upper aspect of her left breast. Nursing her child worsens the breast pain, while putting a cool compress on the area helps with pain control. She denies cough, GI symptoms or other skin alterations and does not have allergies to any medication. Physical exam is consistent with the diagnosis of lactation m...
Nov 20, 2023•12 min•Season 1Ep. 45
A nurse practitioner is newly licensed to practice. Which of the following best describes the NP’s ability to prescribe controlled substances? A. Any NP who meets state-level requirements for a license to practice is able to prescribe controlled substances. B. NPs are significantly restricted nationally from prescribing controlled substances. C. NPs are able to prescribe controlled substances with significant physician oversight. D. Controlled substance prescribing authority for NPs is regulated...
Nov 13, 2023•12 min•Season 1Ep. 44
Mrs. Parr, an 82-year-old woman with a 30-year history HTN and dyslipidemia, treated and at EBP goals, presents with a 3-day history of weakness and urinary incontinence. She was seen in urgent care yesterday, diagnosed with a UTI, and appropriately treated. She resides with her adult daughter who states, “The last two days, Mom kept saying she needed to get to work. She retired 15 years ago. She’s never been confused like this.” The NP understands that, with delirium, the changes in mental stat...
Nov 06, 2023•9 min•Season 1Ep. 43
The NP is seeing a 60-year-old woman with a 10 year history of T2DM. Her current medications include oral metformin and an oral SGLT2-I, and states she is feeling well, without report of blurred vision, excessive thirst or polyuria. She has not had any laboratory tests done in the past 6 months. Which of the following represents the best choice of test to determine her overall glucose control? A. Fasting plasma glucose B. Serum creatinine/ e GFR (estimated glomerular filtration rate) C. Hemoglob...
Oct 30, 2023•8 min•Season 1Ep. 42
A 21 year-old woman with a 15 year history of asthma. presents with acute bacterial rhinosinusitis; she is without fever and in no acute distress. Her current medications include an ICS/LABA inhaler for reliever and prevention asthma therapy, and a LNG-IUD for contraception. She also reports being told by her parents that she has penicillin allergy, and states, “I had a pink rash on my face and body for a few days when I took penicillin at around 3 or 4 years-old.” In considering ABRS antimicrob...
Oct 23, 2023•12 min•Season 1Ep. 41
A 76 year-old man with a 20-year history of HTN presents for a sick visit in the primary care clinic, stating, “I do not think that new medicine agrees with me.” Until recently, his BP was at goal with an ARB, but about 1 week ago, due to continued elevated readings, a second BP med, a thiazide diuretic, was added. Which of the following is most likely to be reported by this patient? A. “Since I started on the medicine, I passed out and woke up on the floor 4 times.” B. “About 2 days after I sta...
Oct 16, 2023•11 min•Season 1Ep. 40
A 60 year-old man who has a 10 year history of Parkinson disease presents with a chief complaint of “flaking skin that just does not go away, sometimes worse, sometimes better”, stating this problem has been present for > 6 years. Concurrent health issues include HTN, dyslipidemia and generalized anxiety disorder. The affected areas are occasionally itchy and will ache when particularly severe. He has used OTC hydrocortisone cream and skin moisturizers without seeing improvement. Physical exa...
Oct 09, 2023•10 min•Season 1Ep. 39
A 35-year-old man who is generally well was diagnosed with scabies 3 days ago presents with a chief complaint. “I do not think that skin medicine I was given worked. I am still really itchy and the rash looks the same”. He reports using topical permethrin as advised. Physical exam reveals excoriated papules on the interdigital area and scattered similar areas in the axillary and groin regions. Microscopic examination of skin scrapings supports the scabies diagnosis. He is otherwise without new f...
Oct 02, 2023•10 min•Season 1Ep. 38
A 28-year-old woman with a longstanding history of injection drug use presents with a 10-day history of malaise, nausea, and fatigue, and a two day “yellow eyes”. Physical exam reveals scleral icterus and mild hepatomegaly with right upper quadrant tenderness. Considering the possibility of acute hepatitis B in the differential, the NP anticipates laboratory results will include. A. The presence of hepatitis B surface antibody (HBsAb) B. Thrombocytosis. C. Leukocytosis. D. The presence hepatitis...
Sep 25, 2023•13 min•Season 1Ep. 37
A 22-year-old woman presents for follow-up after a recent clinic, requested STI screening. Testing for Chlamydia trachomatis was positive. She states, “I am really surprised, I feel fine.” Her current medications include combined oral contraceptive and her LMP was about 10 days ago, with appropriate timing and a 3 day light flow. The NP considers which of the following is the best option? A. Given she is asymptomatic, no further intervention is needed B. Oral azithromycin as a single dose should...
Sep 18, 2023•11 min•Season 1Ep. 36
A 62-year-old woman with T2DM presents 2 days after noticing a “bug bite” on her left lower leg, stating, “I am not sure what bit me.” During this time, the area has increased in size and she reports discomfort in the region. Examination reveals a tender warm, red, erythematous area with poorly demarcated borders, approximately 15 cm at its widest diameter on the anterior lower leg. Calf circumference is equal bilaterally. The patient is with no fever or additional complaints with no additional ...
Sep 11, 2023•10 min•Season 1Ep. 35
The NP sees a well, 18-month-old with a two-day history of clear nasal discharge, dry cough, intermittent fever to 101.4 or 38.5C, and mild crankiness. She's up to date with all recommended vaccination. Parents report everyone at home has this cold. Testing for RSV, COVID-19, influenza are all negative. She is alert, age appropriately resists the exam, which is consistent with viral URI. Her father states, “We got her fever under control by giving her two different medicines around the clock.” H...
Sep 04, 2023•10 min•Season 1Ep. 34
The NP is seeing a 35 year-old well woman for a health promotion and physical exam woman. She has not complaints, is a nonsmoker, a light social drinker with 1-2 glasses of wine per month, and exercises about 30 mins 5 days a week. Her BMI is 22 and vital signs are unremarkable with BP= 110/70. Which of the following is an anticipated finding on her funduscopic exam? A. Retinal arteries wider than veins B. Arteriovenous nicking C. Physiologic cup-to-optic disc ratio of less than 0.5 D. Blurred o...
Aug 28, 2023•8 min•Season 1Ep. 33
A healthy 1 year old, accompanied by his mother, is in for a well child visit. He is due to receive routine immunizations for a child his age. His mother mentions that she is about 6 weeks pregnant and read that, “I know he should get the chickenpox and German measles vaccines today. Since I am pregnant, is this safe?” The NP considers the following: A. Neither vaccine contain live virus and both can be given today. B. Both vaccines contain live virus that the child will not shed, and he can rec...
Aug 21, 2023•11 min•Season 1Ep. 32
A 78 year-old woman with well-controlled hypertension and dyslipidemia presents with a chief complaint of a many month history of pain, described as achiness, and stiffness in the joints both hands, particularly towards the end of the day. A part-time seamstress, she reports this discomfort is worse on work days. She denies redness or heat in the affected regions and has no systemic complaints. Physical exam reveals Heberden and Bouchard nodes bilaterally. These findings are most consistent with...
Aug 14, 2023•11 min•Season 1Ep. 31
A 67-year-old man who is diagnosed with acute bacterial prostatitis presents with a chief complaint of a one-week history of constant perineal pain, arthralgia, irritative voiding symptoms, and intermittent fever. Which of the following is most consistent with anticipated findings on prostatic digital rectal exam (DRE) with this condition? A. An enlarged prostate with obliterated median sulcus B. A prostatic exam that reveals multiple firm, non tender nodular lesions C. A tender, boggy prostate ...
Aug 07, 2023•9 min•Season 1Ep. 30
