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Archer releases online medical community website for Residents and Physicians. Journal articles, questions, images and most sought after lectures and powerpoint presentations, step-by-step guidance and videos on performing procedures in Internal Medicine – all under one roof! Soon to be released : Preparatory course and Question bank for Internal medicine in-training examination and Internal medicine boards.

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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

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