A 60-year-old male with documented ASCVD, obesity with BMI of 34, and type 2 diabetes presents for care. The patient reports he's currently feeling well without episodes of hypoglycemia. Current laboratory assessment includes the following. A1C is 8.6 % and his estimated GFR is at 62. Current medications include metformin at optimized dose and a sulfonyl urea.

Which of the following represents the nurse practitioner's next best action?

A. continue on current therapy and arrange for a three month follow up

B. discontinue the metformin and add a DPP4 inhibitor

C. add a GLP-1 inhibitor and discontinue the sulfonyl urea

D. add basal insulin and titrate to fasting glycemic goals

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YouTube: https://www.youtube.com/watch?v=8ybH1qcskq8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=124

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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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