A 62 year-old male was about to be discharged from the hospital. He was diagnosed with a stroke and was started on medications. He regained some of his strength in both upper and lower extremities but still has a visual field defect with loss of vision on the same side of both eyes. He has an outpatient appointment with a neurologist in two weeks. He is a commercial truck driver and the primary breadwinner for his family. You advised him not to drive until he regains full strength and complete vision. However, the patient reports that he cannot afford not to work and expresses strong desire to drive from tomorrow. What is the most appropriate step in the management of this patient regarding his driving?

A 76 year-old female is brought to your office by her caregiver for an annual physical examination. She reports ‘feeling very down’, not sleeping much, not eating much, not taking her medications properly, not asking for refills on time and having difficulty remembering things. She talks more openly when she is alone with you in the room and becomes reticent when her caregiver enters the room. In the physical examination, she has distinct bruises with pale central areas lined on either side by linear ecchymosis on both upper extremities. She also has some bruising around her eyes and ears. You asked the caregiver to leave the room briefly and asked the patient about the bruises. The patient replies that they happened three weeks ago. You asked the patient, ‘has anyone threatened you or harmed you?’ Patient replied, ‘It happened only once. I am praying for him. It will be alright’. What is the most appropriate next step in the management of this patient?

Mrs. Ruth is a mother of three boys of ages 7, 5 and 3. She brings all three kids to your practice for sick visits. You have been educating her on the importance of immunizations to her and her three children. She refused all immunizations because she heard that vaccines can cause genetic defects. You’ve spent considerable time in clearing the misconceptions about immunizations. You’ve explained where the disinformation about vaccines comes from, and emphasized the collective benefits of vaccinations. You showed her clinical trials which showed how vaccinations work and prevent their targeted diseases. Then, one day she brought her 5 year-old unimmunized boy to your office for an illness visit. The boy has a 3 day history of fever, cough, rhinorrhea, rash and watery eyes. On examination, his temperature is 101.5 F. The boy appears ill but is in no acute distress. He has a red raised rash on his face. His conjunctivae are injected. There are small white papules with bluish-white centers on the buccal mucosa. You noticed a blanching, erythematous, palpable rash over his chest, abdomen and back. You diagnosed him with measles. The mother informs you that her other two boys,who are at home with their dad, are also having similar signs and symptoms, though mild. What would be the best approach to this mother who still refuses immunizations?

Mary is a 10 year-old girl who is having very difficulty following directions given by her teachers. In a recent parent-teacher conference, her teacher told her mother that Mary is not paying attention to details, having difficulty sustaining her attention in tasks and losing her books and pencils in a few days. At home, she is easily distracted, forgetful and having difficulty waiting for her turn. Her mother asked you whether this is attention deficit hyperactivity disorder. Which of the following is true regarding this disease?

Taylor is a 11 year-old boy brought to your office by his mother because his teachers at school reported that Taylor has trouble holding attention on tasks; he does not seem to listen when spoken to directly; he interferes with other students unnecessarily even after being warned not to do so, he fails to give close attention to details; he frequently leaves his seat to go out of the classroom; he blurts out answers before the teacher finish asking the question; he does not wait for his turn. At home, his mother noticed that he is easily distracted; he does not sit quietly at the dinner table, he stops eating one dessert and goes for another dessert, he taps his hands and feet if he has to sit in one place for more than a minute. In the physical examination, you noticed a very talkative child, not able to sit properly in one place and very fidgety. Which of the following is the first-line treatment for his disorder?

Emily is a 15 year-old girl who was not sure what to do with her life. Over the weekend, her dad told her to pack her bags and go to Pittsburgh with him. While her dad attended a business meeting, she took a hike along Tranquil Trail and explored the Monongahela River for over six hours. As she walked through the valleys and along the creeks, she found a sense of mission in her life. She told herself, ‘This is what I am born to do: to preserve this beautiful landscape for the next generation’. Which of the following stages does Emily fit in the psychosocial stages developed by psychologist Erik Erikson?

A mother brought her 3 year-old daughter for her health examination. Mother reports that the child is ‘always in her own world’, not showing interest in things around her, not playing much and not making eye contact when being held. The mother works two jobs and keeps the child with the family of her boyfriend, who attends a suboxone clinic for his opioid dependence and leaves the child with his dad whenever he has to attend drug and alcohol counseling. When the patient was brought to your office 6 months ago, you advised the mother on providing proper physical, emotional and nutritional care to the patient. At that time, you informed her that her daughter’s growth and development is abnormal compared to other children of the same age. Mother reports ‘I am doing everything I can to feed my baby, but she sleeps too much and does not show interest to eat’. Today, in the physical examination, you noticed that this child is 20% below the ideal weight for her height. She is irritable and does not make eye contact with you. What is the most appropriate next step in the management of this child?