An 81-year-old woman with a 30-year history of hypertension and dyslipidemia, both at treatment goal, presents with a 1-week history of a new-onset headache. She states, “I’ve never had a headache like this before in my life.”

She has a history of migraine without aura beginning in her early teens, with only rare episodes since her early 50s. At age 60, she had herpes zoster ophthalmicus, which resolved without visual changes or neurologic sequelae.

Her current symptoms include right-sided scalp tenderness that worsens when she brushes her hair, unusual fatigue, and pain in the right jaw that develops with chewing and is promptly relieved when she stops moving her jaw. She is drinking fluids without difficulty but is eating less because chewing precipitates the jaw pain. She denies dysphagia, fever, diarrhea, constipation, or visual changes. She reports mild nausea associated with the headache.

Physical examination is at her previous baseline except for right-sided scalp tenderness and a thickened, tender right temporal artery area. Vital signs are unremarkable except for BP 155/82 mm Hg.

Which diagnosis best explains this patient's current clinical presentation?

A. A. Giant cell arteritis

B. Headache secondary to elevated blood pressure

C. Migraine without aura

D. Trigeminal neuralgia

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An 81-year-old woman with a 30 year hx of HTN and dyslipidemia, all at treatment goal, presents with a 1-week history of a new onset left sided headache, scalp tenderness and jaw claudication. Suspecting giant cell arteritis, the clinician orders which of the two following tests?

A. Temporal artery ultrasonography

B. C-reactive protein

C. MRI of the brain

D. Carotid artery ultrasound.

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A healthy 30-year-old at 33 weeks' gestation presents for routine prenatal care in late September in the northeast USA. She's not previously received any vaccines. And about the past ten years and states, "I heard there are shots to protect the baby from RSV. My niece had this when she was a month old and got very sick".

Which of the following is the best response?

A. Recommend a single dose of an FDA approved RSV vaccine as soon as possible.

B. The maternal RSV vaccine is recommended with each pregnancy, preferably given in the first trimester.

C. Given that her baby will be born outside of the typical RSV season, the use of maternal RSV vaccine is not recommended.

D. The maternal RSV vaccine is given to provide protection to the mother but not the baby.

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A 12-year-old male presents with his father for a routine Whelchel visit. The father asked to speak to you privately, as he's concerned that his son is, quote, showing some body changes. Close quote during the visit, the child is alert, interactive with physical exam findings consistent with Tanner's Stage three sexual maturation. He remains on his growth curve for height and weight.

When discussing these findings with the father, which of the following is the most accurate statement?

A. These findings are normal for his age.

B. This is an unusual finding in a 12-year-old.

C. This signals he is likely nearly his adult height.

D. He just started puberty changes.

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A seven year old with a diagnosis of asthma since age to present with his parents for a new patient visit. He has cough, wheezing and shortness of breath 4 to 5 days per week and awakens with asthma symptoms about once weekly. His parents states when he's playing soccer, sometimes he needs to stop running because of his cough. So last visit with his prior PCP was about seven months ago when he was prescribed, according to his parents quote, "a pill to take every day to help control his cough". His last dose of this medication was about two months ago because the medication had no refills.

He's currently using albuterol as needed. Two puffs, about 3 to 4 times a day. About. Five days per week to help control his cough and shortness of breath. The medication, per his parent quote, "works pretty well most times". The child is currently feeling well without evidence of acute asthma exacerbation. He is alert oriented, talkative, and able to demonstrate adequate inhaler technique. Peak expiratory flow rate is approximately 60% a predictor.

Which of the following is an appropriate preferred treatment option for this child?

A. Continue current therapy as it is providing adequate symptom control.

B. They begin low dose ICS formoterol therapy, as maintenance and reliever therapy or marked therapy.

C. Begin daily montelukast albuterol as needed.

D. Begin nebulizer budesonide twice daily with nebulizer albuterol as needed.

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A healthy 12 month old child is scheduled for a routine well, child's visit and age appropriate immunizations in three days. The parent message is the nurse practitioner and ask, quote, my mother told me to give her some acetaminophen Tylenol before she gets her shots. That way she won't be uncomfortable afterwards. I want to check with you first. Is this a good idea?

A. Give acetaminophen about one hour before the appointment to relieve to prevent fever and injection site discomfort.

B. If she develops a fever or discomfort after the vaccines, you can give her an age and weight appropriate dose of acetaminophen as needed.

C. Give ibuprofen at the time of the vaccinations and continue it every six hours for the first 24 hours.

D. Try to avoid acetaminophen and ibuprofen for at least 48 hours after the vaccines, so that they can work as well as possible.

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YouTube: https://www.youtube.com/watch?v=721Kl3sP5o4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=156

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According to the latest American College of Cardiology and American Heart Association dyslipidemia guidance, in which of the following patients is it most appropriate to obtain a lipoprotein A level?

A. A twenty-eight-year-old woman with obesity and polyendocrine metabolic ovarian syndrome, formerly known as PCOS, whose father had a myocardial infarction at age 48.

B. A 47-year-old man with well-controlled hypertension for the past five years, without a family history of early cardiovascular disease and an LDL cholesterol of 92

C. A 35-year-old woman with episodic migraine since age 12 and an LDL of 72 who exercises regularly.

D. A 52-year-old man with triglycerides of 320 related to uncontrolled type 2 diabetes.

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A 55-year-old man is seen in follow up six weeks post hospitalization for acute coronary syndrome with drug eluding stent placement, has a 40-pack-year cigarette smoking history and currently smokes two packs of cigarettes per day. His medical history is also significant for stage 3-A CKD, with current estimated GFR of 52. His medications include high-intensity statin therapy and ezetimibe or Zetia, along with standard post ACS and CKD therapies. He states he's feeling well and taking all his medications as advised without adverse effects. Laboratory results today reveal an LDL cholesterol of 98, HDL of 35, triglycerides of 154.

Which of the following is the most appropriate next step in lipid management?

A. As he is feeling well, an LDL cholesterol is post ACS goal. Continue current therapy.

B. Due to his GFR, discontinue Zetia and substitute with bempedoic acid.

C. Add a PCSK9 inhibitor to current regimen.

D. Advise that moderate intensity statin therapy is preferred in stage 3-A CKD.

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