A mother brings her 13-year-old daughter to the office. The girl has had intermittent lower abdominal pain, constipation, and difficulty voiding for 3 months. She says that she is not sexually active. She looks well. She has reached age-specific developmental milestones, and her vital signs are within normal range. On abdominal examination, she is found to have a palpable suprapubic mass that persists after voiding. The girl says that her older sister started having menstrual periods at this age. The patient is surprised that hers have not started. Which one of the following is the best next step?

• A. Urinalysis.
• B. Pelvic ultrasonography.
• C. Abdominal radiography.
• D. Examination of external genitalia.
• E. Measurement of serum human chorionic gonadotropin.

A 35-year-old patient presents to your clinic for assessment of a chronic rash. With the patient's consent, you take a photo of the rash and upload it to their electronic medical record. You explain that you would like to consult with a specialist. That evening, you post a description of the rash to your online physicians' group, being careful to anonymize the details. You get a direct message from a physician who says they have extra training in dermatology and they ask you for a photo of the rash. Which one of the following is the best next step?

• A. Verify the clinic contact details for the physician and send the photo via secure portal.
• B. Text the anonymized photo directly to the physician.
• C. Explain to the physician why you cannot share any photos.
• D. Call the patient and ask permission to send the photo.

A 60-year-old man presents to the office with concerns regarding a pruritic rash, which he has had for several years. He reports a "crawling" sensation on his skin. He is concerned that this rash may be caused by a parasite he may have picked up while serving in the military overseas. On examination, you note multiple crusted lesions on his forearms, neck, chest, scalp, and thighs. There is a complete sparing of the skin on his back. He brought a bottle with fibrous material of different colours that he picked from his wounds. He is otherwise healthy and reports no other symptoms except some chronic fatigue and insomnia related to the itching. Which one of the following treatments is the most appropriate?

• A. Ivermectin
• B. Permethrin
• C. Fluconazole
• D. Butenafine
• E. Doxycycline

A 72-year-old man presents to your clinic accompanied by his 70-year-old husband. The patient reports that, over the last several months, his libido has been very low. Which one of the following would be the best next step?

• A. Refer for couple ' s counselling
• B. Prescribe testosterone
• C. Assess for depression
• D. Interview the couple together
• E. Order serum testosterone levels

A 29-year-old woman presents to the sexually transmitted infection clinic with concerns regarding a copious vaginal discharge. Ten percent potassium hydroxide was used to confirm the diagnosis of which one of the following?

• A. Trichomonas vaginalis.
• B. Gonorrhea.
• C. Group B streptococcus.
• D. Bacterial vaginosis.
• E. Chlamydia trachomatis.