Holiday Misc
This brought Frosty the Snowman to life
What is an old silk hat?
A 73 yr old male with advanced degenerative arthritis of the knees asks what you would recommend for relief. He does not wish to have a total knee replacement. He says that NSAIDs have not been effective. Which one of the following would be the best recommendation?
(a) Acetaminophen
(b) Intra-articular corticosteroids
(c) Intra-articular hylan GF 20 (Synvisc)
(d) Physical therapy for quadriceps strengthening
(e) Tramadol
(d) Physical therapy for quads strengthening
The name of the Grinch's dog
Who is Max?
The dietary herbal supplement with the highest risk for drug interactions is (check one)
A. black cohosh
B. ginseng
C. St. John’s wort (Hypericum perforatum)
D. saw palmetto
E. valerian
C. St. John's wort
St. John’s wort can reduce the effectiveness of multiple medications because it is an inducer of CYP3A4 and P-glycoprotein synthesis. Concurrent use of St. John’s wort with drugs that are metabolized with these systems should be avoided. These include cyclosporine, warfarin, theophylline, and oral contraceptives. St. John’s wort should be avoided in patients taking either over-the-counter or prescription medications.
Noel means this in French
What is Christmas?
The first artificial Christmas tree was made in Germany towards the end of the 19th century. What was the tree made out of?
What is Feathers?
A 66-year-old male recently underwent percutaneous angioplasty for persistent angina with exertion. He does not have any symptoms now. His LDL-cholesterol level is 90 mg/dL.
Which one of the following would be most appropriate for secondary prevention of this patient’s coronary artery disease?
A. No drug treatment
B. Evolocumab (Repatha), 140 mg subcutaneously every 2 weeks
C. Ezetimibe (Zetia), 10 mg daily
D. Rosuvastatin (Crestor), 20 mg daily
E. Simvastatin (Zocor), 40 mg daily
D. Rosuvastatin
Patients <75 years of age with established coronary artery disease should be on high-intensity statin regimens if tolerated. These regimens include atorvastatin, 40–80 mg/day, and rosuvastatin, 20–40 mg/day. Moderate-intensity regimens include simvastatin, 40 mg/day. Monotherapy with non-statin medications (bile acid sequestrants, niacin, ezetimibe, and fibrates) does not reduce cardiovascular morbidity or mortality. The PCSK9 inhibitors evolocumab and alirocumab are second-line or add-on therapies at this time.
The "Miracle on 34th Street" took place in this U.S. City
What is New York City?
A 32-year-old female sees you for a health maintenance visit. She reports that she experiences severe anxiety when involved in social situations. She lives with her mother and dreads meeting unfamiliar people. At work she remains in her cubicle throughout the day and avoids staff parties. She has a history of alcoholism in remission. She has otherwise been in good health and a physical examination is normal.
Which one of the following would be first-line treatment for this patient?
A. Amitriptyline
B. Bupropion (Wellbutrin)
C. Escitalopram (Lexapro)
D. Lorazepam (Ativan)
E. Pregabalin (Lyrica)
C. Escitalopram (Lexapro)
Social anxiety disorder can be treated with psychotherapy, pharmacotherapy, or both. Several medications have been used for the treatment of social anxiety disorder. SSRIs are considered to be the first-line pharmacologic treatment. Response rates reported for the SNRI venlafaxine have been similar to those reported for SSRIs. Randomized trials have also supported the efficacy of benzodiazepines for social anxiety disorder, but they carry a risk of physiologic dependence and withdrawal symptoms and are not recommended for patients with coexisting depression or a history of substance abuse. Response rates to pregabalin have been lower than with SSRIs. Tricyclic antidepressants and bupropion are not considered to be useful in the treatment of social anxiety disorder.
The town of Bethlehem was once part of this empire.
What U.S. state was the first to make Christmas an official holiday?
What is Alabama?
You are initiating pharmacologic therapy for a 75-year-old patient with depression. Which one of the following would be most appropriate for this patient?
A. Amitriptyline
B. Escitalopram (Lexapro)
C. Imipramine (Tofranil)
D. Paroxetine (Paxil)
B. Escitalopram (Lexapro)
Escitalopram is a preferred antidepressant for older patients (SOR C). Paroxetine should generally be avoided in older patients due to a higher likelihood of adverse effects (SOR C). Amitriptyline, imipramine, and paroxetine are highly anticholinergic and sedating, and according to the Beers Criteria, they can cause orthostatic hypotension. They have an “avoid” recommendation (SOR A).
Where was Kevin McAllister's family traveling to in Home Alone 2?
What is Miami?
A 7-year-old female with asthma is brought to your office because of her fourth episode of wheezing in the last 3 months. She has also had to use her short-acting β-agonist rescue inhaler more frequently.
Which one of the following should be added to reduce the frequency of asthma exacerbations? (check one)
A. A leukotriene receptor antagonist
B. A long-acting β-agonist
C. An inhaled corticosteroid
D. Inhaled cromolyn via nebulizer
C. An inhaled corticosteroid
Pediatric asthma is the most commonly encountered chronic illness, occurring in nearly one out of seven individuals. Short-acting β-agonists in the form of metered-dose inhalers are clearly favored for acute exacerbations, as well as for intermittent asthma. Treatment for persistent asthma requires the use of inhaled corticosteroids, with short-acting β-agonists used for exacerbations. For patients not well controlled with those options, either a long-acting β-agonist or a leukotriene receptor antagonist may be added. While both cromolyn and nedocromil are fairly devoid of adverse effects, their use is limited because of a lack of efficacy in the prevention of acute asthma exacerbations.
On ____ day of Christmas we celebrate the three kings.
What is the 12th day of Christmas? (Jan 6th also acceptable)
You know Dasher and Dancer and Prancer and _____.
Who is Vixen?
A 62-year-old female who is a new patient requests a thyroid evaluation because she has a history of abnormal thyroid test results. You obtain a copy of her records, which include a TSH level of 0.2 μU/mL (N 0.4–4.2) and a free T4 level of 2.0 ng/dL (N 0.8–2.7) from 3 years ago. She reports feeling well and has no other health conditions. She does not take any medications.
A physical examination reveals normal vital signs, a BMI of 23 kg/m2, no neck masses, a normal thyroid size, and normal heart sounds. Laboratory studies reveal a TSH level of 0.1 μU/mL, a free T4 level of 2.5 ng/dL, and a free T3 level of 3.1 pg/mL (N 2.3–4.2).
Treatment for this condition would be indicated if the patient has an abnormal...
A. calcium level
B. DXA scan
C. glucose level
D. lipid level
E. thyroid ultrasonography study
B. DXA scan
This patient has subclinical hyperthyroidism as evidenced by her low TSH level with normal free T4 and free T3 levels. Common causes of subclinical hyperthyroidism include Graves disease, autonomous functioning thyroid adenoma, and multinodular toxic goiter. Subclinical hyperthyroidism may progress to overt hyperthyroidism; this is more likely in patients with TSH levels <0.1 μU/mL. Even in the absence of overt hyperthyroidism these patients are at higher risk for several health conditions, including atrial fibrillation, heart failure, and osteoporosis. For this reason it is important to assess for these conditions and consider treating the underlying thyroid condition, as well as the complication. The American Thyroid Association recommends treating patients with complications who are either over age 65 or have a TSH level <0.1 μU/mL.
Lipid and glucose abnormalities are not known to be related to subclinical hyperthyroidism. Calcium levels may be abnormal in hyperparathyroidism but not hyperthyroidism. Thyroid ultrasonography may be helpful to determine the cause of hyperthyroidism but is not used to help decide when to treat subclinical hyperthyroidism.
What does Buddy the elf put on his spaghetti?
What is Syrup?
A 12-year-old female is brought to your office with a 3-week history of left groin pain that is most bothersome after she participates in gym class at her middle school. She does not recall a specific injury and does not participate in extracurricular sports. She had an upper respiratory infection about a month ago but has otherwise been well.
An examination reveals a BMI at the 95th percentile for her age. Her vital signs are within normal limits. A musculoskeletal examination is remarkable for limited internal rotation of the hip.
Which one of the following is the most likely diagnosis?
A. Adductor muscle strain
B. Apophysitis of the anterior superior iliac spine
C. Legg-Calvé-Perthes disease
D. Slipped capital femoral epiphysis
E. Transient synovitis
D. Slipped capital femoral epiphysis
The most common hip disorder in adolescents (ages 8–15) is slipped capital femoral epiphysis (SCFE). Early diagnosis and treatment are critical in preventing disability related to early-onset degenerative disease of the hip. In the past, SCFE has been more common in boys than in girls but that prevalence is changing due to the rise in obesity. SCFE should be suspected in an adolescent who has unexplained pain in the hip, groin, thigh, or knee. It is rarely associated with trauma, overuse, or prior illness. On examination the most indicative sign is limited internal rotation of the involved hip. Bilateral radiographs of the hips, including frog-leg lateral views, should be obtained in any adolescent who presents with a new limp and pain in the groin, hip, thigh, or knee (SOR C).
Adductor muscle strain (groin strain) is very uncommon in adolescents. Patients suspected of having a groin strain should also undergo radiography. Legg-Calvé-Perthes disease and transient synovitis are more common in children under age 10. The presenting symptoms of hip pain and a limp are similar to SCFE. Apophysitis of the anterior superior iliac spine is common in adolescents but is caused by overuse. It is mostly seen in runners, dancers, and ice hockey and soccer players ages 14–18.
The home of the REAL St. Nicholas
What is Turkey?
This was given on the first day of Christmas in the song 'The 12 days of Christmas'.
What is a partridge in a pear tree?
A 43-year-old male who works in a warehouse sees you because of dizziness. He first noticed mild dizziness when he rolled over and got out of bed this morning. He had several more severe episodes that were accompanied by nausea, and on one occasion vomiting occurred after he tilted his head upward to look for items on the higher shelves at work. You suspect benign paroxysmal positional vertigo, so you perform the Dix-Hallpike maneuver as part of the examination.
Which one of the following findings during the examination would confirm the diagnosis? (check one)
A. Nystagmus when vertigo is elicited
B. Vertigo that occurs immediately following the test-related head movement
C. Persistence of vertigo for 5 minutes following the test-related head movement
D. A drop in systolic blood pressure of >10 mm Hg when supine
A. Nystagmus when vertigo is elicited
Benign paroxysmal positional vertigo (BPPV) originates in the posterior semicircular canal in the majority of patients (85%–95% range reported). The Dix-Hallpike maneuver, which involves moving the patient from an upright to a supine position with the head turned 45° to one side and the neck extended 20° with the affected ear down, will elicit a specific series of responses in these patients. Following a latency period that typically lasts 5–20 seconds but sometimes as long as 60 seconds, the patient will experience the onset of rotational vertigo. The objective finding of a torsional, upbeating nystagmus will be associated with the vertigo. The vertigo and nystagmus typically increase in intensity and then resolve within 1 minute from onset.
In "Rudolph the Rednosed Reindeer" there is an elf named Hermey who really wants to be this. (for a living)
What is a dentist?
A 48-year-old male comes to your office for follow-up of recently diagnosed panic attacks. As part of his treatment plan he is taking sertraline (Zoloft), 50 mg daily, and working with a mental health provider who has diagnosed posttraumatic stress disorder associated with a traumatic childhood. He reports that his sleep continues to be interrupted by nightmares.
Which one of the following additional medications may provide long-term control of his symptoms?
A. Atenolol (Tenormin)
B. Lorazepam (Ativan)
C. Prazosin (Minipress)
D. Risperidone (Risperdal)
E. Zolpidem (Ambien)
C. Prazosin (Minipress)
An SSRI or SNRI should be used first as monotherapy for posttraumatic stress disorder (PTSD), and should be optimized before an additional agent is added. Prazosin is an effective augmenting therapy for patients with PTSD and sleep disturbance (SOR B). Other α-blockers and β-blockers have been shown to be ineffective in the treatment of PTSD. Benzodiazepines such as lorazepam can treat symptoms of hyperarousal but have been associated with adverse effects and should be avoided in the treatment of PTSD (SOR B). Hypnotics such as zolpidem are generally reserved for short-term use. There is no evidence to support the use of atypical antipsychotics for PTSD and their use should be avoided (SOR C).
When this person ruled England, he/she abolished Christmas.
(a) Queen Elizabeth
(b) Oliver Cromwell
(c) Henry VIII
Who is Oliver Cromwell