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.

Visit fhea.com to learn more!

A 29-year-old patient presents with a genital lesion he first noted five days ago. The patient reports a new sex partner for the past four weeks with infrequent condom use. He denies dysuria, fever, urinary frequency, abdominal or scrotal pain, or penile discharge. Examination reveals a single well-defined ulcer on the shaft of the penis. The lesion is painless with a clear base and no purulent discharge. Mild non-tender inguinal lymphadenopathy is present. This clinical presentation is most consistent with:

A. genital herpes

B. primary syphilis

C. chancroid

D. Secondary syphilis

---

YouTube: https://www.youtube.com/watch?v=AcXiEUw94kY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=153

Visit fhea.com to learn more!

A 75-year-old woman presents to the urgent care service of her primary care provider's practice for a sick visit with a chief complaint of a two-day history of dysuria, urinary frequency, and urgency. She denies fever, flank pain, nausea, or vomiting. Her past medical history includes hypertension, stage three ACKD, and dyslipidemia. Current medications include an ARB, thiazide diuretic, statin, and an SGLT2i. Vital signs are stable. Physical exam is unremarkable except for mild suprapubic tenderness. Laboratory results include the following: Urinalysis, positive for leukocyte esterase and nitrites. Reference lab is negative for those substances. Estimated GFR is 48, Serum potassium is 4.8.

Which of the following is the most appropriate treatment?

A. Trimethoprim sulfamethoxazole DS

B. Nitrofurantoin

C. Ciprofloxacin

D. Amoxicillin

---

YouTube: https://www.youtube.com/watch?v=2kWxQiKJo20&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=152

Visit fhea.com to learn more!