Which of the following are the most common features of skin changes noted in areas of the feet affected by tinea pedis? A. Widely distributed with consistently raised with areas of hyperpigmentation. B. Localized to the dorsal aspect with central clearing and a raised border C. Involving plantar crusting and interdigital fissures D. Remains stable in size over time with lateral lichenification. --- YouTube: https://www.youtube.com/watch?v=D70UTIMym6w&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&a...
Oct 07, 2024•7 min•Season 1Ep. 89
Mrs. Martinez is a 64-year-old woman with 10 year-history of type 2 diabetes mellitus, HTN, and dyslipidemia. Her current medications include metformin, an SGLT-2 inhibitor, statin, ARB and thiazide diuretic. She is at EBP-advised goals including recent A1c=6.9%. Today, she reports she is feeling well. Her history and physical examination are unremarkable. She mentions that, for the past year, in addition to her prescribed medications, she drinks a special tea blend that her sister makes, taking...
Sep 30, 2024•10 min•Season 1Ep. 88
A 76-year-old woman with presbycusis presents for a follow-up visit on HTN and dyslipidemia, treated with an ARB, thiazide diuretic and a statin, and at treatment goal. Which of the following is she likely to report? A. Occasional difficulty with speech discrimination B. Need to use her prescription eyeglasses to read C. Altered sense of smell D. Diminished sense of touch --- YouTube: https://www.youtube.com/watch?v=cj_Qj5hOvS4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=87 Visit fhea....
Sep 23, 2024•10 min•Season 1Ep. 87
A 24-year-old adult, assigned female at birth, presents to your practice chief complaint of bilateral lower abdominal pain for the past three days, worsening over this time frame. She describes the pain as a heavy pressure like feeling, accompanied by intermittent fever , mild dysuria, yellow vaginal discharge, as well as nausea without vomiting nausea without vomiting. She is tolerating fluids well and has a markedly decreased appetite. Additional history of present illness includes recent LMP,...
Sep 16, 2024•12 min•Season 1Ep. 86
A 14 yo presents with a 4 h history of sudden onset LLQ abdominal and scrotal pain, described as a pulling, burning sensation. He denies vomiting, diarrhea or constipation, and reports mild nausea and is taking fluids without difficulty. HPI is negative for recent trauma to the region, dysuria, penile discharge, genital lesions or fever. He reports milder, similar episodes during the past 3 months, “that just went away.” Physical exam reveals loss of the cremasteric reflex, negative Blumberg sig...
Sep 09, 2024•12 min•Season 1Ep. 85
A 24-year-old woman presents to your practice with a diagnosis of pelvic inflammatory disease, suitable for outpatient treatment. Which of the following is recommended? Chose two that apply. A. A single dose of IM ceftriaxone B. A two-week course of oral doxycycline and oral metronidazole C. A five-day course of oral azithromycin with a one-week course of oral ciprofloxacin D. A single dose of IM penicillin --- YouTube: https://www.youtube.com/watch?v=yZg1jA7SkAc&list=PLf0PFEPBXfq592b5zCthlx...
Sep 02, 2024•9 min•Season 1Ep. 84
A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one-day history of fever, projective cough with yellow sputum and increasing shortness of breath. He denies GI distress but states his appetite is not what it usually is. He has a history of hypertension, type 2 diabetes, and dyslipidemia at guideline-based goals. He is a former smoker, quitting about 10 years ago with approximately a 35-pack-year history and was diagnosed 5 years ago with COPD. Clinical a...
Aug 26, 2024•12 min•Season 1Ep. 83
A 9-year-old female presents for well child care with her parent. She is in the 4th grade, doing well academically, plays soccer on a local team, and reports, “I have 3 best friends”. Health history per parent and child reveals no concerns. On physical exam the clinician's notes the child is at about 40th percentile height and weight for age, and has breast budding and downy, straight, slightly pigmented pubic hair long the labia majora. These physical findings are consistent with: A. Precocious...
Aug 19, 2024•10 min•Season 1Ep. 82
A 40-year-old computer programmer presents for a sick visit with the chief complaint of a two-day history of low back pain. He reports the pain started after many hour stretch of doing yard work. The pain is described as a dull constant ache, worse with activity, better with rest, across the lower back, without radiation to the legs. He denies leg weakness, tingling, or numbness, and states he had similar pain in the past after doing extensive lifting. In considering the diagnosis of lumbar sacr...
Aug 12, 2024•9 min•Season 1Ep. 81
A 22-year-old woman who is 20-weeks pregnant was treated for C. trachomatis 4 weeks ago with an appropriate antimicrobial. She presents today for a follow-up visit and reports she is currently without symptoms, that her partner was also treated, “And we both took the medicine just as we were advised.” Which of the following represents next steps in this patient’s care? Choose two that apply. A. Testing for C. trachomatis should be obtained at today’s visit. B. A repeat of C. trachomatis testing ...
Aug 05, 2024•9 min•Season 1Ep. 80
A 55-year-old man with a BMI of 40%, with the chief complaint of low back pain for the past two weeks. He describes the pain as originating in the lumbar sacral region, with radiation across the left buttock associated with numbness and tingling sensation in his left leg. The pain is worse with sitting and somewhat better with standing. He denies lower extremity weakness or a change in bowel or bladder function. He states, “I've tried ice, heat and ibuprofen and these just take the edge off. I'v...
Jul 29, 2024•9 min•Season 1Ep. 79
A 45-year-old adult presents for a sick visit, with the chief complaint of three-day history of low back pain. Clinical assessment is consistent with lumbar sacral strain. Which of the following represents the most appropriate next step in this person's care? A. Advised three days of bed rest on a firm surface. B. Apply ice or heat to the affected area based on clinical response. C. Refer to neurology for further advice. D. Order a lumbar sacral x ray to help confirm the diagnosis. --- YouTube: ...
Jul 22, 2024•8 min•Season 1Ep. 78
You see a 44-year-old woman with a 6-month history of increasing fatigue despite adequate opportunity for sleep and rest. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW as well as TSH within normal limits. You expect to find which of the following upon review of the patient’s health history? A. Report that she has been consuming a plant-based diet since age 18 B. Report of menorrhagia C. A history of alcohol use disorder D. A diagnosis of rheumatoid arthritis --- Yo...
Jul 15, 2024•9 min•Season 1Ep. 77
A 48-year-old woman presents for follow up on T2DM and HTN. As part of today’s visit, routine labs are ordered. Which of the following is an appropriate form of electronic communication for sharing these results with the patient? A. Private message through Facebook® or similar social media website with patient permission B. Electronic fax or scan uploaded to the patient’s personal account for a third-party file sharing service (e.g., DropBox®) C. Using encrypted email or other messaging service ...
Jul 08, 2024•9 min•Season 1Ep. 76
A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one day history of fever, productive cough with yellow sputum and increasing shortness of breath. His vital signs are as follows, temp 99.8 °F (37.6 °C) , BP 140/85, heart rate 98 beats per minute, and respiratory rate 22 at rest period O2 saturation is 94% on room air. He has a history hypertension and type 2 diabetes, at guideline-based goals. He is a former smoker, quitting about 35 years ago with appro...
Jul 01, 2024•15 min•Season 1Ep. 75
A 49-year-old woman with type 2 diabetes mellitus was started on a standard dose of an ARB daily 6 weeks ago for the management of hypertension. Today her blood pressure is 128/78 mm Hg, stating she is taking the medication without difficulty and is feeling well. The appropriate action at this time would be to: A. Order a white blood cell count to assess for neutropenia. B. Continue her current medication regimen. C. Add HCTZ to enhance HTN control. D. Obtain a 12-lead ECG --- YouTube: https://w...
Jun 24, 2024•8 min•Season 1Ep. 74
Esteban is an 18-month-old child who presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations and has no drug allergies, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankines...
Jun 17, 2024•11 min•Season 1Ep. 73
An 18-month-old toddler, Estaban, presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankiness and intermittent fever to 1...
Jun 10, 2024•13 min•Season 1Ep. 72
A 60 year old man presents with a chief complaint of a 6 month history of increasing fatigue despite adequate rest and sleep. He denies chest pain or difficulty breathing, and reports he is a non smoker. Concurrent history includes a 25 year history of alcohol used disorder, with daily intake of 5-7, occasionally more, 1.5 oz shots of whiskey, and chronic poor nutrition, reporting, “I eat chips and crackers a lot, I do not have the time to make a meal and I cannot afford to eat out. He is curren...
Jun 03, 2024•12 min•Season 1Ep. 71
A 45 year old woman with a 10 year history of hypothyroidism presents for follow up care. She's been taking levothyroxine 100 micrograms per day with excellent adherence. Stating "I take the medicine every morning on an empty stomach with a big glass of water.” She states she's generally feeling well, but notices increased fatigue over the past four months, which she attributes to the stress of starting her graduate studies while working full time. The results of today's laboratory testing inclu...
May 27, 2024•16 min•Season 1Ep. 70
A 28-year-old woman presents with new onset worsening fatigue, present for approximately the last month. She is 28 weeks pregnant with her second child, has a 1.5-year-old healthy child at home, says she remembers being tired towards the end of her pregnancy with her first child, but states, “This is worse than with my last pregnancy”. She denies vaginal bleeding or discharge, abdominal pain, or other concerning issues, is sleeping about 7 hours per night, and has adequate access to nutritious f...
May 20, 2024•15 min•Season 1Ep. 69
A 35 year old presents with chief complaint of “my sinus infection is not getting better”, with continued nasal and sinus congestion, yellow to white nasal discharge, and a feeling of sinus pressure particularly when he bends over. He denies sore throat headache, and GI symptoms, and previously reported fever prior to treatment is now resolved. The EMR documentation notes a prescription for dose-appropriate amoxicillin with clavulanate written 2 1/2 days ago when seen for a sick visit. Patient s...
May 13, 2024•12 min•Season 1Ep. 68
Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick visit, stating, “My stomach has not been right for about 4 days. The illness began with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 24 h ago, last stool was around 4 h ago, reported as yellow-brown in color, small volume and without blood. He has been tolerating clear liquids for the pas...
May 06, 2024•15 min•Season 1Ep. 67
Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 4 h ago, last stool was around 2 h ago, reported as yellow brown in color, small volume and without blood. He has been tolerating a sips of clear liquids for the past 3 h and voided a small amount around 2 h ago. Joesph reports that he is ...
Apr 29, 2024•12 min•Season 1Ep. 66
Sonia is a 15 year old teen who plays varsity basketball and is generally well and up-to-date with health maintenance. She presents for an urgent care visit with a 6-h history of sudden onset nausea, with multiple episodes of vomiting, abdominal cramping and 2 episodes of diarrhea with stool described as light to dark brown without visible blood. Her VS are within normal limits and mucous membranes are slightly dry. She has slightly hyperactive bowel sounds and mild exceptional tenderness withou...
Apr 22, 2024•12 min•Season 1Ep. 65
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 ...
Apr 15, 2024•16 min•Season 1Ep. 64
A three year old otherwise well child for a sick visit. Her caregivers report that the child has been well, with the exception of a number of small, new skin lesions on the chin and arms, present for about 3 days. The child will occasionally rub the lesions, but does not complain about pain, has no fever, no other symptoms. Exam is consistent with non bullous impetigo, with approximately 6 lesions, all less than two to three centimeters in diameter, scattered over the chin and both arms. The chi...
Apr 08, 2024•10 min•Season 1Ep. 63
A 5 year-old otherwise well child presents with a 4-day history of “a skin problem”. . She is without fever and in no acute distress. Her parent advises that other children in the child’s playgroup have developed similar skin lesions. Considering the diagnosis of non bullous impetigo, the NP expects to find which of the following? A : A four-centimeter, round, honey-crusted lesion surrounded by about a 0.5 centimeter area of erythema, localized to the chin. B : Multiple papular skin lesions abou...
Apr 01, 2024•12 min•Season 1Ep. 62
A 33 year-old who is pregnant with her 2d child presents for prenatal care. She does not have record of her immunizations, but states she has not had any vaccines in more than 1 year. She is without complaint, and exam is consistent with gestational age, with FHT= 140 BPM and visible fetal activity. Today which two vaccines are recommended? A : Measles, mumps, rubella. B : Varicella. C : COVID 19. D : Tdap or tetanus-diphtheria-acellular pertussis. --- YouTube: https://www.youtube.com/watch?v=_t...
Mar 25, 2024•12 min•Season 1Ep. 61
Which of the following is consistent with the clinical presentation of placental abruption? a. A 38 year-old with primary HTN, who is now 28 weeks pregnant with her 6th child, presents with a 1-h history of sudden onset abdominal pain as well as dark red vaginal bleeding,dizziness, tachycardia and BP= 88/ 55 b. A 32 year old who's pregnant with her eighth child, now 32 weeks pregnant presenting with A2 hour history of bright red vaginal bleeding stating she does not have abdominal pain. c. 28 ye...
Mar 18, 2024•14 min•Season 1Ep. 60
