A 77-year-old man is in for a routine follow up visit. He has its twenty-year history of type 2 diabetes and hypertension as well as a 5-year history of stage 3B chronic kidney disease, or CKB. At this visit, his A1C is 8.4% and his estimated GFR is 42 mL per minute. His BP is 128/76. He states he's feeling well and denies headache, visual changes, dizziness and hypoglycemic episodes. His medications include metformin, amlodipine, lisinopril and rosuvastatin. In reviewing his current medication, the NP considers which of the following options?

A. Prescribe glipizide

B. Add pioglitazone

C. Continue on his current medication without adjustment

D. Initiate therapy with Canagliflozin

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A 72-year-old woman with a 20-year history of hypertension and dyslipidemia-- both at EBP goals with appropriate drug therapy, as well as a remote history of peptic ulcer disease-- presents for follow up. She is a nonsmoker, drinks about 1- 2 glasses of wine per week and denies the use of other substances. Her daily routine includes a 2- 3 mile walk and she denies history of acute coronary syndrome or other ASCVD related conditions. She mentions that one of her friends takes an aspirin a day to “prevent a heart attack or a stroke”, and further states, “I live alone, and I need to maintain my independence.” According to the latest recommendations from US Preventative Services Task Force, which of the following is the most appropriate advice regarding low dose aspirin use in this patient?

A. Start low dose aspirin therapy 81 mg daily as the vascular benefits outweigh the risk.

B. Best evidence for primary prevention of ASCBT event is with higher dose aspirin at 325 mg a day.

C. The risks associated with aspirin therapy in this patient outweigh the potential benefits.

D. Start aspirin therapy only if the patient has a family history of heart disease and 1st degree relatives.
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YouTube: https://www.youtube.com/watch?v=9uK3CINTFOg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=91

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A 57-year-old man presents for a routine physical exam during history taking. He reports that he drinks approximately 7-to-8 12-ounce beers nightly and denies other substance use, including tobacco. His physical examination is unremarkable except for mild pharyngeal erythema without exudate. In consideration of his health history, which of the following lab results would be anticipated?

A. Elevated platelets

B. Macrocytosis

C. Lymphocytosis

D. Elevated sed rate
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YouTube: https://www.youtube.com/watch?v=57EyxtFcUUY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=90

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