A 52-year-old man presents for an initial primary care visit at the nurse practitioners practice period he has not seen any health care providers since age 38, stating that he has been in good health. Social history, drinking approximately 2 beers per night over the weekend, two nights per week, has a 5 pack year cigarette smoking history, having taken up smoking when he was in college, and quit at age 22. He reports feeling well and without chief complaint or chronic health problems. He asks about what kind of cancer screening he should have. The NP advisors which of the following?

A. Colonoscopy

B. Prostate specific antigen (PSA)

C. Low dose chest CT

D. Given his history, no routine cancer screening is advised.

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A 10-year-old of Middle Eastern ancestry , assigned female at birth, is seen for routine well child care.

She is generally healthy and plays soccer, reporting excellent exercise tolerance, stating, “I’m the fastest midfield on the team.” Physical examination is within normal limits with Tanner stage 2. Height and weight are at 40% tile, consistent with previous measures. Laboratory evaluation reveals a mild microcytic hypochromic anemia with a NL RDW. This likely represents which of the following?

A. Vitamin B 12 deficiency

B. G6PD deficiency

C. Iron deficiency

D. Beta thalassemia minor

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A 70 year old man with a 35 year history of hypertension, dyslipidemia, and a 20 year history of type 2 diabetes presents. He was recently diagnosed with systolic heart failure, presenting with dyspnea on exertion and orthopnea. Prior clinical assessment revealed the murmur of mitral regurgitation. Which of the following would the NP anticipate finding on today’s physical exam?

A. A mid to late systolic murmur that follows a mid systolic click.

B. In early to mid systolic murmur harsh in quality, that radiates to the neck.

C. A holosystolic murmur that radiates to the axilla.

D. A localized mid to late diastolic murmur.

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