cardio test ?s

Question 1

Ms. Leonardo is a 68-year-old woman who presents with a new diagnosis of primary hypertension with BP at 155‒162/92‒95 mm Hg on two different occasions during the past month. Recent lab analysis reveals the following: A1C=5.3% (0.053 proportion), calculated GFR=98 mL/min/1.73 m2. Physical examination findings include the following: BMI=28.2 kg/m2, no S3, S4 or murmur, PMI at 5th ICS, MCL. Funduscopic examination is within normal limits. Which of the following represent(s) the best advice? Answer yes or no to the following choices as Ms. Leonardo’s HTN therapy by EBP standards.

Initiate therapy with a beta blocker with a revisit in two months.

Initiate therapy with a thiazide diuretic with follow-up in 1 month.

Encourage weight reduction through lifestyle modification.

Advise Ms. Leonardo that drug therapy will be initiated when there is evidence of target organ damage.

Answer 1

Initiate therapy with a thiazide diuretic with follow-up in 1 month.
Encourage weight reduction through lifestyle modification.

remember the proper f/u time is one month

Question 2

Mr. Jones, a 52-year-old African-ancestry man, presents for treatment of hypertension. He has been taking a calcium channel blocker for the past 2 months. He is feeling well with no complaint and physical examination is within normal limits. His blood pressure today is 160/94 mm Hg bilaterally. The next best step is to:

Add an ACEI and have the patient follow-up in 2 weeks
Discontinue the calcium channel blocker and start an aldosterone antagonist
Advise Mr. Jones that his blood pressure is in an acceptable range and he should follow-up in approximately 2 months
Prescribe a thiazide diuretic and advise a 1-month follow-up

Answer 2

Prescribe a thiazide diuretic and advise a 1-month follow-up

Question 3

Which of the following medications should be avoided in a 45-year-old man with poorly-controlled hypertension who asks, “What medications can I take when I have a cold?”

Dextromethorphan
Chlorpheniramine
Pseudoephedrine
Guaifenesin

Answer 3

Pseudoephedrine due to its systemic vasoconstriction

Question 4

K. is a 66-year-old man with type 2 DM and HTN who presents with the following lipid profile:

HDL=35 mg/dL (0.9 mmol/L)
LDL=150 mg/dL (3.9 mmol/L)
Triglycerides=210 mg/dL (2.4 mmol/L)

Which of the following represents the best choice of dyslipidemia therapy for this patient?

Optimized dose oral ezetimibe (Zetia®) therapy
Moderate-intensity oral simvastatin (Zocor®) therapy
Injectable evolocumab (Repatha®) therapy
High-intensity oral omega-3 fatty acid therapy

Answer 4

Optimized dose oral ezetimibe (Zetia®) therapy -no it wont decrease it much
Moderate-intensity oral simvastatin (Zocor®) therapy yes-the goal is <100
Injectable evolocumab (Repatha®) therapy no- 
High-intensity oral omega-3 fatty acid therapy- this is for triglycerides

Question 5

M. is a 52-year-old woman who is generally in good health and presents with a LDL= 220 mg/dL (5.7 mmol/L). Recommended initial dyslipidemia therapy offered should be:

Optimized dose oral ezetimibe (Zetia®) therapy
High-intensity oral rosuvastatin (Crestor®) therapy
Injectable evolocumab (Repatha®) therapy
High-intensity oral omega-3 fatty acid therapy

Answer 5

yes-High-intensity oral rosuvastatin (Crestor®) therapy she is >190

Question 6

A 45-year-old woman with hypertension and dyslipidemia is currently taking moderate-intensity statin therapy and she is at LDL-reduction goal. She is feeling well. As part of her ongoing healthcare, the NP considers that:

Serum transaminases should be checked periodically
Evaluation of serum creatine kinase is needed
A CBC with WBC and platelet count is advised
In the absence of symptoms or concerns, no particular laboratory monitoring is recommended

Answer 6

In the absence of symptoms or concerns, no particular laboratory monitoring is recommended

Question 7

The use of which of the following potentially increases bleeding risk during warfarin use.
(Yes or No)

Amoxicillin
St. John’s wort
Naproxen
Gingko biloba

Answer 7

Amoxicillin yes- all abx will they disrupt the flora of the gut which is where Vit K is synthesized
St. John’s wort NO
Naproxen yes cumulative antiplatelet
Gingko biloba yes also due to antiplatelet