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Question of the Week # 138 and 139

138) A 25-year-old woman is diagnosed with major depression. She denies any suicidal ideation. She has no history of manic episodes. She smokes about 1 pack of cigarettes per day.  The patient has been appropriately counselled on smoking cessation and is offered antidepressant therapy. She agrees to antidepressant therapy. The patient is very particular about her weight and would never consider any therapy that would lead to weight gain. Which of the following is the most appropriate next step?

A) Start Mirtazepine

B) Start Fluoxetine

C) Start Venlafaxine

D) Start Bupropion

E) Psychotherapy alone

Q139)  After one week of beginning the therapy, the patient calls you and reports no improvement in her symptoms. She has been using the therapy regularly. She is upset and would like to discontinue the therapy. Which of the following is most appropriate response?

A) “The Medication is not working. I can switch you to a different therapy”

B) “I am concerned about your compliance with the medications”

C) “You will need group therapy”

D) “You will need Electro-convulsive therapy”

E) “There may be a lag of two to six weeks before the therapy works”

Question of the Week # 137

Q137) A 45-year-old man presents to your office for regular health check up. Lately, he has experienced reduced libido and erectile dysfunction . Further work-up reveals no organic cause for his impotence. You offer him sildenafil however, he requests you to provide information on any natural herbal medicine that could likely help his sexual problems. Which of the following is likely to improve his erectile dysfunction?

A) Kava

B) Yohimbine

C) Ephedra

D) St.Johns Wort

E) Ginkgo biloba

Question of the Week # 136

136) A 55-year-old man with history of depression has recently been started on fluoxetine.  The patient has history of severe depression in the past. Fluoxetine dose has been recently increased to obtain adequate control of his symptoms. His depression symptoms are well-controlled now but the patient now complains of  erectile dysfunction. He is deeply concerned about this since this problem is adversely affecting his relations with his wife. Which of the following is most appropriate next step in managing this patient’s symptoms?

A) Decrease the dose of Fluoxetine

B) Start Sildenafil

C) Discontinue Fluoxetine and switch to Bupropion

D) Recommend Yohimbine

E) Recommend penile vacuum pump device.

Question of the Week # 135

Q135) A 45 year old woman was recently diagnosed with Stage II right sided breast cancer with positive axillary lymphnodes. The tumor was positive for estrogen receptors. She received lumpectomy followed by chemotherapy and then, radiation. She is then placed on Tamoxifen three weeks ago. The patient has been experiencing severe hot flashes since the start of Tamoxifen therapy. Most important next step in management:

A) Discontinue Tamoxifen

B) Start Fluoxetine

C) Start Venlafaxine

D) Start low dose estrogen pills

E) Reassure that symptoms will abate

Question of the Week # 134

Q134] A 55 year-old woman comes to your office complaining of  sweating, headache, nausea and vomiting.  This happened shortly after her lunch.  She had some grape fruit juice and redwine with her lunch. She had She has a long history of depression but she does not believe in conventional antidepressants.  She is not being medically treated for depression  and anxiety however, she has been using over the counter herbal medicine for her depression. Which of the following is the most likely medication she has been using ?

a] Ginkgo biloba

b] Kava – Kava

c] St.johns wort

d] Ephedra

e] Yohimbine

Question of the Week # 133

Q133] A 60 year old woman is on clopidogrel therapy and is also taking ginkgo biloba. By altering which of the following does Ginkgo potentiate the effect of clopidogrel? ?

a] Bleeding time

b] Clotting time

c] Reduction of Factor V and VII

d) Displaces clopidogrel from protein binding sites

e) Thrombin time

Question of the Week # 132

Q132] While you are on rounds in psychiatry wards, a 50 yr old depressed female patient tells you that she wants to be discharged soon. She says sometimes she feels like stabbing herself with a dinner knife provided along with her food. Your most important next step:

A] Discharge the patient according to her request
B] Replace the knifes and forks with plastic utensils
C] Arrange one-on one supervision
D] Arrange a nurse to visit her every 30 minutes

Question of the Week # 129, 130 and 131

Q129] You receive a telephone call from a worried mother. She says her 8 month old son just had a seizure lasting for 2 minutes. The description is generalized tonic-clonic. The seizure has subsided. He is feeding well and acting normally. His temperature is 103F  and RR: 28/min.  The child is not in any distress as per mother. She asks you what needs to be done. The most appropriate response :

A] “Take him immediately to the nearest ER”

B]  “This is nothing serious. You need to stay calm”

C]  “Give antipyretic to the child and monitor the temperature”

D] ” Does anyone in your family have epilepsy?”
Q 130] The patient’s mother in the above question also asks you what is the risk of her child developing a recurrent febrile seizure in future. The most appropriate response :

A] There is no such risk to your child

B] Risk is increased if his family member has a history of febrile seizure

C] He has no increased risk since he is younger than one year

D] He is at increased risk of developing intellectual impairment and neurological deficits.
Q131]  The child’s mother is still very concerned and she has further questions. She asks you, ” Doctor. I am very worried. Does this episode of seizure increase my son’s risk of developing future epilepsy?”
Most appropriate response:

A] Your child had a simple febrile seizure and  is definitely at very high risk of developing epilepsy
B] Your son will be at an increased risk of epilepsy if father has history of febrile seizures.
C] If another seizure occurs during this illness with in 24 hours then he will be at increased risk
D] He will not have increased risk of developing future epilepsy.

Question of the Week # 128

Q128]  Parents of a 2-year-old come in to discuss their child’s recent febrile seizures. The child has experienced four seizures, each associated with fever (usually from an ear infection). Each seizure lasted less than 2 minutes and was generalized tonic-clonic. The child was usually post-ictal for about 60 minutes but then returned to his normal level of mental function. The parents are concerned about the long-term significance of these seizures specifically, about any permanent brain damage and retardation. They wonder if their child should be on medication to prevent the seizures.
Which of the following is the most appropriate statement?

A) Children with a history of febrile seizures usually go on to a more complicated seizure pattern as they age.
B) Children with a history of febrile seizures typically perform less well on standardized school tests.
C) Children with febrile seizures typically are growth retarded.
D) Children with febrile seizures are at greater risk for premature death than the general public.
E) Most children who experience febrile seizures develop normally.

Question of the Week # 126 and 127

q126] A 25-year-old man presented to the dermatology clinic with a one-week history of papular lesions on penis. He says they are very itchy. The lesions appeared about the same time on his hands as well. The patient has multiple sexual partners. His wife has similar a problem with itchy papules. The patient denied any penile discharge. On examination he has lesions consisted of firm papules about 1 to 4 mm in diameter. Some papules were present in the finger webs. There were excoriations on other parts of his body. Based on the patient’s history and physical examination, which one of the following is the most likely diagnosis?
A. Bullous pemphigoid.
B. Pemphigus vulgaris.
C. Genital herpes.
D. Scabies.
E. Syphilis.

Q127) The most appropriate treatment for this patient:

A. Imiquomoid
b. Permethrin
c. Liquid nitrogen
d. Acyclovir
e. Penicillin

Question of the Week # 125

Q125) A 55 Year old man comes to your office with complaints of progressively shortness of breath on exertion for the past 3 months. Physical examination reveals scattered wheezes . Pulmonary function tests reveal irreversible obstructive pattern. The patient is started on tiotropium inhaler. His other medications include enalapril for hypertension and over-the-counter vitamin supplements that he routinely uses on a daily basis which include Vitamin A, Vitamin B-complex, Beta-carotene , Selenium and Vitamin E. Chest X-ray is consistent with chronic obstructive airway disease but did not reveal any lung nodules or masses. The patient is counselled about lung cancer risk and strongly counselled on cessation of smoking. In addition to counselling regarding smoking cessation, which of the following is the most important measure to reduce his lung cancer risk?

A) CT scan of the chest every year

B) Discontinue Vitamin E

C) Discontinue Selenium

D) Discontinue Beta Carotene

E) Start Vitamin D supplements for chemoprevention



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Question of the Week #124

Q124) A 50 year old man comes for regular health checkup. His family history is significant for colon cancer in his grandfather at the age of 70 and prostate cancer in his father at age 75. His mother had breast cancer at age 65. The patient recently underwent colonoscopy which was normal. During his visit, he asks you if there are any pills or medications that he could use to prevent cancer.  Which of the following have been shown to prevent cancer in a prospective clinical trial?

A)     Vitamin D

B)      Selenium

C)      Beta Carotene

D)     Finasteride

E)      Vitamin B-complex

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