Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of
... [Show More] osteoporosis?
a. Beta blockers
b. Calcium channel blockers
c. Ace inhibitors
d. Diuretics - correct answer Calcium channel blockers
Which of the following class of drugs is preferred treatment for a diabetic with stage II hypertension?
a. Calcium channel blockers
b. Alpha blockers
c. Angiotensin converting enzyme inhibitor
d. Loop diuretics - correct answer Angiotensin converting enzyme inhibitor
You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had a diagnosis of hypertension. He doesn't check his blood pressure at home. He has a family history of hypertension. What are your recommendations?
a. Start HCTZ 12.5mg daily, purchase a blood pressure cuff, and return to your office in 1 mth
b. Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks.
c. Order EKG, CMP, CBC, and lipid panel, and refer to cardiology.
d. Order a cardiac stress test and lipid panel. - correct answer Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks
You are treating a young adult female with HTN and migraine headaches. Which class of medications could you choose to treat both?
Ace inhibitors
Calcium channel blockers
Beta blockers
Angiotensin receptor blockers - correct answer Beta blockers
A 42-year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements.
Total: 210
LDL: 145
TG 162
HDL 52
What medication would you recommend?
a. Low dose statin
b. Low dose bile acid sequestrant
c. Low dose fibrate
d. Fish oil - correct answer Low dose statin
You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan?
a. Order a CBC and CMP.
b. Order lipid level and serum creatine phosphokinase
(CPK, creatine kinase)
c. Order a 24 hr urine
d. Recommend increasing his fluids and rest. - correct answer Order lipid level and serum creatine phosphokinase (CPK, creatine kinase).
What would you advise this patient regarding taking his atrovastatin (Lipitor)?
Continuing taking the medication until the labs are
available
Take atorvastatin every other day until labs are
available
Take half of the atorvastatin every other day until labs
are available
Stop taking the atorvastatin until the labs are
available - correct answer Stop taking atorvastatin until the labs are available.
A 58 year old male presents to your office with an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved with rest. Which of the following does this best describe?
Acute myocardial infarction
Gastroesophageal reflux disease
Angina pectoris
Acute costochondritis - correct answer Angina pectoris
What is the most common cause of left ventricular hypertrophy in the United States?
Mitral valve prolapse
Chronic atrial fibrillation
Pulmonary hypertension
Chronic hypertension - correct answer Chronic hypertension
Which of the following heart sounds is associated with heart failure?
Still's murmer and S4
S3
S1, S2, and S4
S1, S2, and S3 - correct answer S3
While performing a routine physical exam on a 60-year-old hypertensive male, you notice a bruit over the carotid area on the left side of the neck. There is no induration of the skin. This patient is at higher risk for:
Stroke and coronary heart disease
Temporal arteritis and brain aneurysms
Abdominal aneurysm and congestive heart gailure
Dizziness and headaches - correct answer Stroke and coronary heart disease
A 72-year-old female presents to your office with gradual difficulty breathing, non-productive cough, bilateral swelling of her feet, and a 10 pound weight gain. Upon examination you hear crackles and rhonchi with an S3 heart sound. What is the most likely diagnosis?
COPD
Renal hypertension
Congestive heart hailure
Asthma - correct answer Congestive heart failure
What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds?
Rest and increase fluids
Diuretics, digoxin, and anti-hypertensive medications
Nebulized albuterol and prednisone
Anti-coagulation and cardiology evaluation - correct answer Diuretics, digoxin, and anti-hypertensive medications
You are treating a 49-year-old female who presents with fatigue and palpitations. You check her apical pulse and she is irregular and tachycardic. You obtain an EKG and it reveals afib with rapid ventricular response. What is your treatment plan?
You order a 2D echo.
You admit her to the hospital for new onset afib.
You perform cardiac massage and have her relax.
You order a cardiology consult. - correct answer You admit her to the hospital for new onset afib.
Upon examination of a 17-year-old during a sports physical, you hear a split S2 during inspiration that disappears during expiration. The patient denies chest pain and dyspnea. What will you tell the mother and patient regarding your findings?
You advise the patient to avoid strenuous physical
activity until further investigation
You recommend a referral to cardiology.
Due to the patient being an athlete, you recommend a
stress echo
Educate the mother and patient that this is a benign
finding - correct answer Educate the mother and patient that this is a benign finding.
The first sign of an asthma exacerbation is:
Cough
Wheeze
Dyspnea
Chest tightness - correct answer Cough
According to the NAEPP-3 Guidelines for the Treatment and Management of Asthma, what is the gold standard for daily treatment of mild-persistent asthma?
Inhaled steroids
Long-acting bronchodliators
Short-acting bronchodilators
Combination therapies - correct answer Inhaled steroids
You are treating an adult asthma patient and reviewing her metered dose inhaler (MDI) technique. She demonstrates her MDI technique by shaking the inhaler, placing the inhaler in her mouth, pressing the canister, and inhaling quickly. What is your response?
You praise the patient for demonstrating the correct
MDI technique
You educate the patient taht, first, she should exhale
fully, then shake the inhale, and finally, as she
presses the canister, inhale slowly and fully
You instruct the patient to take a faster, even
inspiratory effort
You educate the patient that she should always use
a spacer or holding chamber with all MDI's - correct answer You educate the patient that, first, she should exhale fully, then shake the inhaler, and finally, as she presses the canister, inhale slowly and fully.
An adult patient with a history of chronic obstructive lung disease (COPD) presents to your office with 1 day of worsening shortness of breath, wheezing, and non-productive cough. You determine he has a COPD exacerbation. What is your treatment plan?
Chest x-ray
Levaquin 500 mg QD for 7 days, Prednisone spurt,
Albuterol/Atrovent inhaler 2 puffs QID
7 - 10 day prednisone spurt, Albuterol/Atrovent
inhaler 2 puffs QID
Z-pak, 7 - 10 day prednisone spurt, Atrovent inhaler
2 puffs QID - correct answer 7-10 days prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID
All of the following are useful in treating patients with COPD except:
Antihistamines
Anticholinergics
Oral steroids
Short-acting beta2-agonists - correct answer Antihistamines
Which of the following is less likely to be found in a patient with emphysema dominant COPD?
A cough that is productive with large amounts of
sputum
Prolonged expiration
Exertional dyspnea
Weight loss - correct answer A cough that is productive with large amounts of purulent sputum
You are treating a patient in your office whom you suspect has chronic lung disease, but you are unsure if you should start treatment today. What do you consider ordering first?
A pulmonary consult
A chest x-ray
An office spirometry
A pulmonary function test - correct answer An office spirometry
You are treating an elderly patient who tells you he has a history of allergies. His concern today is he is coughing more at night for the past 6 weeks and wheezing intermittently. He has no history of heart failure, smoking, or other lung disease. Your physical examination is unremarkable. What are your differential diagnosis(es) for cough?
Select all that apply.
Asthma
Sinusitis
Postnasal drip
GERD - correct answer Asthma
Sinusitis
Postnasal drip
GERD
A chronic cough lasts longer than:
a. 3 weeks.
b. 1 month
c. 6 months.
d. 1 year. - correct answer a. 3 weeks.
You are doing a cerumen extraction and touch the external meatus of your patient's ear. He winces and starts coughing. What is the name of this reflex?
a. Baker phenomenon
b. Arnold reflex
c. Cough reflex
d. Tragus reflex - correct answer b. Arnold reflex
Julie has a postnasal drip along with her cough. You assess her for:
a. Asthma. .
b. Sinusitis.
c. Allergic or vasomotor rhinitis.
d. Influenza. - correct answer c. Allergic or vasomotor rhinitis.
Your patient with hypertension comes in and insists that one of his new medications is causing [Show Less]