Question Answered step-by-step A 55-year-old white man has been diagnosed with essential… A 55-year-old white man has been diagnosed with essential hypertension after his blood pressure consistently measured in the 150/90 mm Hg range on several occasions. He has no other medical problems and is otherwise healthy. He does not smoke, he exercises regularly, and his laboratory values show normal liver and kidney functions. His screening glycated hemoglobin level is 5.2g/dl. Which of the following classes of antihypertensive medications would be an appropriate first-line antihypertensive medication for this patient?Thiazide Diuretic and beta-blockerThiazide diuretic and calcium channel blockerThiazide diuretic and ACE inhibitorCurrent national guidelines have conflicting recommendations about starting with thiazide diuretic alone versus a 2-drug combination.A 55-year-old woman presents to you with extreme tenderness in her first left metatarsophalangeal joint, which is erythematous, swollen, and tender to palpation. She has a history of gout and is taking allopurinol to lower her uric acid levels. She is prescribed indomethacin and colchicine for an acute gout flare-up. At today’s visit, her blood pressure reading is 160/95 mm Hg. During her last visit 2 months ago, it was 145/90 mm Hg. When initiating antihypertensive therapy in this patient, which class of drugs should be avoided?Calcium channel blockersBeta-blockersAngiotensin receptor blockersThiazide’s diureticsThe circumference of a patient’s left calf measured 10cm below tibial tuberosity and is 4cm larger that the diameter of the right calf. There is no swelling of the left thigh. This problem started about 1 week ago without any preceding trauma. She recently traveled to Florida and returned 2 weeks ago. She has spent almost 8 hours in her car. She is otherwise healthy. Her only medications/supplements are fish oil and hydrochlorothiazide for hypertension. The Wells criteria for deep venous thrombosis (DVT) would most support which of the following tests?Doppler compression ultrasonographyContrast venographyD-dimer testComputed tomography (CT) venographyA 59-year-old woman presents to you after losing consciousness at church. She was kneeling during a long service in a crowded church and felt a feeling of warmth and lightheadedness before “everything went dark”. Bystanders deny seeing any involuntary movements during the event, and after a couple of minutes, the patient regained consciousness with no impairment. The patient denies having any chest pain or palpitations. She has not had dyspnea. Findings on her physical examination, which included both neurologic and cardiac examinations, are normal. Initial electrocardiography (ECG) shows normal sinus rhythm, and her laboratory values are normal. The patient’s only medications are atorvastatin for hyperlipidemia and vitamin D with calcium. Which of the following is the most likely diagnosis?Cardiac syncopeVasovagal syncopeCarotid hypersensitivityMedication-induced syncopeA 56-year-old African American man presents to you for an annual physical examination. His medical history is significant for depression and an ankle fracture 2 years ago. He has a healthy lifestyle, does not smoke, and has a body mass index of 24 kg/m2.His family history is significant for prostate cancer in his father at 72 years of age. He takes no medications. His blood pressure, measured 6 months ago was 156/95 mm Hg, and today it is 160/100 mm Hg. What is the most appropriate step in the management of his blood pressure?The patient is in pre-hypertension range, so follow-up observation is in orderHydrochlorothiazideBeta-blockerLisinoprilA new patient, a 55-year-old woman, presents to you for a general medical examination. Her family history is significant for coronary artery disease. She wants to do whatever she can to prevent cardiovascular disease (CVD). Currently, she is not taking ay medications. Her body mass index is 27 kg/m2. Her blood pressure is 128/78 mm Hg. Her lipid profile is total cholesterol 225, high density lipoprotein 35, low density lipoprotein 153, triglycerides 180. The remainder of her laboratory values are normal. What are the indications for medications for this patient according to guidelines from the US Preventative Services Task Force (USPSTF).Start aspirin and low-dose statinsStart a moderate-dose statin and aspirinNo therapy is indicated at this timeStart very low dose statinsHealthy older persons can improve their exercise capacity with cardiovascular training. What specifically does training do?It decreases the maximal cardiac outputIt decreases myocardial oxygen demand for a given level of workIt decreases the maximal ventilatory oxygen uptakeIt decreases the resting heart rateWhich of the following statements is true regarding the role of aspirin in the primary prevention of cardiovascular disease (CVD), according to the US Preventative Services Task Force (USPSTF)?Aspirin is only useful for the secondary prevention of CVDAspirin should be used in every older than 50 years of age as a once-daily regimen.Aspirin use is not advisedUse low-dose aspirin for the primary prevention of CVD in adults aged 50-59 years who have a 10% or higher 10-year CVD risk.A 54-year-old woman presents to you after experiencing an episode of syncope. She stood up from the dinner table after a holiday meal and felt very lightheaded. Her dining companions watched as she fell to the floor, losing consciousness for less than 1 minute. The patient says she now feels fine. She has no history of angina, seizure, dyspnea, hematochezia, melena, or fatigue. Her temperature is 37.1 degree Celsius (98.8-degree Fahrenheit), blood pressure is 120/70 mm Hg, pulse is 82 beats/minute, and respiration rate is 12 breaths/minute. Physical and neurological examination findings are normal. Which of the following is the most important initial test in evaluating the patient’s syncope?Carotid duplex ultrasonographyComplete blood count (CBC)Electrocardiography (ECG)Computed tomography (CT) of the headA 22-year-old man presents to you for his annual physical examination. He is healthy, has no known past medical history, does not smoke or drink alcohol, and has no family history of coronary artery disease (CAD). His lipid panel is significant for low-density lipoprotein (LDL) of 195 mg/dl. Complete blood count, chemistries, and liver function tests are normal. He is currently not taking any medications. His vitals are heart rate 79 beats/minute, respiratory rate 18 breaths/minute, blood pressure 120/80 mm Hg and temperature 37-degree Celsius. His body mass index 24 kg/m2. Physical examination is unremarkable. According to the American College of cardiology (ACC)/American Heart Association (AHA) guidelines on hyperlipidemia, what is the next step in the management of the patient’s condition?EzetimibeObservationAtorvastatinNiacinGemfibrozilA 43-year-old man has been diagnosed with deep venous thrombosis (DVT) of his popliteal vein and started on enoxaparin and warfarin. DVT developed after he was on a flight from Sydney to Los Angeles the week before, during which he developed pain and edema in his left lower extremity. His only comorbidities are hypertension, obesity, and type 2 diabetes mellitus. His initial workup did not reveal any thrombophilia. He has never been diagnosed with DVT or pulmonary embolism before. He does not recall anyone in his family having any “blood clots”. He wants to know for how long he will need to remain on warfarin. What should you tell him?3 months6 months12 months6-8weeksWhich of the following is an indication for endocarditis prophylaxis in a patient undergoing a dental procedure?Symptomatic mitral valve prolapseBicuspid aortic valveAortic stenosisProsthetic valveMitral StenosisA 47-year-old woman with long standing lupus nephritis presents to her physician for her biannual checkup. She is currently taking no medication and she feels generally well. On physical examination, her blood pressure is 160/98 mm Hg. Pressures were equal in both arms. Previous blood pressures have been in the range of 130/70 mm Hg. Her physician asked her to return a week for a recheck of the pressure. At this time, repeat blood pressure was 158/100 mm Hg. The remainder of the physical examination was normalLaboratory studies:Serum creatinine: 4.3 mg/dLBlood urea nitrogen: 38 mg/dLSerum potassium: 5.1 mEq/LUrinary protein: 1 g/24hrsThese laboratory results were only slightly higher than those taken 6 months earlier. This patient is presumed to have hypertension as the result of her lupus nephritis. Which of the following anti-hypertensive agents is a first line drug in this patient?Symptomatic blocker such as aldometBeta-blockerThiazide diureticAngiotensin-converting enzyme (ACE) inhibitorThe patient has a history of hypertension and his taking lisinopril and hydrochlorothiazide. He also takes fish oil and multivitamin supplements. He smokes 0.5 pack/day and does not drink alcohol. Doppler ultrasonography of the lower extremities does not reveal any deep venous involvement, but it does reveal an isolated thrombus in a tributary of the great saphenous vein that enters the saphenous vein at the mid-thigh level. Neither the saphenous nor femoral vein shows thrombus. Which of the following is the most appropriate treatment for the patient?Unfractionated heparinCorticosteroidsNonsteroidal anti-inflammatory drugsWarfarinAn 86-year-old white man presents to you for a routine physical examination. His medical history includes gastroesophageal reflux disease and depression. He is on pantoprazole and escitalopram. He is a retired salesman who remains physically active. He drinks red wine once a week. He smokes 1 pack/day and has 30 pack year smoking history. He has no complaints and is currently without symptoms. On today’s visit he appears healthy. Vital signs are temperature 98.4-degree Fahrenheits, heart rate 55 beats/minute and regular, respiratory rate 18 breaths/minute, and blood pressure 170/70 mm Hg. His body mass index is 30 kg/m2. At a previous visit 6 months ago, his blood pressure was 120/80 mm Hg. General physical examination is unremarkable and neurologic examination is normal. His complete blood count and chemistries are within normal limits. What would be the most appropriate next step in the management of his hypertension?LisinoprilMetoprololHydrochlorothiazideTrial of therapeutic lifestyle changes (e.g., smoking cessation, weight loss, low salt diet)A 75-yearold man presents to you for the complaint of leg pain. He tells you that he gets a cramping ache in his calves when he walks more than 100 feet; the pain, he explains, is relieved by rest. His medical history is notable for hypertension and hypercholesterolemia. He takes aspirin, rosuvastatin, and amlodipine. He has a prior history of smoking 1 to 2 packs of cigarette per day for 50 years, but he quit 5 years ago. His ankle-brachial index is 0.8. What is the most appropriate step to improve his ability to walk?Femoral-popliteal bypass surgeryChanging aspirin to clopidogrelSupervised exercise programPentoxifyllineA 66-year-old white woman with a longstanding history of rheumatoid arthritis presents to you for a routine visit. On a visit 3 months ago, her blood pressure was 145/90 mm Hg and you recommend lifestyle changes. Today, her blood pressure is 150/86 mm Hg and you diagnose her with hypertension. She also complains of pain, so she is taking acetaminophen and ibuprofen to manage her pain in addition to monthly injections of anti-tumor necrosis factor alpha agents, which are managed by her rheumatologist. Which class of antihypertensive agents is most effective in patients receiving non-steroidal anti-inflammatory drugs?Calcium channel blockerAngiotensin-converting enzyme inhibitorsAngiotensin receptor blockersBeta-blockersA 22-year-old woman fell during a softball game. Her parents are concerned because a friend of theirs experienced sudden cardiac death while exercising. They believe her daughter had a syncopal episode as the cause of the fall, but she never lost consciousness and the patient believes this was just an accidental fall. Currently, she is asymptomatic. Cardiac auscultation in left lateral decubitus and orthostatic position revealed no systolic murmur or prominent point of maximal impulse. Findings on echocardiography showed evidence of septal hypertrophy (> 15 mm). No systolic anterior movement of the mitral valve or intraventricular gradient was observed. What will be the best management of this patient’s condition?DisopiramidePacemaker implantationNadololWatchful observationA 56-year-old patient with a history of aortic valve replacement 18 months ago will be undergoing cystoscopy to evaluate recent hematuria. His urologist wants to know what endocarditis prophylaxis the patient will need prior to surgery. What is the appropriate response?Oral amoxicillin 2 g 1 hour before surgeryNo prophylaxis recommendedOral clindamycin 600 mg 1 hour before surgeryOral cephalexin 2 g 1 hour before surgeryYou are ready to discharge home a 53-year-old white man with newly diagnosed stable angina. His medical history includes hypertension and moderate asthma. His lipid panel shows a low-density lipoprotein level of 135 mg/dL and non-high-density lipoprotein cholesterol level of 155 mg/dL. You explain to your patient that the main goals of treatment in patient with stable angina is to prevent myocardial infarction and cardiac death as well as to reduce symptoms. Which of the following combinations should you prescribe to best achieve the goals of therapy?Clopidogrel, beta blocker, calcium channel blocker, angiotensin-converting enzymes (ACE) inhibitor, and a nitrateAspirin, calcium channel blocker, angiotensin-converting enzyme (ACE) inhibitor, statin, and a nitrateClopidogrel, aspirin, angiotensin-converting enzyme (ACE) inhibitor, and a nitrateAspirin, beta-blocker, statin, angiotensin-converting enzyme (ACE) inhibitor, and a nitrateClopidogrel, calcium channel blocker, and ranolzine. Health Science Science Nursing NURS 621 Share QuestionEmailCopy link Comments (0)