2561 2018 CME (Q&A); Last updated on 2018/2562 4 29, a full moon day;

ACP (American College of Physicians); ACS (American Cancer Society); ANS (Autonomic Nervous System); ASD (Atrial Septal Defect); ASV (Average Successive Variability); BMD (Bone Mineral Density); CGM (Continuous Glucose Monitor); COPD (Chronic Obstructive Pulmonary Disease); CT (Computed Tomography); DNA (deoxyribonucleic acid) e.g. from cell to its nucleus to its chromosome (2 strings) to DNA (codes) ... ; Dx (Diagnosis); FDA (Food and Drug Administration); HAL (Hemorrhoidal Artery Ligation); HPV (Human Papilloma Virus); IFF (if-and-only-if); Pt (Patient); Q&A (Questions & Answers); UV (Ultra Violet);

CME (Q&A) no. 222; low dose aspirin is (Tx) for prevention of cardiovascular disorder; in 2018/2561, Hyogo College of Medicine (www.hyo-med.ac.jp), Japan, reported at AHA (American Heart Association) 's scientific session, i.e. low dose aspirin can prevent NOT ONLY cardiovascular BUT ALSO

(a) IBD (Inflammatory Bowel Disease);
(b) dementia (cognitive impairment);
(c) type 1 diabetes' insulin levels;
(d) nasal allergy;

Answer: dementia (cognitive impairment);

CME (Q&A) no. 217; regarding 2 weeks old infant's pacifier vs. breastfeeding info would be:

(a) after lactation is established for 2 weeks old (infant), pacifier can be used;
(b) secretion of milk by mammary glands (lactation) till 4 months of age (infant);
(c) IFF lactation is established, using pacifier does not affect likelihood of infant;
(d) statements (a), (b), and (c) are correct;

Also see: Specialties PD;

Answer: statements (a), (b), and (c) are correct;

CME (Q&A) no. 200; double stranded DNA is cut by:

(a) active enzyme; digestive enzyme; protein digesting enzyme; respiratory enzyme;
(b) type II restriction enzyme;
(c) flavin-enzyme; flavo-enzyme;
(d) enzyme inhibitor (binding molecules);
(e) DNA repairing enzyme;
(f) enzyme commission number codes;
(g) linked enzyme assay e.g. immuno-sorbent; Enzyme unit;
(h) enzyme kinetic (chemical reaction);
(i) plant enzyme a.k.a. vegetable enzyme;
(j) hydrolytic enzyme (hydrolase is enzyme WHICH catalyzes);
(k) this DOMAIN (Gene Therapy System) DNA repairing enzymes; 2020s, early 21st century and beyond;

well trained kids! replied : HOW could you design this DOMAIN (Gene Therapy System) 's DNA repairing enzymes sir ? since we know kouso enzyme is in liquid form, enzyme is NOT in physical form;

i , me , me : you well trained kids! 1st to understand BLI (Body Length Index), limited by, caused by C Sequence Number (BF1) growth rate (since 2000s); 2nd to understand enzyme commission number codes obey iroColourWaveForm 's color codes and its gravity spots; 3rd to understand physical PHYSICS (hole, string) doko WHERE hole board defines string's direction (a.k.a. directional since 1980s); reversed engineering of filters to defined environment would be DNA repairing enzymes;

well trained kids! replied; Um! that might be blue vs. green, regarding filters to defined environment, because we're in solar system (our earth, our moon); reversed would be blue must be defined by green, green must be defined blue; are we now thinking correctly sir ?

i , me , me : Yes. mochiron of course; Remark: use light's instinct, and our earth's 1 way DEE; And Then, hopefully you well trained kids will be creating DNA repairing enzymes; And Then, don't forget to form your own billionaire club;

i , me , me : have you ever seen DEE pattern in heart shape? have you ever realize mouth alike DEE pattern forms at defined momentum ?

well trained kids ! replied: no, not yet; is it dream, guessing, imaginary sir ?

i , me , me : hint would be slow-down time period ... ; because, to be human beings, approx.  23 lunar weeks, or 32 JUN time period ... ;

answer: type II restriction enzyme;

CME (Q&A) no. 186; http://cdc.gov/hiv recommends HIV test (age between 13 and 64) at least once in (regular health care) routines; PEP, post exposure prophylaxis; PrEP, pre exposure prophylaxis; preferred regimen is Tenofovir Disoproxil Fumarate (TDF) 300mg with emtricitabine FTC 200mg once daily, combined with either raltegravir (RAL) 400mg twice daily, or dolutegravir (DTG) 50mg once daily; IFF STD, Gonorrhea and Chlamydia infections can be Dx (diagnosis) by:

(a) if Ag/Ab (combined antigen and antibody) testing is unavailable, antibody test is recommended;
(b) nPEP is indicated for persons without HIV infections; i.e. after PEP;
(c) nucleic acid amplification;
(d) Syphilis serology test, for STD;

Remark: all (a, b, c, d) statements are correct, but question emphasizes Gonorrhea and Chlamydia infections;

answer: nucleic acid amplification;

CME (Q&A) no. 169; cardiovascular stroke risk increases, coronary & cardiovascular disease risk increases, and non fatal MI risk increases, because of:

(a) abnormal uppermost quintile ASV in triglycerides; blood becomes thicker;
(b) HDL cholesterol;
(c) limited number of lipids (e.g. 3 lipids) level for ASV;
(d) non of the above;

Remark: cardiologists monitor patients' Average Successive Variability (ASV) in triglycerides (number mg/dL); HDL cholesterol is known as good cholesterol;

Answer: abnormal uppermost quintile ASV in triglycerides;

CME (Q&A) no. 165; regarding ultrasound, normal lung A lines can be defined by:

(a) (Y = Ln X) spine line (DEE (pleural effusion)) indicates normal lung A lines;
(b) zero Curvature based lung area is NOT smooth surface;
(c) ultrasound prompts no 3 lines are in vertical distance consecutively;
(d) C Sequence Number (BF1 distance) based 3 lines are vertically consecutive, and they are horizontally parallel;

Remark: ultrasound prompts no 3 lines are in vertical distance (i.e. abnormal lung B lines) consecutively; regarding abnormal lung B lines, and consolidated lung of pneumonia, zero Curvature based lung area is NOT smooth surface; ultrasound should be scanned along with "parallel" ribs' (left and right, based on spine's (a.k.a. Mid Line) upward direction and downward direction) regarding scanning of normal lung A lines;

ultrasound normal lung A lines;

Answer: C Sequence Number (BF1 distance) based 3 lines are vertically consecutive, and they are horizontally parallel;

CME (Q&A) no. 155; in a health care system (e.g. hospitals), chemotherapy way of Tx, gene therapy system way of Tx, immunological way of Tx, and surgical way of Tx, would be by:

(a) nutritionist;
(b) radiologist;
(c) oncologist;
(d) geriatric psychologist;

Also see: Specialties ON;

Answer: oncologist;

CME (Q&A) no. 150; early Parkinson disease (typical tremor) Dx is:

(a) typical tremor in high frequency;
(b) typically refer to pediatric neurologist;
(c) typical tremor progresses from fingers to forearm;
(d) typical psychogenic tremor consistently;

Also see: Specialties N;

Answer: typical tremor progresses from fingers to forearm;

CME (Q&A) no. 149; Medtronic (www.medtronic.com) 's CGM (Continuous Glucose Monitor), FDA (Food and Drug Administration) approved for type 1 diabetes, (age ≥ 14 year), and its (the device) info:

(a) monitor arm's tandem, And Then, its sensor works automated insulin delivery as data;
(b) previous model device works only at abdomen;
(c) new 2018/2561 model works as arm-placement indication (can be on arm, facing the arm's tandem);
(d) statements (a), (b), and (c) are correct;

Also see: Device Acronym;

Answer: statements (a), (b), and (c) are correct;

CME (Q&A) no. 144; Tx for erythrasma would be:

(a) Potassium Hydroxide (KOH) testing result should be negative;
(b) bid, 2 weeks, topical 2% miconazole;
(c) bid, 2 weeks, topical gel, 1% clindamycin;
(d) all a, b and c are correct and should be together as Tx;

Remark: in common, skin is KOH tested 1st; if KOH testing positive, then diff Dx and Tx ... ;

Also see: Specialties D;

Answer: all a, b and c are correct and should be together as Tx;

CME (Q&A) no. 141; Pt age < 24 years, having sign and symptom (loud heart sound, mild cough, wheezing) and CT Dx prompts Atrial Septal Defect (ASD), so WHICH one of the following heart condition is ASD:

(a) gated cardiac CT (LA, LV, RA, RV) flowing from RA to LA to LV;
(b) gated cardiac CT (LA, LV, RA, RV) flowing from LV to LA to RA;
(c) anterior chamber wall disorders cannot be cured;
(d) Gated Cardiac CT (LA, LV, RA, RV) can be color coded by this DOMAIN 's Gene Therapy System;

Also see: Specialties CD;

Answer: gated cardiac CT (LA, LV, RA, RV) flowing from RA to LA to LV;

CME (Q&A) no. 133; virtual mucopexy means:

(a) either infrared coagulation or rubber band ligation can produce satisfactory outcome;
(b) HAL and lifting hemorrhoidal prolapse;
(c) infrared photocoagulation (a.k.a. coagulation therapy) Tx for internal hemorrhoids;
(d) laser photocoagulation;

Remark: laser photocoagulation is Tx for eyes;

Answer: HAL and lifting hemorrhoidal prolapse;

CME (Q&A) no. 130; to prevent fracture, regarding Pt with low BMD (osteoporosis), ACP 's guideline is:

(a) 5 years continuous pharmacologic treatment;
(b) during therapy, Bone Mineral Density (BMD) should be checked every 2 years;
(c) bisphosphonates (aledronate, risedronate) is NOT a class of drug indicated for male Pt;
(d) myeloma, osteoporosis, and Paget's disease (deterioration of bone tissue) are NOT age related;

Remark: age related low BMD is osteoporosis disease (this DOMAIN recommends eating dried anchovies fish daily and naturally i.e. to avoid osteoporosis); age related malignant tumor of bone marrow is myeloma disease; age related Paget's disease is deterioration of bone tissue; bisphosphonates, class of drug WHICH increases bone density and bone strength;

Also see: Specialties FP; Specialties OBG; Specialties Skeletal;

Answer: 5 years continuous pharmacologic treatment;

CME (Q&A) no. 128; for decreasing Clostridium difficile infection (common infection in colon, a.k.a. C. Difficile) rate, WHICH one is correct intervention:

(a) using chlorhexidine gluconate for bathing;
(b) coordinated program of antimicrobials (a.k.a. antibiotic stewardship);
(c) using Pulsed Xenon UV disinfection;
(d) cleaning with hydrogen peroxide (H2O2) liquid solution;

Also see: Specialties GE; Specialties ID;

Answer: antibiotic stewardship;

CME (Q&A) no. 125; COPD exacerbation can be reduced by:

(a) pro biotic course;
(b) opioid agonist (agonist is Tx drug WHICH activates defined receptors in the brain);
(c) smoking cessation;
(d) estrogen therapy;

Remark: estrogen therapy is for postmenopausal women; high risk of respiratory depressions EXIST if opioid agonist; smoking causes COPD; Also see: Specialties PCC;

Answer: smoking cession;

CME (Q&A) no. 124; common vaginitis Dx and Tx would be:

(a) following statements ((b), (c), and (d)) are TRUE;
(b) IFF pregnancy, topical antifungal for vulvovaginal candidiasis;
(c) IFF recurrent vulvovaginal candidiasis, weekly follow-up Tx for 6 months;
(d) IFF vaginal discharge with odor, swab specimens for Dx of bacterial vaginosis;

Answer: all following (b), (c), and (d) are TRUE;

CME (Q&A) no. 122; WHICH one is ACS (American Cancer Society)' recommended cancer screening, among the following statements:

(a) cancer screening (rectal): annual prostate specific antigen testing for male Pt IFF age < 30 years;
(b) cancer screening (cervical): HPV DNA testing for female Pt IFF age (20 - 30), every 5 years;
(c) cancer screening (lung): low dose CT for Pt IFF age (55 - 75) with 30 pack-per-year smoking history;
(d) cancer screening (breast): annual mammography for female Pt IFF age < 30 years;

Also see: Specialties ON;

Answer: low dose CT for Pt IFF age (55 - 75) with 30 pack-per-year smoking history;

CME (Q&A) no. 121; in 2018/2561, www.medicaldevicedepot.com 's discounted medical devices are:

(a) EKG with interpretation, available by Bionet Cardio Care 2000, Burdick ELI 250c, Schiller AT-2 Plus, and Welch Allyn CP150;
(b) via your (PC, Personal Computer), Autonomic Nervous System (ANS) and Sudomotor Assessment, CLIA free allergy test, and Neuro-Cognitive Testing (e.g. anxiety, dementia, depression, PTSD, TBI, ... );
(c) EMR compatible spirometry; Family Practice Exam Table; GE EKG machine; Lifeline AED; PC based EMR compatible cardiology; Vital Sign Monitor (blood pressure, pulse oximetry, temperature);
(d) all a, b and c are correct and should be together as (Dx) medical devices ... ;

Answer: all a, b and c are correct and should be together as (Dx) medical devices;

CME (Q&A) no. 120; opioid (narcotic) addiction can be Tx by:

(a) respiratory depression as Tx;
(b) Buprenorphine therapy as Tx with its adverse effect constipation;
(c) effectively blunt the heroin as Tx, every 12 hours;
(d) none of the above;

Answer: Buprenorphine therapy as Tx with its adverse effect constipation;

CME (Q&A) no. 119; common Tx (treatment) for hemorrhoids is:

(a) hot spring water bath;
(b) reduce drinking water;
(c) lower fiber diet;
(d) using stool softeners;

Also see: Specialties GE;

Answer: using stool softeners;

CME (Q&A) no. 117; 17 years old obesity (BMI > 28) teenager is known socially isolated, and then to determine whether the child has been bullied or not, the child should be asked:

(a) the child feels safe at school;
(b) using evidence based screening tool;
(c) questions on parental supports;
(d) initialized screening question: e.g. have you ever been bullied ?

CHP, Child and Adolescent Psychiatry;

Answer: the child feels safe at school;

CME;

Gene Therapy System;

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