MISC - Sample Questions (Midterm Topics) Flashcards by Juan Carlos Cornelio

A 55-year-old non-Hispanic black male has hypertension. His past medical history also includes diabetes and hyperlipidemia. According to the ACC/AHA guidelines, which among the choices represents the most appropriate blood pressure goal for the patient?

a. Less than 140/85
b. Less than 135/85
c. Less than 130/80
d. Less than 140/80

c. Less than 130/80

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A 59-year-old non-Hispanic white patient presents for treatment of hypertension. His past medical history also includes diabetes, hyperlipidemia, and hypertension. The patient’s blood pressure is 150/93 (both today and the last visit). Which is a recommended initial therapy to treat hypertension in this patient?

a. Enalapril
b. Hydralazine
c. Verapamil
d. Metoprolol

a. Enalapril

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A 45-year-old male complains of constipation. He was recently started on two antihypertensives due to elevated systolic blood pressure (greater than 20 mmHg above goal). His current medications include lisinopril, chlorthalidone, verapamil, rosuvastatin, and aspirin. What is most likely contributing to his constipation?

a. Chlorthalidone
b. Verapamil
c. Aspirin
d. Lisinopril

b. Verapamil

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Which antihypertensive medication can cause the rare side effect of angioedema?

a. Amlodipine
b. Fosinopril
c. Prazosin
d. Propranolol

b. Fosinopril

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A 52-year-old female has uncontrolled hypertension (BP of 154/82 mmHg) on treatment with lisinopril. She recently had a myocardial infarction and her past medical history includes diabetes, hypertension, hyperlipidemia, and osteoarthritis. Considering her compelling indications, which agent may be appropriate to add to her antihypertensive therapy?

a. Clonidine
b. Olmesartan
c. Furosemide
d. Metoprolol

d. Metoprolol

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The blood pressure of a patient with essential hypertension is at goal on treatment with enalapril. Since initiation of enalapril, the serum creatinine has increased 25% above baseline. What is the appropriate next step for the enalapril therapy?

a. Discontinue enalapril
b. Reduce dose of enalapril
c. Continue current dose of enalapril
d. Increase dose of enalapril

c. Continue current dose of enalapril

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Which of the following correctly outlines a major difference in electrolyte disturbances associated with thiazide and loop diuretics?

a. Thiazide diuretics decrease K+ and loop diuretics increase K+
b. Thiazide diuretics increase K+ and loop diuretics decrease K+
c. Thiazide diuretics decrease Ca2+ and loop diuretics increase Ca2+
d. Thiazide diuretics increase Ca2+ and loop diuretics decrease Ca2+

d. Thiazide diuretics increase Ca2+ and loop diuretics decrease Ca2+

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Which can precipitate a hypertensive crises following abrupt cessation of therapy?

a. Clonidine
b. Diltiazem
c. Valsartan
d. Hydrochlorothiazide

a. Clonidine

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Which of the following is a dihydropyridine calcium channel blocker?

a. Amlodipine
b. Metoprolol
c. Verapamil
d. Lisinopril

a. Amlodipine

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A 45-year-old man was started on therapy for hypertension and developed a persistent, dry cough. Which is most likely responsible for this side effect?

a. Lisinopril
b. Losartan
c. Nifedipine
d. Atenolol

A. Lisinopril

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An elderly patient with a history of heart disease has difficulty breathing and is diagnosed with acute pulmonary edema. Which treatment is indicated?

a. Acetazolamide
b. Chlorthalidone
c. Furosemide
d. Spironolactone

c. Furosemide

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A group of college students is planning a mountain climbing trip to the Andes. Which is most appropriate for them to take to prevent altitude sickness?

a. A thiazide diuretic (ex. hydrochlorothiazide)
b. An anticholinergic (ex. atropine)
c. A carbonic anhydrase inhibitor (ex. acetazolamide)
d. A loop diuretic (ex. furosemide)

c. A carbonic anhydrase inhibitor (ex. acetazolamide)

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An alcoholic male has developed hepatic cirrhosis. To control the ascites and edema, which should be prescribed?

a. Acetazolamide
b. Chlorthalidone
c. Furosemide
d. Spironolactone

d. Spironolactone

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A 55-year-old male with kidney stones needs a medication to decrease urinary calcium excretion. Which diuretic is best for this indication?

a. Torsemide
b. Hydrochlorothiazide
c. Spironolactone
d. Triamterene

b. Hydrochlorothiazide

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A 75-year old woman with hypertension and glaucoma is being treated with chlorthalidone, amlodipine, lisinopril, and acetazolamide. In clinic today, she complains of acute joint pain and redness in her great toe, which is diagnosed as gout. Which medication is most likely to have caused the gout attack?

a. Amlodipine
b. Acetazolamide
c. Chlorthalidone
d. Lisinopril

c. Chlorthalidone

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Which is contraindicated in a patient with hyperkalemia?

a. Acetazolamide
b. Chlorthiazide
c. Ethacrynic acid
d. Eplerenone

d. Eplerenone

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A 59-year-old male patient in the intensive care has metabolic alkalosis. Which therapy will treat this condition?

a. Amiloride
b. Hydrochlorothiazide
c. Mannitol
d. Acetazolamide

d. Acetazolamide

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A male patient is placed on a new medication and notes that his breasts have become enlarged and tender to the touch. Which medication is he most likely taking?

a. Furosemide
b. Hydrochlorothiazide
c. Spironolactone
d. Triamterene

c. Spironolactone

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A patient with heart failure with reduced ejection fraction researched his medications on the Internet and found he was taking two “diuretics”, bumetanide and spironolactone. He asks if this is a mistake with his therapy. What is the best response?

a. Spironolactone is used to prevent hyponatremia
b. Spironolactone is used to reduce heart structure changes and decrease the risk of death
c. Bumetanide is used to decrease the potassium lost from spironolactone therapy
d. This is a duplication error and one diuretic should be stopped

b. Spironolactone is used to reduce heart structure changes and decrease the risk of death

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Which diuretic has been shown to improve blood pressure in resistant hypertension or those already treated with three blood pressure medication including a thiazide or thiazide-like medication?

a. Indapamide
b. Furosemide
c. Mannitol
d. Spironolactone

d. Spironolactone

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A patient is newly diagnosed with HFrEf and is asymptomatic. Which is the most appropriate drug to initiate for symptomatic and survival benefits?

a. Dobutamine
b. Furosemide
c. Lisinopril
d. Sacubitril/Valsartan

c. Lisinopril

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Which of the following statements best describes the action of ACE inhibitors on the failing heart?

a. Increased vascular resistance
b. Decreased cardiac output
c. Reduced preload
d. Increased aldosterone

c. Reduced preload

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A Hispanic man with HFrEF currently takes maximally tolerated doses of metoprolol succinate and enalapril, along with moderate-dose furosemide. He is euvolemic, but continues to have HF symptoms. The systolic blood pressure is low, but the patient does not have signs or symptoms of hypotension. Which is the best recommendation to improve HF symptoms and survival in this patient?

a. Stop enalapril, wait 36 hours, and start sacubitril/valsartan
b. Start digoxin
c. Start fixed-dose hydralazine and isosorbide dinitrate
d. Start spironolactone

d. Start spironolactone

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Beta blockers improve cardiac function in HF by:

a. Decreasing cardiac remodeling
b. Increasing cardiac rate
c. Increasing renin release
d. Activating norepinephrine

a. Decreasing cardiac remodeling

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A 70-year-old woman has HFrEF and hypertension. She takes lisinopril and metoprolol tartrate. She feels well and has no cough, shortness of breath, or edema. Which of the following changes is most appropriate for her drug therapy? a. Initiate digoxin b. Change lisinopril to losartan c. Initiate ivabradine d. Change metoprolol tartrate to metoprolol succinate

d. Change metoprolol tartrate to metoprolol succinate

A 75-year-old white man with HFrEF reports stable HF symptoms. His current drug therapy includes optimal-dose enalapril, carvedilol, and spironolactone. Which is the best recommendation to improve HF symptoms and survival? a. Start fixed-dose hydralazine/isosorbide dinitrate b. Start ivabradine c. Replace enalapril with sacubitril/valsartan d. Start digoxin

c. Replace enalapril with sacubitril/valsartan

How is spironolactone beneficial in HF? a. Promotes potassium secretion b. Acts as aldosterone agonist c. Prevents cardiac hypertrophy d. Decreases blood glucose

c. Prevents cardiac hypertrophy

Which of the following is important to monitor in patients taking digoxin? a. Chloride b. Potassium c. Sodium d. Zinc

b. Potassium

Which of the following describes the mechanism of action of milrinone in HF? a. Decreases intracellular calcium b. Increases cardiac contractility c. Decreases cAMP d. Activates phosphodiesterase

b. Increases cardiac contractility

BH is a 52-year-old African American woman who has HFrEF. She is seen in clinic today reporting stable HF symptoms, but is having occasional peripheral brightness. Otherwise, vision is unchanged. Current medication regimen includes sacubitril/valsartan, carvedilol, fixed-dose hydralazine and isosorbide dinitrate, ivabradine, and bumetanide. Which is the best recommendation to minimize the adverse effect of peripheral brightness? a. Stop all HF medications immediately b. Discontinue sacubitril/valsartan only c. Do nothing; the adverse effect will slowly improve over time d. Reduce the dose of ivabradine

d. Reduce the dose of ivabradine

A 60-year-old woman had a myocardial infarction. Which agent should be used to prevent life-threatening arrhythmias that can occur post myocardial infarction in this patient? a. Digoxin b. Flecainide c. Metoprolol d. Procainamide

c. Metoprolol

Suppression of arrythmias resulting from a reentry focus is most likely to occur if the drug: a. Has vagomimetic effects on the AV node b. Is a beta-blocker c. Converts a unidirectional block to a bi-directional block d. Slows conduction through the atria

c. Converts a unidirectional block to a bi-directional block

A 57-year-old man is being treated for an atrial arrythmia. He complains of dry mouth, blurred vision, and urinary hesitancy. Which antiarrhythmic drug is he most likely using? a. Metoprolol b. Disopyramide c. Dronedarone d. Sotalol

b. Disopyramide

A 58-year-old woman is being treated for chronic suppression of a ventricular arrythmia. After 1 week of therapy, she complains of severe upset stomach and heartburn. Which antiarrhythmic drug is the likely cause of these symptoms? a. Amiodarone b. Digoxin c. Mexiletine d. Propranolol

c. Mexiletine

A 78-year-old woman has been newly diagnosed with atrial fibrillation. She is not currently having symptoms of palpitations or fatigue. Which is appropriate to initiate for rate control as an outpatient? a. Dronedarone b. Esmolol c. Flecainide d. Metoprolol

d. Metoprolol

Which of the following is correct regarding digoxin when used for atrial fibrillation? a. Digoxin works by blocking voltage-sensitive calcium channels b. Digoxin is used for rhythm control in patients with atrial fibrillation c. Digoxin increases conduction velocity through the AV node d. Digoxin levels of 1-2 ng/mL are desirable in the treatment of atrial fibrillation

d. Digoxin levels of 1-2 ng/mL are desirable in the treatment of atrial fibrillation

All of the following are adverse effects of amiodarone, except: a. Cinchonism b. Hypothyroidism c. Pulmonary fibrosis d. Blue skin discoloration

a. Cinchonism

Which arrhythmia can be treated with lidocaine? a. Paroxysmal supraventricular tachycardia b. Atrial fibrillation c. Atrial flutter d. Ventricular tachycardia

d. Ventricular tachycardia

A clinician would like to initiate a drug for rhythm control of atrial fibrillation. Which of the following coexisting conditions would allow for initiation of flecainide? a. Hypertension b. Left ventricular hypertrophy c. Coronary artery disease d. Heart failure

a. Hypertension

Which statement regarding dronedarone is correct? a. Dronedarone is more effective than amiodarone b. QT interval prolongation is not a risk with dronedarone c. Dronedarone increases the risk of death in patients with permanent atrial fibrillation or symptomatic heart failure d. There is no need to monitor liver function with dronedarone

c. Dronedarone increases the risk of death in patients with permanent atrial fibrillation or symptomatic heart failure

Which of the following best describes stable angina? a. Angina that occurs more frequently or with progressively less exercise or stress than before b. Angina due to spasm of coronary arteries c. Angina due to increased myocardial demand which is reproducible and relieved by rest or nitroglycerin d. Angina pain accompanied by increases in serum biomarkers of myocardial necrosis

c. Angina due to increased myocardial demand which is reproducible and relieved by rest or nitroglycerin

Which medication should be prescribed to all angina patients to treat an acute attack? a. Isosorbide dinitrate b. Nitroglycerin patch c. Nitroglycerin sublingual tablet or spray d. Ranolazine

c. Nitroglycerin sublingual tablet or spray

Which of the following instructions is important to communicate to a patient receiving a prescription for the nitroglycerin patch? A. Apply the patch at onset of angina symptoms for quick relief. B. Remove the old patch after 24 hours of use, then immediately apply the next patch to prevent any breakthrough angina pain. C. Do not use sublingual nitroglycerin in combination with the patch. D. Have a nitrate-free interval of 10 to 12 hours every day to prevent development of nitrate tolerance.

D. Have a nitrate-free interval of 10 to 12 hours every day to prevent development of nitrate tolerance.

A 64-year-old man was prescribed atenolol and sublingual nitroglycerin after his recent hospitalization for unstable angina. Which of his current medications should be discontinued? A. Sildenafil B. Amlodipine C. Metformin D. Lisinopril

A. Sildenafil

Which of the following correctly ranks the calcium channel blockers from most active on the myocardium to most peripherally active? A. Diltiazem, amlodipine, verapamil B. Verapamil, diltiazem, nifedipine C. Nifedipine, verapamil, diltiazem D. Amlodipine, diltiazem, verapamil

B. Verapamil, diltiazem, nifedipine

A 76-year-old man with uncontrolled hypertension is experiencing typical angina pain that is relieved with rest and sublingual nitroglycerin. He has a high blood pressure (178/92 mm Hg) and a low heart rate (54 bpm). Which is the most appropriate therapy for his angina at this time? A. Ranolazine B. Verapamil C. Metoprolol D. Amlodipine

D. Amlodipine

A 65-year-old male experiences uncontrolled angina attacks that limit his ability to do household chores. He is adherent to a maximized dose of ẞ-blocker with a low heart rate and low blood pressure. He is unable to tolerate an increase in isosorbide mononitrate due to headache. Which is the most appropriate addition to his antianginal therapy? A. Nifedipine B. Aspirin C. Ranolazine D. Verapamil

C. Ranolazine

A 62-year-old man with ischemic heart disease complains of angina pain that has been getting progressively worse over the past 30 minutes despite use of nitroglycerin. Which of the following is the best course of action? A. Change nitroglycerin to a long-acting nitrate B. Initiate metoprolol C. Initiate ranolazine D. Refer him to the nearest emergency department for immediate evaluation.

C. Initiate ranolazine

Which is correct regarding antianginal therapy in patients with heart failure with reduced ejection fraction? A. B-Blockers have been associated with reduced mortality B. Dihydropyridine calcium channel blockers should be avoided C. B-Blockers with ISA are preferred over those without ISA D. Nondihydropyridine calcium channel blockers should be used in patients with heart failure with reduced ejection fraction who cannot tolerate ẞ-blockers

A. B-Blockers have been associated with reduced mortality

A 45-year-old woman with type 1 diabetes has been diagnosed with Prinzmetal angina. Which of the following is correct regarding management of angina in this patient? A. B-Blockers are the treatment of choice but should be avoided because of her diabetes. B. Nitroglycerin is not beneficial for this type of angina. C. She should be counseled to take nitroglycerin before physical activity to prevent symptoms. D. Felodipine will be more effective than verapamil.

D. Felodipine will be more effective than verapamil.

Which of the following is the most common adverse effect of antihyperlipidemic drug therapy? A. Elevated blood pressure B. Gastrointestinal disturbance C. Neurologic problems D. Heart palpitations

B. Gastrointestinal disturbance

Which of the following hyperlipidemias is characterized by elevated plasma levels of chylomicrons and has no drug therapy available to lower the plasma lipoprotein levels? A. Type I B. Type II C. Type III D. Type IV

A. Type I

Which of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3- methylglutaryl coenzyme A reductase? A. Fenofibrate B. Cholestyramine C. Lovastatin D. Gemfibrozil

C. Lovastatin

Which of the following nonstatin drugs lowers LDL-C most effectively? A. Niacin B. Alirocumab C. Cholestyramine D. Ezetimibe

B. Alirocumab

Which of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation? A. Niacin B. Fenofibrate C. Cholestyramine D. Fluvastatin

C. Cholestyramine

A 65-year-old man has type 2 diabetes mellitus and an LDL-C of 165 mg/dL. Which is the best option to lower LDL-C and decrease the risk of ASCVD events in this patient? A. Fenofibrate B. Colesevelam C. Rosuvastatin D. Ezetimibe

C. Rosuvastatin

A 62-year-old female with hyperlipidemia and hypothyroidism is prescribed cholestyramine and levothyroxine (thyroid hormone). What advice would you give this patient to avoid a drug interaction between her cholestyramine and levothyroxine? A. Stop taking the levothyroxine as it can interact with cholestyramine. B. Take levothyroxine 1 hour before cholestyramine on an empty stomach. C. Switch cholestyramine to colesevelam as this eliminates the interaction. D. Switch cholestyramine to colestipol as this eliminates the interaction.

B. Take levothyroxine 1 hour before cholestyramine on an empty stomach.

A 42-year-old man was started on sustained-release niacin 2 weeks ago. He reports uncomfortable flushing and itchiness that he thinks is related to the niacin. Which of the following can help manage this adverse effect of niacin therapy? A. Administer aspirin 30 minutes prior to taking niacin. B. Administer aspirin 30 minutes after taking niacin. C. Increase the dose of niacin. D. Change the sustained-release niacin to immediate-release niacin.

A. Administer aspirin 30 minutes prior to taking niacin.

A 72-year-old man with hyperlipidemia and renal insufficiency has been treated with high-intensity atorvastatin for 6 months. His LDL-C is 131 mg/dL; triglycerides, 710 mg/dL; and HDL-C, 32 mg/dL. His physician wishes to add another agent for hyperlipidemia. Which is the best option to address the hyperlipidemia in this patient? A. Fenofibrate B. Niacin C. Colestipol D. Gemfibrozil

B. Niacin

Which patient population is most likely to experience myalgia (muscle pain) or myopathy with use of HMG CoA reductase inhibitors? A. Patients with renal insufficiency B. Patients with gout C. Patients with hypertriglyceridemia D. Patients taking warfarin (blood thinner)

A. Patients with renal insufficiency