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, ending about three days ago with normal timing and normal flow, she is sexually active with two male partners, and describes that the last episode of coitus six days ago was painful for deep pelvic discomfort. The physical exam reveals a temp of 100.4 Fahrenheit, rest of vital signs within normal limits, mild lower abdominal discomfort to light and deep palpation without rebound, yellow vaginal discharge and cervical motion tenderness without palpable pelvic mass. This clinical presentation is most consistent with:

A. Acute Appendicitis

B. Pelvic Inflammatory Disease

C. Ovarian Cyst

D. Ectopic Pregnancy
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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 sign and a high riding left testicle.

A. Testicular Neoplasia

B. Acute Epididymitis

C. Incarcerated Inguinal Hernia

D. Testicular Torsion
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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
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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 assessment confirms the diagnosis of community-acquired pneumonia, suitable for outpatient treatment. Which of the following represents the most appropriate antimicrobial option?

A. Oral levofloxacin

B. Injectable ceftriaxone

C. Oral azithromycin

D. Oral amoxicillin
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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 puberty

B. Early onset normative puberty

C. Age-appropriate pubertal findings

D. Concern for a GNrH producing lesion
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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 sacral strain, which of the following would most likely be noted on clinical assessment in this patient?

A. Diminished to absent lower extremity DTRs

B. Patient report of new-onset difficulty with voiding.

C. Paraspinal muscle tenderness

D. Positive straight leg raise test
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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 should be conducted at 1 month postpartum.

C. Given she is without symptoms and her partner was also treated, no further C. trachomatis testing is advised.

D. In the absence of new clinical findings, follow-up test is advised at around 28-32 weeks gestation.

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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've had back pain like this in the past. Usually just lasts a couple of days and it's not that bad. I'm going to try that again and it's not this bad.” This history of present illness is most consistent with:

A. Lumbar Radiculopathy

B. Spinal Stenosis

C. Vertebral Fracture

D. Lumbar Sacral Strain
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