Endocrine
A 48-year-old female with type 2 diabetes mellitus has been unable to achieve optimal glycemic control with lifestyle modifications alone. This is the 1st line oral agent that should be added.
What is Metformin?
A patient recently diagnosed with allergic rhinitis presents for persistent eye redness and itchiness despite taking the maximum dose of Fexofenadine (Allegra). Adding a medicine in this class of medications is the next step in medical management.
What are intranasal corticosteroids, i.e. Fluticasone or Budesonide?
A 35-year-old male has a negative past medical history and a normal physical examination. He reports that he smokes half a pack of cigarettes per day and has 3–4 beers per week. A comprehensive metabolic panel reveals an ALT (SGPT) of 30 U/L (N 10–40) and an AST (SGOT) of 84 U/L (N 10–30). His liver disease is likely due to the consumption of what product.
What is alcohol?
A 50-year-old man presents for a routine health maintenance visit. You recommend colonoscopy for colorectal cancer screening, but he is uncomfortable with the invasive nature of the test. Instead, you recommend this non-invasive screening test, which if normal, can be done once every 3 years.
What is FIT-DNA, i.e. Cologuard?
A 64-year-old male with midsternal chest pain is brought to the emergency department by ambulance. He becomes pulseless and apneic, and CPR is begun. Cardiac monitoring shows ventricular tachycardia with a rate of 160 beats/min. This is the next step in management.
What is defibrillation.
A 63-year-old female sees you for evaluation of recurrent right foot swelling and redness. She has a history of obesity and type 2 diabetes with retinopathy, nephropathy, and peripheral neuropathy. She does not have any pain in the foot, fever, or chills. She does not recall any trauma or other inciting event. Vital signs are WNL. Her right foot appears swollen, red, warm to the touch, and is not tender to palpation. There are no open sores or calluses. A WBC count is normal. Radiographs reveal soft-tissue edema with no other abnormalities. You diagnose her with what condition in the foot?
What is Charcot neuroarthropathy?
A 45-year-old male presents to your office with a 2-month history of a nonproductive cough, mild shortness of breath, fatigue, and a 5-lb weight loss. On examination his lungs are clear. A PPD skin test is negative. A chest radiograph shows bilateral hilar adenopathy and his angiotensin converting enzyme level is elevated. A biopsy of the lymph node shows a noncaseating granuloma. This is the 1st-line treatment.
What is Prednisone?
A 25-year-old gravida 1 para 0 at 24 weeks gestation comes to your office with right lower extremity swelling and pain. Her pregnancy has been uncomplicated so far. Lower extremity Doppler ultrasonography confirms a right lower extremity deep vein thrombosis (DVT). This medication is chosen to treat her DVT.
What is subcutaneous enoxaparin (Lovenox)?
A 33-year-old gravida 3 para 2 presents for prenatal care 8 weeks after her last menstrual period. You tell her that this immunization is recommended for all women with each pregnancy.
What is Tdap?
This fluoroquinolone is indicated as 1st-line therapy for community-acquired pneumonia in a patient that does not require hospitalization.
What is Levofloxacin?
A 27-year-old female with a past medical history of polycystic ovary syndrome (PCOS) would like to become pregnant. This treatment for PCOS is associated with greater live-birth and ovulation rates?
What is Letrozole (Femara)?
In a double-blind randomized trial, letrozole was associated with greater live-birth and ovulation rates compared to clomiphene (SOR A). A Cochrane review indicated that metformin does not increase fertility in patients diagnosed with polycystic ovary syndrome (PCOS). Spironolactone and finasteride are both used to treat PCOS in women who do not desire pregnancy.
This class of medications is indicated to reduce "air-hunger"/breathlessness in end-of-life care.
What are opiates?
A GFR of 48 mL/min2 is this stage of chronic kidney disease.
What is stage IIIa (45-60)?
A 54-year-old female sees you for a wellness examination. Her last screening mammography 10 years ago revealed dense breasts but was otherwise normal. A past history of radiation for Hodkin's disease would warrant screening for breast cancer with this modality.
What is MRI?
MRI of the breasts should be reserved for women at very high risk for breast cancer such as those with genetic mutations, a history of breast irradiation, or a very high-risk family history. Women who had chest radiation therapy during childhood or adolescence, generally for Hodgkin’s disease, are at an extremely high risk for breast cancer.
A previously healthy 6-year-old male is brought to your office because he has a fever. After a complete history and physical examination, you are concerned that the child has Rocky Mountain spotted fever. This medication is the most appropriate management.
What is Doxycycline?
A patient is found to have a cold thyroid nodule and undergoes surgical removal. During a post-operative visit, her physical exam is significant for hoarseness. The most likely nerve damaged branches off of this cranial nerve?
X (vagus)
A 48-year-old female presents with dyspnea with exertion. She has never smoked. A physical examination is normal, including vital signs and pulse oximetry. A chest radiograph reveals mild hyperexpansion of the chest, and pulmonary function testing reveals an FEV1/FVC ratio of 0.67, unchanged after bronchodilator use. An EKG and stress echocardiogram are normal. This is the most likely cause of her newly diagnosed COPD.
alpha-1 antitrypsin deficiency
After group B streptococcus (GBS), this microorganism is the next most likely bug to cause neonatal sepsis.
What is Escherichia coli?
A 75-year-old white male presents to your office following hospitalization for an episode of heart failure. An echocardiogram demonstrated an EF of 35% He is on a guideline-directed beta-blocker, ACE-i, and aldosterone antagonist. You recommend this SGLT-2 inhibitor because it has been shown to decrease hospitalizations for patients with heart failure.
What is Empagliflozin (Jardiance)?
A 45-year-old woman with PMH obesity presents to the ED for acute mid-epigastric/right upper quadrant pain. She is febrile and tachycardic. Lactic acid is 5.1 mmol/L. She ultimately undergoes a HIDA scan that demonstrates gallstone pancreatitis. You give her a bolus of NSS, then set her IV fluid infusion at this rate for the 1st three hours.
What is 30 cc/kg/h?
A 46-year-old female with a past medical history of polycystic ovary syndrome and migraine headaches presents with bilateral, hyperpigmented patches along her mandible. The patches are asymptomatic but bother her cosmetically and seem to be darkening. This class of medications would be most likely to contribute to her melasma.
What are oral contraceptives?
Melasma is a progressive, macular, nonscaling hypermelanosis of skin exposed to the sun, typically involving the face and dorsal forearms. It is often associated with pregnancy and the use of oral contraceptives or anticonvulsants
The COVID-19 variant B.1.612.2 is more widely known by this letter of the Greek alphabet.
Abrupt onset of multiple seborrheic keratoses associated with underlying gastrointestinal malignancy is referred to as this "sign".
What is Leser-Trelat?
A 52-year-old male sees you for a routine health maintenance examination. He does not take any medications, does not drink alcohol, and is feeling well. A physical examination is normal with the exception of a BMI of 33 kg/m2. Routine laboratory studies reveal mild elevations of ALT (SGPT) and AST (SGOT), which remain elevated on repeat testing 2 months later. Hepatitis B and hepatitis C testing are negative. He is presumed to have NASH, but iron studies are indicated to rule out this liver condition.
What is hereditary hemochromatosis?
A 66-year-old man with an 80-pack-year history of tobacco use presents to the ED via ambulance for acute-onset, severe tearing chest and back pain. His blood pressure is 190/115. CT angiogram chest confirms aortic dissection. This medication is 1st-line to reduce his blood pressure in the ED.
What is Esmolol IV? Note, the loading dose is 500–1,000 mcg/kg/min administered over 1 min followed by a 50 mcg/kg/min infusion rate.