QUESTION: 81

WM did not receive influenza vaccine prior to the start of this season, it’s now December. He did get influenza vaccine last year. Which of the following is correct course of action?

Skip influenza vaccine for this year since it’s too late.
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.
Start Amantadine 200mg daily

Answer(s): D

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. Starting Tamiflu or Amantadine is not recommended for prevention. It has indication for treatment and prophylaxis.

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QUESTION: 82

FT is a 23-year-old newly diagnosed type I diabetes admitted to the hospital due to diabetes ketoacidosis. 2 days after being on insulin drip, anion gap is closed. Physician would like your help in transitioning her to subcutaneous insulin. She suggests using insulin glargine once a day and Insulin lispro three time a day at ratio of 70:30. 70 % of long and 30 % of short acting insulin. FT received average of 70 units of insulin in 24hrs.
Which of the following would be the best insulin regimen?

49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals
25 units of Insulin Glargine subcutaneous daily and 15 units of Insulin Lispro subcutaneous three times a day with meals
40 units of Insulin Glargine subcutaneous daily and 10 units of Insulin Lispro subcutaneous three times a day with meals
46 units of Insulin Glargine subcutaneous daily and 8 units of Insulin Lispro subcutaneous three times a day with meals
52 units of Insulin Glargine subcutaneous daily and 6 units of Insulin Lispro subcutaneous three times a day with meals

Answer(s): A

Explanation:

70% of 70 units = 49 units of Insulin Glargine daily 30% of 70 units = 21 units of Insulin Lispro daily. Dived in 3 doses would be 7 units three times a day. FT’s Insulin regimen should be 49 units of Insulin Glargine subcutaneous daily and 7 units of Insulin Lispro subcutaneous three times a day with meals

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QUESTION: 83

In the US Nurses’ Health Study (NHS) cohort study, where they looked at association of regular aspirin use (≥two 325 mg tablets/week) and colorectal cancer in 82,911 women found (RR, 0.77; 95% CI, 0.67–0.88) over 20 years of follow-up. In an another analysis of the NHS, regular aspirin use, investigator also found (hazard ratio [HR]=0.72, 95% CI 0.56–0.92), what does this say about the mortality from colorectal cancer? How can this data best be interpreted?

Those who takes aspirin ≥2 times/week have 23% lower risk of colorectal cancer
Those who takes aspirin ≥2 times/week have 0.77% lower risk of colorectal cancer
Those who takes aspirin ≥2 times/week have 28% lower risk of colorectal cancer
Those who takes aspirin ≥2 times/week have 23% reduction in death from colorectal cancer
None of the above is correct

Answer(s): A

Explanation:

Relative risk can be stated as 0.77 times as likely or 0.77 times the risk, but it could also be illustrated as a relative risk reduction and stated as a 23% risk reduction or 23% lower risk by taking the medication.

Reference:

https://www.ncbi.nlm.nih.gov/books/NBK63647/

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QUESTION: 84

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?

Incidence rate
Prevelance rate
Odds ratio
Relative risk
Confidence Interval

Answer(s): D

Explanation:

RR = rate of an outcome occurring in an exposed group (treatment group/intervention group) divided by the rate of an outcome occurring in an unexposed group (control group) Ex: Relative Risk = Rate of UTI in patients taking drug XYZ / rate of UTI in patients not on drug XYZ

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938757/

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