Match term to definition
1-124 of 124
Select a term to match it with its definition
Correct Answer: B. Varenicline
Varenicline blocks nicotine receptors from behind bound by nicotine, thus reducing the
'rewarding' effects of smoking. In head-to-head trials, it was found to be more effective
than nicotine replacement or bupropion. Early concerns about psychiatric side effects
have later been found to be unsupported.
Incorrect Answers:
A. Nicotine replacement therapy with patches, gum, or lozenges has been found to be
effective for nicotine cessation as well, but less effective than varenicline.
C. Bupropion is a norepinephrine and dopamine enhancing agent which is also effective
,for smoking cessation, especially in patients with depression. However, it is less effective
than varenicline.
D. Nortriptyline is a tricyclic antidepressant which is a second-line agent for smoking
cessation.
A 44-year-old women presents at your office with a request for assistance
with smoking cessation. Which of the following has been shown to be the
most effective pharmacologic therapy for cessation?
A. Nicotine replacement therapy
B. Varenicline
C. Bupropion
D. Nortriptyline
Correct Answer: C. Lowered thyroxine binding globulin (TBG) levels
Anabolic steroids can lower thyroxine-binding globulin (TBG) levels which, in turn, can
decrease total T4 levels, although free T4 remains the same.
Incorrect Answers:
A. This patient has multiple features that are consistent with anabolic steroid use,
including acne, a rapid increase in weight and muscle mass, and mood swings. In men
steroid use decreases serum luteinizing hormone and follicle-stimulating hormone
levels, which leads to decreased endogenous testosterone production, decreased
spermatogenesis, and testicular atrophy. There is also an increased estrogen production
due to the aromatization of circulating testosterone which can lead to gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a suppression
of clotting factors II, V, VII, and X.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased
serum HDL cholesterol, increased serum LDL cholesterol, increased total cholesterol,
and increased blood pressure. These effects appear to be reversible when anabolic
steroid use is discontinued. The risk of sudden death from cardiovascular causes can
occur in an athlete abusing anabolic steroids even when there is no evidence of
,atherosclerosis. This is due to an increased risk of thrombus formation while using
anabolic steroids.
A 16-year-old male presents because he is concerned about acne. He first
began to notice worsening acne 6 months ago and began using over-the-
counter benzoyl peroxide and, after 3 months, saw his primary care physician
who prescribed tretinoin and oral tetracycline. He states that he has been
using both medications for the last 3 months but there is no improvement in
acne. He also states he has noticed he is very quick to anger and moody over
the last few months and wonders whether that is a side effect of the acne
medications. He is a football player for his high school and has been
participating in extra practices to "bulk up" in the hopes of achieving a college
scholarship. Upon closer inspection, he has gained 30 pounds in the last 3
months but does not appear overweight, rather has increased muscle mass.
He states that a friend on the football team has been giving him pills to help
his performance. Which of the following is most likely to be identified?
A. Increased serum luteinizing hormone levels
B. Decreased prothrombin time
C. Lowered thyroxine binding globulin (TBG) levels
D. Increased serum HDL cholesterol
Correct Answer: A. Escitalopram
SSRIs are the first-line treatment choice for depressive disorders in older patients. They
are generally well- tolerated and safe.
Treating depression in older patients requires a thorough review of comorbid illnesses
and medications. There should also be careful follow-up and monitoring of side effects.
Incorrect Answers:
B. Tricyclic antidepressants (TCA) are generally advised against in patients with cardiac
arrhythmias. They can also worsen or affect narrow angle glaucoma , constipation, and
BPH. TCAs can cause confusion.
C. Doxepin is also a TCA (see explanation for B)
D. MAO inhibitors require special dietary and medication restrictions (many aged
, cheeses, meats, for example). This is not generally the first choice in medications for
antidepressant medications. One positive of MAOIs is that MAOI medications have very
little cardiac conduction effects.
Give this one a go later!
A depressed 75-year-old woman with a history of myocardial infarction s/p
stent, cardiac arrhythmia (on coumadin), and emphysema presents to your
office for the continuation of care. Which medication would you choose to
treat her depression?
A. Escitalopram
B. Nortriptyline
C. Doxepin
D. Selegiline
Correct Answer: C. Impetigo
While pruritis can be associated with impetigo, it is not typically the presenting symptom.
Non-bullous impetigo is the most common form of impetigo and it is characterized by
lesions that begin as papules and progress to form vesicles surrounded by erythema. The
vesicular lesions become pustular and then breakdown to form a crust that has a
characteristic honey colored appearance. Lesions usually involve face and extremities.
Bullous impetigo is less common and is characterized by enlargement of the vesicular
lesions to form bullae filled with clear yellow fluid.
Incorrect Answers:
A, B, D. Intense itching is characteristic of pediculosis pubis, scabies, and atopic
dermatitis. All of these conditions may present similarly to the patient above and should
be included in the differential diagnosis.
Vital Concepts:
Non-bullous impetigo is the most common form of impetigo and it is characterized by
lesions that begin as papules and progress to form vesicles surrounded by erythema. The
vesicular lesions become pustular and then breakdown to form a crust that has a
characteristic honey-colored appearance. Lesions usually involve face and extremities.
1-124 of 124
Select a term to match it with its definition
Correct Answer: B. Varenicline
Varenicline blocks nicotine receptors from behind bound by nicotine, thus reducing the
'rewarding' effects of smoking. In head-to-head trials, it was found to be more effective
than nicotine replacement or bupropion. Early concerns about psychiatric side effects
have later been found to be unsupported.
Incorrect Answers:
A. Nicotine replacement therapy with patches, gum, or lozenges has been found to be
effective for nicotine cessation as well, but less effective than varenicline.
C. Bupropion is a norepinephrine and dopamine enhancing agent which is also effective
,for smoking cessation, especially in patients with depression. However, it is less effective
than varenicline.
D. Nortriptyline is a tricyclic antidepressant which is a second-line agent for smoking
cessation.
A 44-year-old women presents at your office with a request for assistance
with smoking cessation. Which of the following has been shown to be the
most effective pharmacologic therapy for cessation?
A. Nicotine replacement therapy
B. Varenicline
C. Bupropion
D. Nortriptyline
Correct Answer: C. Lowered thyroxine binding globulin (TBG) levels
Anabolic steroids can lower thyroxine-binding globulin (TBG) levels which, in turn, can
decrease total T4 levels, although free T4 remains the same.
Incorrect Answers:
A. This patient has multiple features that are consistent with anabolic steroid use,
including acne, a rapid increase in weight and muscle mass, and mood swings. In men
steroid use decreases serum luteinizing hormone and follicle-stimulating hormone
levels, which leads to decreased endogenous testosterone production, decreased
spermatogenesis, and testicular atrophy. There is also an increased estrogen production
due to the aromatization of circulating testosterone which can lead to gynecomastia.
B. Anabolic steroid use can lead to increased prothrombin time as well as a suppression
of clotting factors II, V, VII, and X.
D. Anabolic steroid use can have multiple cardiovascular effects including decreased
serum HDL cholesterol, increased serum LDL cholesterol, increased total cholesterol,
and increased blood pressure. These effects appear to be reversible when anabolic
steroid use is discontinued. The risk of sudden death from cardiovascular causes can
occur in an athlete abusing anabolic steroids even when there is no evidence of
,atherosclerosis. This is due to an increased risk of thrombus formation while using
anabolic steroids.
A 16-year-old male presents because he is concerned about acne. He first
began to notice worsening acne 6 months ago and began using over-the-
counter benzoyl peroxide and, after 3 months, saw his primary care physician
who prescribed tretinoin and oral tetracycline. He states that he has been
using both medications for the last 3 months but there is no improvement in
acne. He also states he has noticed he is very quick to anger and moody over
the last few months and wonders whether that is a side effect of the acne
medications. He is a football player for his high school and has been
participating in extra practices to "bulk up" in the hopes of achieving a college
scholarship. Upon closer inspection, he has gained 30 pounds in the last 3
months but does not appear overweight, rather has increased muscle mass.
He states that a friend on the football team has been giving him pills to help
his performance. Which of the following is most likely to be identified?
A. Increased serum luteinizing hormone levels
B. Decreased prothrombin time
C. Lowered thyroxine binding globulin (TBG) levels
D. Increased serum HDL cholesterol
Correct Answer: A. Escitalopram
SSRIs are the first-line treatment choice for depressive disorders in older patients. They
are generally well- tolerated and safe.
Treating depression in older patients requires a thorough review of comorbid illnesses
and medications. There should also be careful follow-up and monitoring of side effects.
Incorrect Answers:
B. Tricyclic antidepressants (TCA) are generally advised against in patients with cardiac
arrhythmias. They can also worsen or affect narrow angle glaucoma , constipation, and
BPH. TCAs can cause confusion.
C. Doxepin is also a TCA (see explanation for B)
D. MAO inhibitors require special dietary and medication restrictions (many aged
, cheeses, meats, for example). This is not generally the first choice in medications for
antidepressant medications. One positive of MAOIs is that MAOI medications have very
little cardiac conduction effects.
Give this one a go later!
A depressed 75-year-old woman with a history of myocardial infarction s/p
stent, cardiac arrhythmia (on coumadin), and emphysema presents to your
office for the continuation of care. Which medication would you choose to
treat her depression?
A. Escitalopram
B. Nortriptyline
C. Doxepin
D. Selegiline
Correct Answer: C. Impetigo
While pruritis can be associated with impetigo, it is not typically the presenting symptom.
Non-bullous impetigo is the most common form of impetigo and it is characterized by
lesions that begin as papules and progress to form vesicles surrounded by erythema. The
vesicular lesions become pustular and then breakdown to form a crust that has a
characteristic honey colored appearance. Lesions usually involve face and extremities.
Bullous impetigo is less common and is characterized by enlargement of the vesicular
lesions to form bullae filled with clear yellow fluid.
Incorrect Answers:
A, B, D. Intense itching is characteristic of pediculosis pubis, scabies, and atopic
dermatitis. All of these conditions may present similarly to the patient above and should
be included in the differential diagnosis.
Vital Concepts:
Non-bullous impetigo is the most common form of impetigo and it is characterized by
lesions that begin as papules and progress to form vesicles surrounded by erythema. The
vesicular lesions become pustular and then breakdown to form a crust that has a
characteristic honey-colored appearance. Lesions usually involve face and extremities.
