Home Meds
A patient with a history of osteoporosis is started on alendronate. To minimize the most serious side effect, they should be instructed to do this after taking the medication
What is remain upright for at least 30 minutes to prevent esophagitis?
A 50-year-old patient with a 25 pack-year smoking history wants to discuss lung cancer screening. This is the USPSTF guideline regarding his eligibility.
What is that screening is recommended with low-dose CT if the patient is between 50-80 years old and has a 20+ pack-year smoking history?
A patient with severe sepsis has a serum lactate of 5.0 mmol/L and hypotension despite IV fluids. This medication should be administered next.
What is norepinephrine (first-line vasopressor)?
A 35-year-old woman presents with a painless thyroid nodule. After an ultrasound shows a suspicious lesion, this is the next best step.
What is a fine-needle aspiration biopsy?
A 50-year-old patient with metabolic syndrome wants to start an exercise regimen. According to current guidelines, this is the minimum recommended weekly duration of moderate-intensity aerobic activity.
What is 150 minutes per week (or 30 minutes per day times 5 days)?
This oral diabetes medication carries a risk of lactic acidosis
What is metformin?
A 55-year-old woman with no history of smoking or cardiovascular disease asks about aspirin for primary prevention. Based on USPSTF guidelines, this is the most appropriate recommendation
What is to avoid aspirin due to the risk of bleeding outweighing benefits?
A 65-year-old male presents with sudden-onset "ripping" chest pain radiating to the back. This bedside test is most useful for rapidly assessing the suspected diagnosis.
What is a point-of-care ultrasound (for aortic dissection)?
A 45-year-old woman with weight gain, muscle weakness, and facial plethora has an elevated late-night salivary cortisol. This is the next step in confirming the diagnosis
What is a low-dose dexamethasone suppression test (for Cushing’s syndrome)?
A patient with obesity wants to lose weight. This dietary pattern, known for emphasizing whole grains, lean proteins, and healthy fats, has the most evidence for cardiovascular benefits.
What is the Mediterranean diet?
A patient with depression and a history of smoking cessation attempts is prescribed an antidepressant that also helps with tobacco cravings. This is the mechanism of action of the drug
What is norepinephrine-dopamine reuptake inhibition (bupropion)?
A 40-year-old man with obesity and hypertension presents for a routine checkup. This screening test should be performed based on current USPSTF guidelines
What is diabetes screening with an A1c or fasting glucose test?
A patient with a history of IV drug use presents with fever and a new systolic murmur. This is the most appropriate initial diagnostic test.
What is transthoracic echocardiography (TTE) for infective endocarditis?
A patient presents with hypertension, hypokalemia, and metabolic alkalosis. After confirming an elevated aldosterone-to-renin ratio, this test should be performed next.
What is adrenal vein sampling (to differentiate unilateral from bilateral hyperaldosteronism)?
A patient with insomnia has difficulty falling asleep. They are advised to use their bed only for sleep and intimacy to reinforce this psychological principle.
What is stimulus control?
A patient with hypertension and chronic kidney disease is started on an ACE inhibitor. After one week, their serum creatinine increases by 35%. This is the next best step.
What is continuing the medication and rechecking creatinine in 2 weeks?
A 25-year-old sexually active woman with no symptoms presents for a well visit. This STI screening test is recommended
What is chlamydia and gonorrhea screening?
A 25-year-old woman presents with syncope after prolonged standing in a warm environment. This test helps confirm the most likely diagnosis.
What is a tilt-table test (for vasovagal syncope)?
A patient with newly diagnosed hypothyroidism is started on levothyroxine. They return in 6 weeks with persistently elevated TSH. This dietary supplement may be interfering.
What is calcium or iron (which impairs levothyroxine absorption)?
A patient with chronic stress and anxiety is interested in non-pharmacologic approaches. This mindfulness-based intervention has been shown to reduce stress and improve emotional well-being.
What is mindfulness-based stress reduction (MBSR)?
A 70-year-old with atrial fibrillation is started on warfarin. Despite appropriate dosing, their INR remains subtherapeutic. This common medication is most likely interfering
What is rifampin (or any CYP450 inducer)?
A 67-year-old male with no previous colonoscopy asks about colorectal cancer screening. If prior screening was normal, this is the recommended interval for repeat testing
What is every 10 years for colonoscopy (or every 1 year for FIT testing)?
A patient with suspected opioid overdose is given naloxone but does not respond. This is the most likely explanation
What is an overdose on synthetic opioids (e.g., fentanyl, which may require higher doses)?
DOUBLE JEOPARDY: A patient with long-standing diabetes presents with early morning hyperglycemia. After checking a 3 AM glucose, it is found to be low. This phenomenon is responsible.
What is the Somogyi effect (rebound hyperglycemia after nocturnal hypoglycemia)?
A sedentary office worker with chronic low back pain is advised to try this type of exercise, which strengthens core muscles and improves posture.
What is Pilates?