Contraception
Dizziness
Random
Hormone Therapy & Menopause
The Clinic Special
100
Which of the following women can safely use combined hormonal contraception?
a. 36 y/o healthy woman with common migraine (migraine without aura)
b. 19 y/o woman with migraine with aura
c. 22 y/o woman with prior DVT not taking any anticoagulation
d. 28 y/o smoker who is otherwise healthy
What is d. 28 y/o smoker who is otherwise healthy?
100
Your next patient is James Stewart, a 56-year-old man with hypertension and benign prostatic hypertrophy. He has been feeling dizzy for the last several weeks. He particularly has a sense of dizziness when he gets up out of bed in the morning. He has a vague sense of feeling faint with this, but it passes within a few seconds after he stands up. He denies feeling a sense of motion. His only medical problems are hypertension and benign prostatic hypertrophy. He was started on atenolol three months ago for hypertension, and on tamsulosin approximately three weeks ago.
Which of the following physical findings is the most likely to be present that will help solidify your diagnosis?
a) A 30-point drop in systolic blood pressure when he moves from a supine to a standing position.
b) Marked upbeat torsional nystagmus with a Dix-Hallpike maneuver.
c) Disconjugate gaze on extra-ocular movement examination
d) Vesicles on the tympanic membrane
e) Decreased vibratory sense in his lower extremities with diminished ankle jerk reflexes.
What is A: A 30-point drop in systolic blood pressure when he moves from a supine to a standing position.
100
What year was Prisma Health created?
What is 2017?
100
A 50 year-old female sees you for follow-up and has number of complaints: fatigue, arthralgias, weight gain and dyspareunia. She thinks these symptoms are due to menopause and wants to take hormones.
Which ONE of her following symptoms is most likely NOT associated with menopause?
a) Fatigue
b) Weight gain
c) Dyspareunia
d) Arthralgias
What are Arthralgias?
100
What is the name of all 4 team nurses in clinic?
Who are Beth, Cindy, Heather, and Amanda?
200
20 y/o woman has been using Depo Provera for contraception but is overdue for her injection (nearly 1 week beyond the 2 week grace period). She’s scheduled to get her injection in a few days but had unprotected intercourse less 55 hours ago. She wants to discuss options for emergency contraception. Which one of the following has the highest efficacy for this patient?
a. 2 doses of multiple tablets of a combined oral contraceptive
b. Single dose of ulipristal (Ella)
c. Emergency contraception isn’t effective > 48 hrs after intercourse
d. Single dose of levonorgestrel (Plan B)
What is D, Single dose of levonorgestrel (Plan B)
200
Your next patient is Barbara BelGeddes, a 63-year-old woman who is in your office for an urgent visit today. She was sitting at the breakfast table this morning and slowly developed the sense that she was feeling dizzy. She describes a sense of the world moving around her, which doesn't change when she changes position. Ms. BelGeddes has no hearing loss or tinnitus. She has no recent illnesses. She does have a headache, which is unusual for her. She is having some difficulty walking, but doesn't tend to fall to one side or the other. She has a past medical history significant for long-standing poorly-controlled hypertension and type II diabetes.
On physical exam, you note that she has profound nystagmus. Based on the history above, what feature of the physical exam below would you most likely find?
a) Spontaneous horizontal nystagmus
b) Fast-phase of nystagmus remains to the left side regardless of direction of gaze
c) Catch-up saccade present with head impulse testing
d) Spontaneous vertical nystagmus with profound torsional component
e) Amplitude of the nystagmus decreases with fixation of gaze
What is d) Spontaneous vertical nystagmus with profound torsional component
200
What did the number of pleats in a chef's hat represent?
What is the number of ways a chef knew how to cook a specific food item?
200
A 47-year-old recently menopausal female is concerned about the complaints that many of her friends have about the symptoms of menopause. She is interested in taking hormone therapy to avoid these problems.
Which ONE of the following symptoms or conditions does not respond to hormone therapy?
a) Osteoporosis
b) Vasomotor symptoms
c) Vaginal atrophy
d) Urinary incontinence
What is Urinary Incontinence?
200
When ordering a MAP prescription how must you place the order?
What is 90 supply with 3 refills, NO PRINT?
300
Which of the following is a contraindication to combined hormonal contraceptives?
a. Elevated triglycerides
b. Pancreatitis
c. Prediabetes
d. Prothrombin gene mutation
What is D, Prothrombin gene mutation?
300
Tom Helmore is a 40-year-old man with hypercholesterolemia, who urgently presents to clinic complaining of the sudden onset of dizziness that began this morning. He has never before experienced these symptoms and wonders if he may be having a stroke. His initial symptoms were brought on when rolling over in bed. He describes the room spinning for about a minute. He did not go to work today as he was unable to drive this morning, but was able to do so this afternoon. He has no associated headache, aural symptoms, fever or nausea. What is the most likely cause of his vertigo?
a) Ménière Disease
b) Acoustic neuroma
c) Vestibular neuritis
d) BPPV
e) Ruptured berry aneurysm
What is BPPV?
300
Who was the 32nd president of USA?
Who was Franklin Delano Roosevelt?
300
A 65 year-old widow with a history of breast cancer has recently begun a new relationship with a male partner. She has been experiencing mild discomfort with intercourse. She has an intact uterus. Which of the following would be the best option for her initial treatment?
What is C, topical lubricant alone?
300
How many years did Dr. Jindal live in her prior house before moving into her new one?
What is 15 years?
400
21 y/o healthy patient initiated combined hormonal contraceptive 2 weeks ago on the 1st day of her period. She is now calling your office complaining of side effects. Which side effect would prompt reconsideration of this form of contraceptive?
a. Nausea
b. Breakthrough bleeding
c. Breast swelling and tenderness
d. New onset headache
What is D, No onset headache.
400
A 76-year-old woman with diabetes and hypertension presents with 3 months of feeling unwell. She notes that she has a low-grade headache nearly every day, and feels like her body is moving to either side even when she is sitting still. She feels unsteady on her feet, swaying left and right when she walks. She has not had headaches previously. Which of the following statements is correct?
a) Mild symptoms of dizziness suggest a peripheral cause of vertigo rather than a central cause.
b) Neuroimaging with MRI should be done, even if the physical exam is normal.
c) The most likely cause of her symptoms is a ruptured berry aneurysm.
d) Vestibular migraine is the most likely explanation of her symptoms.
What is b) Neuroimaging with MRI should be done, even if the physical exam is normal?
400
What fruit has the highest amount of Vitamin C per serving?
What is a Kakadu plum?
400
A 47 year-old menopausal female complains of frequent hot flashes, primarily at night. She does not want to take hormone replacement because of a strong family history of breast cancer. Concerning non-hormonal treatment options for menopausal symptoms, which of the following is correct?
a) Clonidine is effective and has few side effects.
b) SSRI antidepressants have been shown to be as effective as estrogen at treating menopausal symptoms.
c) Gabapentin given as an evening dose has been shown to be useful for relieving nocturnal hot flashes.
d) Black cohosh is effective at relieving the symptoms of menopause.
What is C, Gabapentin given as an evening dose has been shown to be useful for relieving nocturnal hot flashes?
400
What is Amy, social worker, last name?
What is Abdalla?
500
Combined hormonal contraception has proven benefit in preventing which of the following malignancies?
A. Colorectal cancer
B. Endometrial cancer
C. Ovarian cancer
D. All of the above
What is D, all of the above?
500
Kim Novak is a 34-year-old woman who presents to your office with 4 days of dizziness. She describes the dizziness as a sense of her head-spinning. It lasts for only about 10 seconds and then fades away. It seems to be triggered by changes in her position, particularly when she turns to the left side. The symptoms tend to be particularly severe when she first gets up in the morning, and then decrease as the day progresses. She denies headache, hearing loss, and tinnitus. She has no significant past medical history.
Her physical exam is normal, except that she has upbeat-torsional nystagmus with Dix-Hallpike maneuver when her head is turned to the left, but not the right.
Which of the following is the most appropriate next step?
a) Obtain an MRI of the head
b) Repeat the Dix-Hallpike maneuver multiple times with the patient looking to the left until the symptoms and nystagmus no longer appear
c) Treat with a course of meclizine for one week and have the patient return to the office for an attempt at a canalith repositioning maneuver if no resolution in that time
d) Treat with a course of methylprednisolone
e) Perform a canalith repositioning maneuver with the patient looking to the left side at the start of the procedure.
What is e) Perform a canalith repositioning maneuver with the patient looking to the left side at the start of the procedure?
500
What are the 4 Coagulation Factors involved in the intrinsic coagulation cascade pathway?
What are the 12, 11, 9, 8?
500
Your 49-year-old menopausal female patient who has been taking HT for the past year also recalls hearing that there may be other complications associated with HT. Which ONE of the following statements about the complications of HT is correct?
a) Oral HT with estrogen alone does not increase the risk of venous thromboembolism.
b) HT with estrogen + progestin increases the risk of ovarian cancer.
c) HT with estrogen + estrogen + progestin increases the risk of uterine cancer.
d) HT with estrogen + progestin may increase the risk of breast cancer.
What is D, HT with estrogen + progestin may increase the risk of breast cancer.?
500
What is Dr. Jindal's favorite genre of music?
What is country music?