GIM

Question 1

Treatment options for depression in terminally ill patients

Answer 1

1) SNRI/SSRI
2) Tricyclic antidepressants
3) Mirtazepine
4) Stimulant therapy (methylphenidate)

Consider stimulant therapy if concomitant fatigue with short life expectancy (has rapid onset of action and helps with fatigue)

Question 2

Treatment options for acute bacterial prostatitis

Answer 2

Ciprofloxacin

TMP-SMX

Question 3

Eval of breast mass based on age

Answer 3

<30 - ultrasound

>30 - mammography and ultrasound

Question 4

MELD cutoff for liver transplant referral

Answer 4

15

Question 5

Indications for PCSK9 inhibitors (alirocumab)

Answer 5

Very high risk for ASCVD despite optimal statin therapy

Criteria for very high risk ASCVD are more than on major ASCVD event or one major ASCVD event plus multiple high risk conditions as below:

1) > 65 or older
2) heterozygoul familial hypercholsterolemia
3) prior CABG/PCI outside of a major ASCVD event
4) DM
5) HTN
6) CKD
7) Current smoking
8) Persistently elevated LDL (>100) despite statin + ezetimibe

Question 6

Kava tea should be avoided in what underlying condition?

Answer 6

Liver disease

Derived from piper methysticum, associated with potential risk for severe liver injury

Question 7

What affects the validity of cross-sectional studies?

Answer 7

Recall bias and confounding

Question 8

Treatment recommendations for Trichomonas

Answer 8

Metronidazole 2 g once

Treat sexual partners
Test for cure in 3 months
Test for HIV (2-3x risk of HIV if positive for trichomonas)

Question 9

Diagnostic characteristics of persistent depressive disorder (previously dysthymic disorder)

Answer 9

Depressed mood most of the time for the last 2 years with at least two additional symptoms: appetite change, fatigue, decreased self-esteem, insomnia, poor concentration, feeling hopeless

Question 10

Findings in opioid-indueced hyperalgesia

Answer 10

1) pain character changes during opioid therapy
2) pain decreased with dose-reduction
3) cognitive slowing
4) hyperreflexia
5) myoclonus

Question 11

When can DAPT be held following stent (placed for stable ischemic heart disease or ACS) for urgent surgery?

Answer 11

Hold P2Y12 inhibitor if minimum of 30 days since BMS or 3 months since DES

Continue aspirin

If taking aspirin for primary or secondary prevention (but no history of stent placement), discontinue aspirin 5 days before surgery

Question 12

Indications for PPSV23 vaccination in immunocompetent individuals

Answer 12

1) Chronic heart disease
2) Chronic Liver disease
3) Chronic lung disease
4) Diabetes
5) Cochlear implants
6) CSF leak
7) Alcoholism
8) Cigarette smoking

Question 13

Pressure ulcer prevention in high risk patients

Answer 13

1) Advanced static mattress or
2) Advanced static overlay

Frequent patient repositioning has a paucity of data in high risk patients

Question 14

LR+

Answer 14

sensitivity/(1-specificity)

Question 15

LR-

Answer 15

(1-sensitivity)/specificity