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The TSH level is below therapeutic range 0. Bioequivalent of oral to intravenous levothyroxine is ratio, so changing any dose to IV above 75mcg dose wound be to increase the dose. Bahn R, et al. Accessed May 18, The mean decrease in Heart Rate after initiating a beta blocker XYZ in 90 patients was 24 beat per minute with standard error of 3.

Question 16 Explanation:. Chest x-ray upon admission showed pneumonic infiltrate in the left lower lung and possible early pneumonia in the right lung base.

She was not on any antibiotics prior to admission. Question 17 Explanation:. D is the correct answer because she came from a nursing home she should be treated as having healthcare-care associated pneumonia risk for MDR. If it was a community acquired pneumonia transferred to ICU what would be the antibiotics of choice considering the patient has no penicillin allergy and no pseudomonas risks? Question 18 Explanation:. A is the correct answer because according to the IDSA CAP guidelines, antibiotics that should be started are a beta-lactam and either azithromycin or a fluoroquinolone for patients without penicillin allergy.

B is wrong because this option does not include a beta-lactam. Vancomycin is inappropriate because this is community-acquired pneumonia and therefore the patient is not at risk for MRSA as he would be if he had healthcare or hospital acquired pneumonia. Clinical Infectious Diseases. In a cohort study where the investigators looked at the association between smoking and throat cancer for 20 years found the relative risk of How can this data best be interpreted?

Smokers had 14 times the risk of throat cancer compared to non-smokers. Question 19 Explanation:. Reference: Irwig, Les. Chapter Relative risk, relative and absolute risk reduction, number needed to treat and confidence intervals. Smart health choices: making sense of health advice. Judy Irwig, Retrieved Jan. Question 20 Explanation:. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia.

Prior exposer to Ciprofloxacin and Levofloxacin. Question 21 Explanation:. Infection with the influenza virus has been shown to be a risk factor for MRSA. Other risk factors for multi-drug resistant HAP, VAP, and HCAP are previous use of antibiotics within the last 90 days, current hospitalization of 5 d or more, local high occurrence antibiotic resistance, immunosuppressive state, or risk factors for HCAP 2 or more days of hospitalization in past 30 days, residence in a long term care facility or nursing home, family member with multidrug-resistant pathogen, home wound care, family member with multidrug-resistant pathogen, chronic dialysis within the last 30 days, or home infusion therapy.

Investigations have shown that fluoroquinolones are associated with predisposing patients to MRSA infections. Fluoroquinolones and the Risk for Methicillin-resistant Staphylococcus aureus in Hospitalized Patients.

Emerging Infectious Diseases. JP is a 40yr old male who was found lying on the floor with several empty liquor bottles by his friend. Toxicology report negative except for high alcohol level. His liver enzymes and renal function are normal. No past medical history. What measures can one take to prevent ventilator associated Pneumonia VAP?

Twice daily oral decontamination with Chlorhexidine. A and C are appropriate measures to prevent VAP. Question 22 Explanation:. Other suggested measures for VAP prophylaxis are small bowel feeding instead of gastric feeding, prophylactic probiotics, alcohol based hand washing policy, early discontinuation of invasive devices, early tracheostomy, and reducing reintubation rates.

Giving prophylaxis antibiotic is not recommended. Ventilator-associated pneumonia in the ICU. Critical Care. What vitamin should the patient receive to avoid Wernicke- Korsakoff syndrome? Question 23 Explanation:. Reference: Management of moderate and severe alcohol withdrawal syndromes. Accessed May 24, What is the treatment of choice for his acute alcohol withdrawal? Question 24 Explanation:. Benzodiazepines are the most studied drugs for alcohol withdrawal treatment.

Long-acting agents such as Diazepam and Chlordiazepoxide may be used. Antipsychotics are not recommended to treat alcohol withdrawal. Haloperidol is an antipsychotic, an inappropriate choice. Management of drug and alcohol withdrawal. N Engl J Med ; A good general review of the management of the most common syndromes. Management of moderate and severe alcohol withdrawal syndromes.

Which of the following would be appropriate chronic treatment of choice for his alcohol withdrawal? Question 25 Explanation:. Acamprosate is indicated for ethanol dependence, but only in patients who have become abstinent. Diazepam is not indicated for ethanol dependence but for acute alcohol withdrawal. Metronidazole may interfere with the metabolism of ethanol, resulting in disulfiram-like effects.

Patients should try to avoid ethanol ingestion to avoid the risk of undesirable side effects. Duloxetine is not indicated to treat alcohol withdrawal. Reference: Doering P, Boothby L. A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill, Question 26 Explanation:.

Surgery, trauma major trauma or lower-extremity injury , immobility, lower-extremity paresis, cancer active or occult , cancer therapy hormonal, chemotherapy, angiogenesis inhibitors, radiotherapy , venous compression tumor, hematoma, arterial abnormality , previous VTE, increasing age, pregnancy and the postpartum period, estrogen-containing oral contraceptives or hormone replacement therapy, selective estrogen receptor modulators, erythropoiesis-stimulating agents, acute medical illness, inflammatory bowel disease, nephrotic syndrome, myeloproliferative disorders, paroxysmal nocturnal hemoglobinuria, obesity, central venous catheterization, and inherited or acquired thrombophilia.

Patients with coagulopathy not related to anticoagulation use. Requirement for mechanical Ventilator for over 48hrs. Question 27 Explanation:. Am J Health Syst Pharm. How many patients would you need to treat with rivaroxaban rather than enoxaparin to prevent 1 VTE event? Question 28 Explanation:. Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. JM is a 66 YOM comes to your clinic complaining of excessive thirst and urination for the past 1 month.

His past medical history includes hypertension and dyspepsia. Home medications includes Amlodipine 5mg by mouth daily and Famotidine 20 mg by mouth twice. He is 5 feet 8 inches and weighs pounds. A1C must be above 6. Question 29 Explanation:. Answer choices A, B, and C are also correct options for criteria to meet diagnosis for any patient, however they do not fit this patient specifically.

Only one of these 4 criteria has to be met to meet diagnosis. American Diabetes Association. In Standards of Medical Care in Diabetes Diabetes Care ;39 Suppl. Garber AJ, et al. Endocr Pract. Which of the following statements is true regarding piperacillin-tazobactam and ampicillin-sulbactam? Piperacillin-tazobactam covers Acinetobacter, ampicillin-sulbactam does not.

Piperacillin-tazobactam covers ESBL, ampicillin-sulbactam does not. Piperacillin-tazobactam covers pseudomonas, Ampicillin-sulbactam covers Acinetobacter. Neither Piperacillin-tazobactam or ampicillin-sulbactam has anaerobic coverage.

Question 30 Explanation:. A is wrong because ampicillin-sulbactam covers Acinetobacter and piperacillin-tazobactam has variable coverage for Acinetobacter. Reference: Gilbert D. The Sanford Guide to Antimicrobial Therapy Sperryville, Va. A patient comes in with urosepsis with risk factors for ESBL. What is the best option to start empiric therapy? Question 31 Explanation:. Ertapenem is the drug of choice for ESBL empirically due to higher percentage of sensitivity.

It can be de-escalated once culture and sensitivity available. Her allergies are sulfa and Moxifloxacin. Question 32 Explanation:. Cefepime coverage is narrower than that of piperacillin-tazobactam and the culture is sensitive to Cefepime. Which of the following are risk factors for clostridium Difficile?

Question 33 Explanation:. Advanced age, previous antimicrobial usage, duration of hospitalization, cancer chemotherapy, GI surgery, tube feeding, and use of acid-suppressing medications. Infection Control and Hospital Epidemiology. Doi: Given the data above what is the absolute risk of cardiovascular death with Dronedarone group in severe heart failure patients? Question 34 Explanation:. Absolute risk: 0.

What is the relative risk of cardiovascular death using Dronedarone therapy compared to placebo? Question 35 Explanation:. Relative risk: 2. Study that looked at mortality after Dronedarone Therapy for Severe Heart Failure What is the absolute risk of cardiovascular death in placebo group in severe heart failure patients?

Question 36 Explanation:. Study that looked at mortality after Dronedarone Therapy for Severe Heart Failure What is the relative risk increase using Dronedarone compared to placebo in severe heart failure patients? Question 37 Explanation:. Relative risk increase: 1. Question 38 Explanation:. Unless contraindicated, high-intensity statin therapy should be used. Question 39 Explanation:. Which of the following clinical laboratory tests should be ordered and evaluated if a patient complains of unexplained severe muscle symptoms or fatigue while on statin therapy?

Question 40 Explanation:. Creatine Phosphokinase CPK should be evaluated if a patient experiences unexplained severe muscle symptoms or fatigue while receiving statin therapy. Results from a case-control study where they assessed whether a drug is associated with decrease in weight showed odds ratio for weight change 0. The data inconclusive to whether the drug is associated with change in weight. Question 41 Explanation:. These results would suggest a look into the p-value to determine the significance of these results.

Reference: Szumilas, M. Which of the following medication may increase LDL? Question 42 Explanation:. LDL can be elevated by diuretics, cyclosporine, glucocorticoids, and amiodarone. Which of the following statement is true based on the given information? The rate of death from any cause was lower in the Apixaban group than in Warfarin group.

The rate of death from any cause was not significant in the Apixaban group Vs Warfarin group. Warfarin had significantly lower rate of death compared to Apixaban. Since there is no p value no conclusion can be drawn from the given data. Question 43 Explanation:. So it is appropriate to make a statement: The rate of death from any cause was lower in the Apixaban group than in Warfarin group the meaning of 1 in a confidence ration indicates that the risk reduction in the outcome is the same between the two groups.

Answer C is wrong because the rate of death in the warfarin group was higher than the rate in the Apixaban group 3. JAMA ; Apixaban is superior to warfarin in reducing rate of stroke or systemic embolism among patients with atrial fibrillation. Apixaban is as effective as warfarin in reducing rate of stroke or systemic embolism among patients with atrial fibrillation. Apixaban is more effective than warfarin in reducing rate of stroke but not systemic embolism among patients with atrial fibrillation.

Apixaban is superior to warfarin in reducing rate of stroke but warfarin is noninferior in reducing systemic embolism among patients with atrial fibrillation. Question 44 Explanation:. Answer A is incorrect because presented p-value is for noninferiority, not for superiority. Based on the given information, no conclusions about superiority can be made. Answer B. The p-value provided is for noninferiority, it can be concluded that Apixaban is as effective as warfarin in reducing rate of stroke or systemic embolism among patients with atrial fibrillation.

Answer C is incorrect. Stroke and systemic embolism were combined into one primary outcome here for this confidence interval, so more information is needed to determine which agent did better for the specific type of event, either stroke or systemic embolism.

Answer D. For the same reason as with C, these two events are represented as combined into one primary outcome and more information would be needed.

Lifestyle modification and lisinopril 2. Lifestyle modification and amlodipine 2. Life style modification and metoprolol succinate 25md daily. Question 45 Explanation:. A 65 years old Caucasian man with a history of hypertension, hypercholesterolemia presents to your clinic. His current medication includes Valsartan mg daily, atorvastatin 80mg daily, hydrochlorothiazide 25mg daily and Amlodipine 10mg daily. Which of the following is the best medication to add?

Nifedipine 30mg Extended release oral daily. Question 46 Explanation:. A 37 years old Caucasian Man with no past medical history presents to your clinic. Life style modification and hydrochlorothiazide 25mg daily.

Question 47 Explanation:. The patient is under the age of 60 and is considered a member of the general population since there is no known history, and he is Caucasian.

JNC8 does not address definitions of hypertension and prehypertension, but defines the threshold for initiating pharmacologic therapy. Medications should be started when SBP is mmHg or higher.

Both choices B and C are appropriate options at appropriate starting doses. What is the relative risk reduction of using Rivaroxaban over Enoxaparin?

Question 48 Explanation:. Relative risk reduction: 0. What is the absolute risk reduction of using Rivaroxaban over Enoxaparin? Question 49 Explanation:. Absolute risk reduction: 0. Question 50 Explanation:. Categorical data includes ordinal ordered categories and nominal unordered categories. Age is not categorical because age can fall under any continuous number, so it is considered quantitative, continuous data.

Sex is nominal categorical data. NKDA and weighs 80 Kg. CT abdomen and pelvis with contrast confirmed advanced pancreatitis. Vitals: RR 16, Pulse , Temperature Which of the following is the best initial approach for his management of acute pancreatiits? Early aggressive intravenous hydration with Lactate Ringer. Early aggressive intravenous hydration with Normal Saline.

Early aggressive oral hydration with electrolyte balanced drink. Question 51 Explanation:. Thus, D and B, and C are incorrect. Antibiotics should be given for an extrapancreatic infection. Prophylactic antibiotics should be given to all patients with acute pancreatitis.

Antibiotic should be given to patients with sterile necrosis. Question 52 Explanation:. Antibiotics should be given for an extrapancreatic infection, such as cholangitis, catheter-acquired infection, bacteremia, urinary tract infection, and pneumonia. Routine use of prophylactic antibiotics in patients with severe acute pancreatitis is not recommended.

The use of antibiotics in patients with sterile necrosis to prevent the development of infected necrosis is not recommended. Also, routine use of prophylactic antibiotics in patients with severe acute pancreatitis is not recommended. Thus, B, C, and D are incorrect. Which of the following drug ME is on, have reported cases of pancreatitis? Question 53 Explanation:. All of the above medications has reported cases of pancreatitis. Kaurich T. Availbale at: www. Accessed September 29, Question 54 Explanation:.

Serum lipase has a sensitivity and specificity for acute pancreatitis and may rise within hours of the onset of symptoms, and peak at 24 hours. Thus answers A, B, and D are incorrect. Reference: Acute Pancreatitis. What is the first-line agent for prevention of Hypertriglyceridemia-induced acute pancreatitis?

Question 55 Explanation:. Patients with very high triglyceride levels i. Fibrates or niacin is practical first0line choices for these patients. Thus, A is incorrect. Thus, D is incorrect. Insulin therapy is initiated for acute pancreatitis treatment, thus C is incorrect. When Apheresis is unavailable, besides aggressive hydration, what is optimal alternative for treatment of Hypertriglyceridemia-induced acute pancreatitis?

Continuous intravenous insulin infusion with blood sugar parameters. Heparin units subcutaneous twice daily. Short duration of high dose of fenofibrates. Question 56 Explanation:. Answers C and D are incorrect, as they are utilized for preventative care. Typically IV infusion of regular insulin is started at a rate of 0.

The serum glucose should initially be measured every hour to monitor glucose levels and the insulin infusion should be adjusted accordingly. Triglyceride levels should be monitored every 12 to 24 hours with adjustment of the insulin dosage as needed. Intravenous insulin should be stopped when triglyceride levels are Reference: I. Hypertriglyceridemia-induced Acute Pancreatitis.

Physician orders to give magnesium sulfate 2gm intravenously, potassium chloride 40meq intravenously, sodium phosphate 15 mmol intravenously and Calcium chloride 2gm intravenously.

Which of the following electrolytes should not be infused together in the same intravenous line? Magnesium sulfate 2gm intravenously and Potassium chloride 40meq intravenously. Sodium phosphate 15 mmol intravenously and Calcium chloride 2gm intravenously. Potassium chloride 40meq and Calcium chloride 2gm intravenously. Magnesium sulfate 2gm intravenously and Calcium chloride 2gm intravenously. Question 57 Explanation:. Calcium salts and phosphates are inherently incompatible and will precipitate, thus one should not infusing sodium phosphate and calcium chloride together in the same intravenous line.

Reference: Clinical Pharmacology. Question 58 Explanation:. Which of the following if true regarding intravenous calcium gluconate 1gm and intravenous calcium chloride 1gm? Calcium gluconate provides 4. Calcium gluconate 1gm and calcium chloride 1gm both provide 4. Calcium gluconate provides Calcium gluconate 1gm and calcium chloride 1gm both provide Question 59 Explanation:.

Accessed September 30, There were total of cases of syphilis with reported new case of syphilis in Dresner County in The population of Dresner County in was , people. What is the incidence proportion of syphilis in in Dresner County? Question 60 Explanation:. The population of Dresner County is , people. What is the incidence rate of syphilis in in Dresner County?

Question 61 Explanation:. Question 62 Explanation:. Nadolol is not proven to reduce mortality in patients with systolic CHF. The efficacy of nadolol in HF has not been determined. For patients taking nadolol, it should be used with caution in those with compensated heart failure and patients should be monitored for a worsening of the condition. Bisoprolol, carvedilol, and sustained-release metoprolol succinate are the beta-blockers that have been proven to reduce mortality in patients with systolic CHF.

These 3 beta-blockers have been effective in reducing the risk of death in patients with chronic HFrEF. Other beta-blockers were found to be less effective. Bucindolol did not exhibit uniform effectiveness across different populations. Metoprolol tartrate was found to be less effective in HF clinical trials. J Am Coll Cardiol. TM is a 78 YOW with a history of hypertension, hypercholesterolemia and arthritis was admitted for proximal arterial fibrillation.

While in the hospital she was placed on diltiazem drip and eventually, converted to oral diltiazem mg. What would be the most appropriate change to make on her therapy? Change Simvastatin 40mg to Atorvastatin 40mg po daily. Change Simvastatin to Lovastatin 20mg po daily. Question 63 Explanation:. Answer C. Diltiazem has a major drug interaction with Simvastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily. FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor simvastatin to reduce the risk of muscle injury.

December 15, Question 64 Explanation:. Short-course antibiotic therapy is associated with less antibiotic exposure and antibiotic resistance. This would result in reduced costs and side effects.

The benefits of therapy are not reduced with a shorter duration. Clin Infect Dis. PM is a 62 YOM who has never received zoster vaccine. When he was 57 year old he had an episode of herpes zoster. He wants to know if he is a candidate for zoster vaccine. Which of the following statement is true? No he is not a candidate for zoster vaccine since he already had herpes zoster and has built immunity to it.

Yes he is still candidate for zoster vaccine regardless of his prior episode of herpes zoster. No he is not a candidate, since it is recommended for patients who are 65 years old and above. No he is not a candidate since it is only indicated for patients who are under 60 years of age. Question 65 Explanation:. A single dose of zoster vaccine is recommended for all adults 60 years or older, regardless of whether they report a prior episode of herpes zoster, thus A is wrong.

Also, although 2nd and 3rd episodes of herpes zoster can occur, the annual incidence of recurrence is not known. Although the FDA recommends the administration of the vaccine for individuals 50 years or older, the ACIP recommends that vaccinations begin at 60 years, thus C and D are incorrect. Accessed September 27, Adult Immunization Schedule. Centers for Disease Control and Prevention. Updated April 20, JP 77 YOW with a history of hypertension, just got admitted for Ischemic Stroke what would be the most appropriate pharmacotherapy recommendation upon discharge?

Question 66 Explanation:. A stroke falls under the category of clinical ASCVD, which includes includes acute coronary syndromes, or a history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin.

This patient is under 75 years old, and such patients with clinical ASCVD should receive moderate-intensity statin therapy. However, ATP4 acknowledges that the older patients in the corresponding RCTs were likely to be healthier than those in the general population, so treatment can be individualized.

Given the options above, a high intensity statin is the most appropriate option. The decision to start at the 80 mg dose of atorvastatin instead of the 40 mg dose is based on the recommendation to down titrate if the patient is unable to tolerate the 80 mg dose as opposed to up-titrating in accordance with the IDEAL trial.

Due to contamination of water supply in a small town there were several outbreak of gastroenteritis. Construct a contingency table. What is the odds ratio OR?

What is the relative risk RR? Question 67 Explanation:. Cases are patients that had gastroenteritis and non-cases are patients that did not have the illness present.

Szumilas, M. DM is a 75 YOW with a history of systolic heart failure who presents to the ER with a 5 days history of progressive worsening of shortness of breath. Bilateral pleural effusions. No chills or fevers. Current medication is enalapril 20mg oral daily, carvedilol 6. Which of the following would be the immediate course of action? Lasix 40mg intravenously twice daily and monitor fluid status. Increase enalapril to 40mg oral twice daily. Increase Carvediolol to 25mg orally twice daily.

Question 68 Explanation:. Initiating Lasix 40 mg IV twice daily would be the immediate course of action in order to improve symptoms of fluid retention. Fluid status would be monitored. Normal saline would not be given. DM would most likely have fluid restricted 1.

For enalapril, the max dose is 20 BID for the treatment of heart failure. Increasing Enalapril would not improve symptoms of heart failure in the short term. Carvedilol would not be increased until after the patient is stable and IV diuretics stopped as well as any vasodilators and inotropic agents.

Which of the following medication would be most appropriate to initiate when DM is maxed out on diuretics? Question 69 Explanation:.

Nitroglycerin would be the most appropriate to initiate when DM is maxed out on diuretics. IV nitroglycerin helps to rapidly reduce pulmonary congestion. There is also no dosage adjustments provided for renal impairment. Sodium nitroprusside can also dilate pulmonary vasculature. However, in patients with renal impairment, there is a risk of thiocyanate accumulation and toxicity. Nesiritide has a longer half-life compared to nitroglycerin and nitroprusside and may result in adverse effects occurring for a longer period of time, such as hypotension.

Studies have also indicated that patients may be at risk for worsening renal function and increased mortality while taking nesiritide. A recent meta-analysis indicated that there was no significant increase in mortality. When compared to placebo, there was no increased risk of mortality in those treated with nesiritide.

However, it is associated with an increased risk of cardiovascular adverse events such as bradycardia and hypotension. Dobutamine would not be used in this case. It would be used as short-term management in those with cardiac decompensation in order to maintain perfusion and preserve end-organ performance in those with cardiogenic shock; bridge therapy in those with stage D heart failure who are unresponsive to guideline-directed medical therapy and device therapy awaiting a heart transplant or mechanical circulatory support; treat those with severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output, or to provide palliative therapy in select patients.

The guidelines also stated that intermittent IV positive inotropic therapy has no proven value in patients with stage C heart failure. In: Clinical Pharmacology [database on the Internet].

Available from: www. Efficacy and safety of nesiritide in patients with decompensated heart failure: a meta-analysis of randomised trials. BMJ Open. DM feels much better her SOB is improved. All the diuretics have been stopped. Her hemodynamics are stable. What would be the next appropriate course of action? Increase the Carvedilol to Change carvedilol 3.

Question 70 Explanation:. The next appropriate course of action would be to increase Carvedilol. Since all diuretics have been stopped and her hemodynamics stable, initiating a beta-blocker is appropriate. The dose would be gradually increased every 2 weeks to the highest dose tolerable.

 
 


 

The Board of Pharmacy Specialties has provided an overview video of BPS and the role Board Certified Pharmacists play in improving patient outcomes, eliminating medication errors and reducing healthcare costs globally. BPS recognizes that users may have concerns about privacy issues as they navigate the Internet. BPS is committed to providing users with a safe, secure environment in which to secure information. We recommend visiting the Federal Trade Commission website for more information about general privacy issues.

For more information about our Privacy Policy, click here. At BPS, we use a feature on your Internet browser called a “cookie”. A cookie is a small text file often including a unique identifier that is sent to a user’s web browser from a website’s computer and stored on a user’s computer’s hard drive or on a tablet or mobile device collectively, “Computer”.

A cookie stores a small amount of data on your computer about your visit to the website. Cookies do not collect any personal data stored on your hard drive or computer. Change Simvastatin to Lovastatin 20mg po daily. Question 63 Explanation:. Answer C. Diltiazem has a major drug interaction with Simvastatin. Given the current options, the best choice is to change to Atorvstatin 40 mg po daily. FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor simvastatin to reduce the risk of muscle injury.

December 15, Question 64 Explanation:. Short-course antibiotic therapy is associated with less antibiotic exposure and antibiotic resistance. This would result in reduced costs and side effects. The benefits of therapy are not reduced with a shorter duration. Clin Infect Dis. PM is a 62 YOM who has never received zoster vaccine. When he was 57 year old he had an episode of herpes zoster. He wants to know if he is a candidate for zoster vaccine.

Which of the following statement is true? No he is not a candidate for zoster vaccine since he already had herpes zoster and has built immunity to it.

Yes he is still candidate for zoster vaccine regardless of his prior episode of herpes zoster. No he is not a candidate, since it is recommended for patients who are 65 years old and above. No he is not a candidate since it is only indicated for patients who are under 60 years of age.

Question 65 Explanation:. A single dose of zoster vaccine is recommended for all adults 60 years or older, regardless of whether they report a prior episode of herpes zoster, thus A is wrong. Also, although 2nd and 3rd episodes of herpes zoster can occur, the annual incidence of recurrence is not known. Although the FDA recommends the administration of the vaccine for individuals 50 years or older, the ACIP recommends that vaccinations begin at 60 years, thus C and D are incorrect.

Accessed September 27, Adult Immunization Schedule. Centers for Disease Control and Prevention. Updated April 20, JP 77 YOW with a history of hypertension, just got admitted for Ischemic Stroke what would be the most appropriate pharmacotherapy recommendation upon discharge?

Question 66 Explanation:. A stroke falls under the category of clinical ASCVD, which includes includes acute coronary syndromes, or a history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin. This patient is under 75 years old, and such patients with clinical ASCVD should receive moderate-intensity statin therapy.

However, ATP4 acknowledges that the older patients in the corresponding RCTs were likely to be healthier than those in the general population, so treatment can be individualized. Given the options above, a high intensity statin is the most appropriate option. The decision to start at the 80 mg dose of atorvastatin instead of the 40 mg dose is based on the recommendation to down titrate if the patient is unable to tolerate the 80 mg dose as opposed to up-titrating in accordance with the IDEAL trial.

Due to contamination of water supply in a small town there were several outbreak of gastroenteritis. Construct a contingency table.

What is the odds ratio OR? What is the relative risk RR? Question 67 Explanation:. Cases are patients that had gastroenteritis and non-cases are patients that did not have the illness present. Szumilas, M. DM is a 75 YOW with a history of systolic heart failure who presents to the ER with a 5 days history of progressive worsening of shortness of breath.

Bilateral pleural effusions. No chills or fevers. Current medication is enalapril 20mg oral daily, carvedilol 6. Which of the following would be the immediate course of action? Lasix 40mg intravenously twice daily and monitor fluid status. Increase enalapril to 40mg oral twice daily. Increase Carvediolol to 25mg orally twice daily. Question 68 Explanation:. Initiating Lasix 40 mg IV twice daily would be the immediate course of action in order to improve symptoms of fluid retention.

Fluid status would be monitored. Normal saline would not be given. DM would most likely have fluid restricted 1. For enalapril, the max dose is 20 BID for the treatment of heart failure. Increasing Enalapril would not improve symptoms of heart failure in the short term.

Carvedilol would not be increased until after the patient is stable and IV diuretics stopped as well as any vasodilators and inotropic agents. Which of the following medication would be most appropriate to initiate when DM is maxed out on diuretics?

Question 69 Explanation:. Nitroglycerin would be the most appropriate to initiate when DM is maxed out on diuretics. IV nitroglycerin helps to rapidly reduce pulmonary congestion. There is also no dosage adjustments provided for renal impairment. Sodium nitroprusside can also dilate pulmonary vasculature. However, in patients with renal impairment, there is a risk of thiocyanate accumulation and toxicity.

Nesiritide has a longer half-life compared to nitroglycerin and nitroprusside and may result in adverse effects occurring for a longer period of time, such as hypotension. Studies have also indicated that patients may be at risk for worsening renal function and increased mortality while taking nesiritide.

A recent meta-analysis indicated that there was no significant increase in mortality. When compared to placebo, there was no increased risk of mortality in those treated with nesiritide. However, it is associated with an increased risk of cardiovascular adverse events such as bradycardia and hypotension.

Dobutamine would not be used in this case. It would be used as short-term management in those with cardiac decompensation in order to maintain perfusion and preserve end-organ performance in those with cardiogenic shock; bridge therapy in those with stage D heart failure who are unresponsive to guideline-directed medical therapy and device therapy awaiting a heart transplant or mechanical circulatory support; treat those with severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output, or to provide palliative therapy in select patients.

The guidelines also stated that intermittent IV positive inotropic therapy has no proven value in patients with stage C heart failure. In: Clinical Pharmacology [database on the Internet]. Available from: www. Efficacy and safety of nesiritide in patients with decompensated heart failure: a meta-analysis of randomised trials. BMJ Open. DM feels much better her SOB is improved. All the diuretics have been stopped. Her hemodynamics are stable. What would be the next appropriate course of action?

Increase the Carvedilol to Change carvedilol 3. Question 70 Explanation:. The next appropriate course of action would be to increase Carvedilol. Since all diuretics have been stopped and her hemodynamics stable, initiating a beta-blocker is appropriate. The dose would be gradually increased every 2 weeks to the highest dose tolerable.

She would also be monitored for congestive signs and symptoms of HF Digoxin would not be added. Even though digoxin can improve symptoms in mild to moderate HF, long-term treatment had no effect on mortality. It does have the potential to decrease hospitalizations for HF. Carvedilol would not be changed to metoprolol tartrate since metoprolol tartrate was found to be less effective in patients with heart failure.

Enalapril would not be increased. Proportion of people in a population who have a particular disease at a specified point in time or over a specified period of time is definition as which of the following?

Question 71 Explanation:. Dicker, R. Numerators, denominators and populations at risk. Which of the following would be the most appropriate option for management of his type 2 diabetes Mellitus? Discontinue Metformin, add Pioglitazone 30mg by mouth daily.

Discontinue Metformin, add Empagliflozin 10mg by mouth daily. Discontinue Metformin, add Exenatide 2mg SQ once weekly.

Question 72 Explanation:. Pioglitazone is not a good option since it can exacerbate his CHF and caries a black box warning.

Question 73 Explanation:. The patients A1C goal should be 65 years. The Reference: I. Question 74 Explanation:. Relative risk can be stated as 0. Irwig, Les.

He did get influenza vaccine last year. Which of the following is correct course of action. Skip influenza vaccine for this year since he received vaccine last year. Start WM on Tamiflu to prevent him from getting influenza. Vaccinate him with influenza vaccine since influenza season lasts until March in your community.

Question 75 Explanation:. Influenza vaccine is recommended annually, thus, WM should not skip it this year, and B is incorrect. Also, per the CDC, seasonal influenza outbreaks can occur as early as October, however, most activity peaks in January or later. Thus, it is not too late for WM to receive his vaccine in December, thus A is incorrect. Lastly, antiviral medications such as Tamiflu are an important adjunct to vaccinations.

They are recommended as early as possible for any patient with confirmed or suspected influenza who, is 1 Hospitalized, 2 has severe, complicated, or progressive illness or 3 is at higher risk for influenza complications. Thus, WM is not a candidate with the given information and C is incorrect. Question 76 Explanation:. Those who takes aspirin regularly have 0.

Question 77 Explanation:. Hazard ratio can be used to compare time-to-event data between 2 groups. In this case the time to event was 20 years-to-death from colorectal cancer and the groups were patients taking aspirin mg 2 or more times a week and patients that did not.

With the HR being 0. Reference: Sedgwick, Philip, and Katherine Joekes. After reviewing his vaccination records you find that he has received 1 dose of Tdap when he was 60 years old, had influenza vaccine and PPSV23 3 years ago when he was admitted in the hospital for exacerbation of HF.

It is Oct , what vaccine should JM receive? Question 78 Explanation:. Patient is also a candidate for the herpes zoster vaccine as he is over the age of A Tdap booster is recommended every 10 years, thus JM is a candidate as his last Tdap was 12 years ago. Patient is not a candidate for MMR, as individuals, who have been born prior to are considered immune to measles and mumps patient born in Reference: Adult Immunization Schedule. Accessed September 5, Which of the following would be most appropriate to treat stenotrophomonas maltophilia?

Question 79 Explanation:. Meropenem, ciprofloxacin, and vancomycin have no coverage. The rate that an outcome will occur given a particular exposure, compared to the rate of the outcome occurring in the absence of that exposure is definition of which of the following? Question 80 Explanation:. JK is a 67 years African American man who presents to your clinic for his blood pressure management.

His past medical history includes Peptic ulcer disease and hypertension. He says he has been adherent to his medication and lifestyle.

He currently takes Which of the following is the best strategy to manage his blood pressure? Question 81 Explanation:. Results from a Meta-analysis where they looked at frequency of postoperative arterial fibrillation in patients on Ascorbic acid after cardiac surgery found odds ratio, 0. How can you interpret this data? There was no statistically significant difference in frequency of postoperative arterial fibrillation after cardiac surgery.

Question 82 Explanation:. Odds ratio of 0. Exposure is the use of ascorbic acid. Question 83 Explanation:. This is based on surveillance data. They are also some of the most frequent isolates identified in international surveillance programs.

Therefore, the guidelines recommend treatment to cover these bacteria. Question 84 Explanation:. Number of new cases per population at risk in a given time period is a definition of which of the following? Question 85 Explanation:. KS is a 48 year old lady who presents to the ER with vertigo, nausea and vomiting after eating food from the previous night. She denies any focal numbness, tingling and weakness. She was having some unsteadiness and dizziness throughout the day. Her past medical history includes of multiple sclerosis, hypertension, diabetes, and hyperlipidemia.

Her MS has been stable on glatiramer acetate for 7 years. What is the treatment of choice for MS exacerbation? Methylprednisone mg IVPB daily for 4 days, followed by oral taper. Methylprednisone 1gm IVPB daily for 5 days followed by oral taper. Methylprednisone mg IVPB daily for 4 days. Question 86 Explanation:.

A literature review of management of MS exacerbation treatments concluded that IV steroids are the preferred route of administration. High doses of IV methylprednisolone varying from to mg for days has been found to be effective. Oral steroid tapers have no supporting evidence. Management of acute exacerbations in multiple sclerosis. Ann Indian Acad Neurol. Which of the following diagnostic lab test is recommended by the Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society in addition to clinical criteria to guide discontinuation of antibiotics?

Question 87 Explanation:. The use of PCT levels can decrease antibiotic exposure without increasing treatment failure or mortality. As a result, costs are reduced as well as the occurrence of side effects.

Current evidence does not support the use of CPIS to guide discontinuation of antibiotics since it is not reliable enough to determine whether antibiotic therapy should be continued or not.

CRP was not mentioned in the guidelines as to whether it can be used to determine discontinuation of antibiotic therapy or not. To do this, consult the help features on your browser.

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