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Cardiology > Cardiology: Multiple Choice and Other Questions > Flashcards

Cardiology: Multiple Choice and Other Questions Flashcards

1
Q

A 48 year-old male has HTN. Select all meds that could be used for initial monotherapy.

  1. 5 mg amlodipine daily
    (5 mg - 10 mg)
  2. 25 mg metoprolol daily
    (25 mg - 100 mg)
  3. 20 mg lisinopril daily
    (20 mg - 40 mg)
  4. 100 mg losartan daily
    (50 mg - 100 mg)
  5. 12.5 mg chlorthalidone
    (12.5 mg - 25 mg)
A
  1. 5 mg amlodipine daily
    (5 mg - 10 mg)
  2. 20 mg lisinopril daily
    (20 mg - 40 mg)
  3. 12.5 mg chlorthalidone
    (12.5 mg - 25 mg)
    Check for sulfa allergy

NOTE: #4 (100 mg losartan daily) is not appropriate as a starting dose since 100 mg is the max dose.

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2
Q

Select all labs/tests that should be checked in 2 weeks if amlodipine is prescribed for HTN.

  1. Potassium
  2. BUN, Cr
  3. Glucose
  4. EKG
  5. A1C
  6. LFTs
  7. Labs would not be needed
A
  1. Labs would not be needed
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3
Q

Select all labs/tests that should be checked in 2 weeks if lisinopril is prescribed for HTN.

  1. Potassium
  2. BUN, Cr
  3. Glucose
  4. EKG
  5. A1C
  6. LFTs
  7. Labs would not be needed

What labs should be checked if losartan is prescribed?

A
  1. Potassium
  2. BUN, Cr

These should be checked at initiation and at each change in dose.

The same should be checked when losartan is prescribed.

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4
Q

Select all labs/tests that should be checked in 2 weeks if chlorthalidone is prescribed for HTN.

  1. TSH
  2. EKG
  3. Uric acid
  4. Glucose
  5. Calcium
  6. Potassium
  7. Labs would not be needed
A
  1. Potassium
    (since K+/fluids can be lost with TZDs)
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5
Q

You prescribed 20 mg lisinopril for your patient who returns 4 weeks later with the following BPs:

1 month ago: 138/90
21 days ago: 135/85
14 days ago: 130/90
12 days ago: 140/95
2 days ago: 138/90
1 day ago: 135/85

Which of the following choices are reasonable?

  1. Continue plan for another 4 weeks
  2. Increase lisinopril to 40 mg daily
  3. Add 50 mg losartan
  4. Add 5 mg amlodipine
  5. Add 12.5 mg chlorthalidone

Why?

A
  1. Increase lisinopril to 40 mg daily
  2. Add 5 mg amlodipine
  3. Add 12.5 mg chlorthalidone

NOTE: #3, losartan, is not appropriate since losartan is an ARB and lisinopril is an ACE - these SHOULD NOT be prescribed together!

Why?

The lisinopril dose should be increased or another HTN med should be added since the maximum drop in BP due to any particular med/dose will have been achieved within 4 weeks.

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6
Q

Your patient with HTN has the following lipid panel. Should you initiate a statin?

CHO 210 mg/dL
HDL 38 mg/dL
LDL 130 mg/dL
TRI 323 mg/dL
A1C 6.5%
ASCVD 10-year risk 10.8%

A

Yes

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7
Q

You’ve prescribed 10 mg rosuvastatin for a patient with an ASCVD score of 10.8%. This is:

  1. precarious if LFTs have not been ordered recently.
  2. an example of primary prevention.
  3. aggressive considering his risk factors.
  4. going to reduce his risk of a cardiovascular event by 30% - 49%.
A
  1. an example of primary prevention.

NOTE: #4 is true but it is not the best response and the question only asked for 1 answer.

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8
Q

What is the risk of prescribing an initial dose of 10 mg of rosuvastatin for a HTN patient with the following labs (what is the starting dose)?

CHO 210 mg/dL
HDL 38 mg/dL
LDL 130 mg/dL
TRI 323 mg/dL
A1C 6.5%
ASCVD 10-year risk 10.8%

A

Risk: none
Starting dose: 5 mg

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9
Q

For a patient with the following lipid panel values who is starting a statin, should a fibrate be initiated, too?

CHO 210 mg/dL
HDL 38 mg/dL
LDL 130 mg/dL
TRI 323 mg/dL
A1C 6.5%
ASCVD 10-year risk 10.8%

A

No, triglycerides will drop about 15% with statin

(start fibrates at TRI ≥ 500 mg/dL)

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10
Q

Select all options for correcting a patient’s recent increase in BP. His current meds are:

5 mg amlodipine
0.8 mg tamsulosin
50 mcg levothyroxine
220 mg naproxen
5 mg rosuvastatin

  1. Add a medication
  2. Stop a medication
  3. Increase dose of BP med
  4. Have him check his BP twice daily for 2 weeks and send to NP
A
  1. Stop a medication (naproxen, since it can interfere with BP meds)
  2. Have him check his BP twice daily for 2 weeks and send to NP
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11
Q

A patient, 78, with a history of HTN, HLP, gout, BPH, RAI (radioactive iodine) for hyperthyroidism, and OA complains of painful, edematous R knee for about 10 weeks. What is the most likely reason for his complaint?

  1. Gout
  2. OA
  3. DVT
  4. PAD

How are the correct answers ruled out?

A
  1. OA

Gout: Not likely for 10-week duration

DVT: Not likely for 10-week duration and no other typical s/s present

PAD: Joint pain is not consistent with typical presentation

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12
Q

What is the likely cause of LE edema x 10 weeks in a 78 year-old patient with HTN, HLP, gout, radioactive iodine for hyperthyroidism, and OA? He’s taken amlodipine, rosuvastatin, and levothyroxine for months but recently started naproxen. His labs, with normal ranges following) are:

BUN: 19 mg.dL (8 - 25)
Cr: 1.2 mg/dL (0.5 - 1.5)
eGFR: 62 ml/min (>60)
K+: 4.6 mEq/L (3.5 - 5.1)
CHO: 170 mg/dL (< 200)
LDL: 86 mg/dL (< 100)
HDL: 58 mg/dL (> 40)
TRI: 123 mg/dL (< 150)

  1. Heart failure
  2. Renal failure
  3. Amlodipine
  4. Naproxen
A
  1. Naproxen
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13
Q

Select all applicable options for addressing mild LE edema x 6 weeks in a 78 year-old patient with HTN, HLP, gout, BPH, radioactive iodine for hyperthyroidism, and OA. His meds are amlodipine, rosuvastatin, tamsulosin, levothyroxine, and naproxen.

  1. Ask about SOB, chest pain, cough
  2. Add furosemide
  3. Stop amlodipine
  4. Stop naproxen
  5. Order a TSH
  6. Order a BNP
  7. Order a chest x-ray
A
  1. Ask about SOB, chest pain, cough
  2. Stop naproxen
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14
Q

What medication could be safely added to address an 86 year-old patient’s HTM after her triamterene/HCTZ was discontinued due to elevated K+ if her diagnoses are HTN, OA, HLP, osteoporosis, hypothyroidism, MI with stent 10 years ago, CAD medically-treated, 20 pack-year smoking history (quit 10 years ago), and her meds are rosuvastatin, metoprolol, clopidogrel, ASA, levothyroxine, and naproxen.

  1. Restart triamterene/HCTZ after K+ level returns to normal
  2. Diltiazem 120 mg daily
  3. Amlodipine 2.5 mg daily
  4. Losartan 5 mg daily
A
  1. Amlodipine 2.5 mg daily
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15
Q

How would you handle an 86 year-old, asymptomatic patient with HTN, OA, HLP, osteoporosis, hypothyroidism, MI with stent placement 10 years ago, CAD medically-treated, 20 pack-year smoking history (quit 10 years ago), who takes rosuvastatin, metoprolol, clopidogrel, ASA, triamterene/HCTZ, levothyroxine, nitro tab SL, and who has the following labs:

A
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16
Q

What is the likely cause of LE edema x 10 weeks in a 78 yea-old patient with HTN, HLP, gout, RAI (radioactive iodine) for hyperthyroidism and OA? He’s taken amlodipine, rosuvastatin and levothyroxine for months but recently started naproxen.

His labs are:

BUN 19 mg/dL (8 - 25)
Cr 1.2 mg/dL (0.5 - 1.5)
eGFR 62 ml/min (>60)
K+ 4.6 mEq/L (3.5 - 5.1)
CHO 170 mg/dL (<200)
LDL 86 mg/dL (<100)
HDL 58 mg/dL (>40)
TRI 123 mg/dL (<150)

  1. Heart failure
  2. Renal failure
  3. Amlodipine
  4. Naproxen
A
  1. Naproxen
17
Q

Select all applicable options for addressing mild LE edema x 6 weeks in a 78 year-old patient with HTN, HLP, gout, BPH, RAI (radioactive iodine) for hyperthyroidism, and OA. His meds are amlodipine, rosuvastatin, tamsulosin, levothyroxine, and naproxen.

  1. Ask about SOB, chest pain, cough
  2. Add furosemide
  3. Stop amlodipine
  4. Stop naproxen
  5. Order a TSH
  6. Order a BNP
  7. Order a chest x-ray
A
  1. Ask about SOB, chest pain, cough
  2. Stop naproxen
18
Q

What medication could be safely added to address an 86 year-old patient’s HTN after her triamterene/HCTZ was discontinued due to elevated K+ if her diagnoses are HTN, OA, HLP, osteoporosis, hypothyroidism, MI with stent 10 years ago, CAD medically-treated, 20 pack-year smoking history (quit 10 years ago), and her meds are rosuvastatin, metoprolol, clopidogrel, ASA, levothyroxine, and naproxen.

  1. Restart triamterene/HCTZ after K+ levels return to normal
  2. Diltiazem 120 mg daily
  3. Amlodipine 2.5 mg daily
  4. Losartan 5 mg daily
A
  1. Amlodipine 2.5 mg daily
19
Q

How would you handle an 86 year-old, asymptomatic patient with HTN, HLP, osteoporosis, hypothyroidism, MI with stent 10 years ago, CAD medically-treated, 20 pack-year smoking history (quit 10 years ago) who takes rosuvastatin, metoprolol, clopidogrel, ASA, triamterene/HCTZ, levothyroxine, nitrotab SL, and naproxen, and who has the following labs?

           4 mo ago        Today BUN    23 mg/dL        23 mg/dL   (8 - 25) Cr        1.4 mg/dL       1.4 mg/dL   (0.5 - 1.5) eGFR   54 mg/dL        52 mg/dL    (> 60) K+        5.1 mmol/L    5.6 mmol/L  (3.5 - 5.1) Na+     135 mmol/L   134 mmol/L  (135 - 143) Ca++    8.8 mg/dL       8.8 mg/dL    (8.6 - 10.4) Cl-       102 mmol/L    102 mmol/L  (98 - 110)
  1. Refer to nephrology
  2. Refer to ER
  3. Add a medication
  4. Discontinue a medication
A
  1. Discontinue a medication
    (triamterene/HCTZ)
20
Q

Select all options of medications that would be beneficial to discontinue in an 86 year-old patient with HTN, OA, HLP, osteoporosis, hypothyroidism, MI with stent 10 years ago, 20 pack-year smoking history (quit 10 years ago), who develops heart failure, considering she takes rosuvastatin, metoprolol, clopidogrel, ASA, levothyroxine, and naproxen. Why?

  1. Amlodipine
  2. Naproxen
    3 Levothyroxine
  3. Rosuvastatin
A
  1. Amlodipine
    (no CCB with heart failure since it will decrease the force of cardiac contractions)
  2. Naproxen
    (can add fluids)
21
Q

Which patient is most appropriate to screen today for an AAA (assuming no previous screening)?

  1. 40 year-old smoker, DM, family history of AAA, on statin, BMI 30
  2. 68 year-old nonsmoker, DM, on statin, family history of AAA
  3. 86 year-old with history of a-fib, HTN, HLP
A
  1. 68 year-old nonsmoker, DM, on statin, family history of AAA
22
Q

What modality is used to screen for AAA?

A

Abdominal ultrasound

23
Q

If peripheral artery disease is suspected in the lower extremities in a 68 year-old man, what might be an expected finding? Select all that apply.

  1. Ankle brachial index (ABI): 0.75
  2. Sparse hair growth on lower legs
  3. Nonsmoker
  4. Diminished pedal pulses
  5. No episode of intermittent claudication
  6. Age > 75 years
  7. History of heart failure
A
  1. Ankle brachial index (ABI): 0.75
  2. Sparse hair growth on lower legs
  3. Diminished pedal pulses
24
Q

A 32 year-old woman has mitral valve prolapse. She experiences palpitations if she takes pseudophedrine. Where is mitral valve prolapse best auscultated?

  1. Mitral listening point
  2. Aortic listening point
    3 Tricuspid listening point
  3. Pulmonic listening point
A
  1. Mitral listening point
25
Q

A 66 year-old patient who has chest pain associated with aortic stenosis is in the NP’s office for surgical clearance. What choice describes this murmur when auscultated?

  1. A diastolic murmur near the apex
  2. Systolic sounds heard in the midsternal area
  3. Diastolic murmur near the L sternal border, 2nd intercostal space
  4. Systolic heard loudest near the 2nd intercostal space, R sternal border
A
  1. Systolic heard loudest near the 2nd intercostal space, R sternal border
26
Q

The NP is examining a patient who has a murmur best heard at the apex during diastole. It is unchanged whether the patient is supine or lying. What murmur is most likely?

  1. Aortic stenosis
  2. Mitral valve prolapse
  3. Aortic regurgitation
  4. Mitral stenosis

Is this significant?

A
  1. Mitral stenosis

YES!!!

27
Q

A 52 year-old plumber has been having intermittent chest pain associated with aortic regurgitation. What would you expect in listening to the murmur?

  1. A late diastolic click
  2. Diastolic sounds heard loudest near the 2nd intercostal space, R sternal border
  3. Diastolic sounds heard in the midsternal area
  4. Intermittent diastolic murmur heard near the L sternal border
A
  1. Diastolic sounds heard loudest near the 2nd intercostal space, R sternal border
28
Q

All of the following patients have an audible murmur. Which is most likely to have a physiologic murmur?

  1. A 70 year-old with heart failure
  2. A 45 year-old patient with hypertension
  3. A 30 year-old marathoner
  4. A 16 year-old athlete

Why?

A
  1. A 16 year-old athlete

Reason: Physiologic murmurs are heard when heart muscle is growing/stretching

Cardiology (8 decks)

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