Questions

Question 1

Case
A 45-year-old male patient with a 5-year history of hypertension presents for a checkup and review of blood work. Blood work is notable for fasting blood sugar 133 mg/dL. The physician decides to prescribe lisinopril. The patient calls the physician a week after being prescribed the medication and reports moderate tongue swelling.

Question
What is the most likely mechanism of the tongue swelling experienced by this patient?

Answer 1

Decreased catabolism of bradykinin

Question 2

Sodium nitroprusside is administered intravenously in the cases of hypertensive emergency and causes prompt vasodilation. If given orally, the drug can cause death because of

Answer 2

Tissue anoxia

Question 3

Case
A 33-year-old man presents with severe thirst and frequent urination; symptoms have been developing over the past month. He claims to consume more than 8 liters of fluids per day. Despite that, he is always thirsty.

Fasting blood glucose is 90 mg/dL. On brain MRI, the hyperintensity of the posterior pituitary is absent.

Question
What drug is likely used to treat this patient?

Answer 3

Desmopressin

Question 4

Of the following, which class of diuretics would be the most effective diuretic in patients with acute renal failure?

K+ Sparing Diuretic
Thiazide Diuretic
Loop Diuretic
Osmotic Diuretic

Answer 4

Loop Diuretic

Question 5

The function of the angiotensin family of peptides is to act as

Answer 5

Vasoconstrictors

Question 6

Case
A 62-year-old female patient is being treated for chronic congestive heart failure; ejection fraction is 40%. She has been put on hydrochlorothiazide therapy. Serum electrolyte levels are being monitored and show a persistent hypokalemia.

Question Highlights
What is most appropriate to add to this patient’s therapeutic regimen?

Valsartan
Sacubitril-valsartan
Furosemide
Hydrochlorothiazide

Answer 6

Sacubitril-valsartan

Question 7

Some diuretics antagonize the effects of aldosterone at the cortical collecting tubule and the late distal tubule. These drugs are most useful in the therapy of mineralocorticoid excess. Which of the following drugs causes direct pharmacological antagonism of mineralocorticoid receptors?

Triamterene
Spironolactone
Furosemide
Hydrochlorothiazide
Amiloride

Answer 7

Spironolactone

Question 8

Historically ganglion blockers were the first drugs to be used for the treatment of hypertension. They are no longer used on account of the toxic effects associated with them. Which one of the following is a ganglion-blocking drug that is used even today to lower blood pressure?

Answer 8

Trimethaphan

Question 9

A 60-year-old patient presents to the office with complaints of chest pain. During the conversation, the patient indicates that he is under a lot of stress at his job. His blood pressure is 175/102 mmHg, pulse is 84bpm. ECG showed slightly negative T-waves in II, III, and aVF. You decide to initiate the treatment with metoprolol-XL, 50mg a day instructing the patient not to stop the medication abruptly without doctor’s supervision. Out of the following, what describes the best reason behind your warning?

Undesirable negative inotropic action
Inefficient therapeutic response
Onset of heart failure
Precipitation of ischemic events
AV nodal depression
Increase of myocardial relaxation
Decrease of afterload

Answer 9

Precipitation of ischemic events

Question 10

A 54-year-old female presents with complaints of shortness of breath and leg edema usually visible by the end of the day. She did not have those symptoms before. Auscultation displayed a prominent S3 gallop rhythm. If you were to initiate digitalis in this patient, what would be the most likely explanation for its beneficial therapeutic action?

Answer 10

Increased Cardiac Output

Question 11

Case
A 65-year-old African American man presents in your office for a follow-up for hypertension. 3 months earlier, you prescribed furosemide. He checks his blood pressure daily and states that it is markedly lower since he has been on the medication, but it feels like his heart is skipping a beat once in a while.

Question
What deficiency is most likely?

Answer 11

Potassium

Question 12

A 67-year-old female with the history of shortness of breath and leg edema is seeing you in the office for a follow-up visit. She is also taking enalapril and metoprolol. You decide to add digoxin to her treatment plan. Out of the following, what is the main adverse effect of treatment with digoxin?

Answer 12

Proarythmia

Question 13

Case
A 25-year-old overweight African American man presents with concerns about his blood pressure. 3 months ago, he reports elevated blood pressure at a work health fair. He has checked his blood pressure in local grocery stores and he knows that the readings were “above normal.” He has a strong family history of hypertension. His blood pressure is 175/95 mm Hg in the left arm and 172/99 mm Hg in the right arm.

Question
What drug should be initiated along with appropriate lifestyle modifications?

1 Hydrochlorothiazide
2 Metoprolol
3 Enalapril
4 Losartan
5 Labetolol

Answer 13

Hydrochlorothiazide

Question 14

A significant number of patients started on ACE inhibitor therapy for hypertension are intolerant and must be switched to a different class of drug. What is the most common manifestation of this intolerance?

Answer 14

Incessant Cough

Question 15

Comparison of prazosin with atenolol shows that

Answer 15

Both increase sympathetic outflow from the CNS

Question 16

A 73-year-old man with a history of a recent change in his treatment for moderately severe hypertension is brought to the emergency department because of a fall at home. Which of the following drug groups is most likely to cause postural hypotension and thus an increased risk of falls?

Answer 16

Alpha1-selective receptor blockers

Question 17

Which one of the following is characteristic of nifedipine treatment in patients with essential hypertension?

A
Competitively blocks angiotensin II at its receptor

B
Decreases calcium efflux from skeletal muscle

C
Decreases renin concentration in the blood

D
Decreases calcium influx into smooth muscle

E
Increases calcium excretion in the urine

Answer 17

Decreases calcium influx into smooth muscle

Question 18

A patient with hypertension and angina is referred for treatment. Metoprolol and verapamil are among the drugs considered. Both metoprolol and verapamil are associated with which one of the following?A
Diarrhea

B
Hypoglycemia

C
Increased PR interval

D
Tachycardia

E
Thyrotoxicosis

Answer 18

Increased PR interval

Question 19

A 32-year-old woman with hypertension wishes to become pregnant. Her physician informs her that she will have to switch to another antihypertensive drug. Which of the following drugs is absolutely contraindicated in pregnancy?

A
Atenolol

B
Losartan

C
Methyldopa

D
Nifedipine

E
Propranolol

Answer 19

Losartan

Question 20

A patient is admitted to the emergency department with severe tachycardia after a drug overdose. His family reports that he has been depressed about his hypertension. Which one of the following drugs increases the heart rate in a dose-dependent manner?

A
Captopril

B
Hydrochlorothiazide

C
Losartan

D
Minoxidil

E
Verapamil

Answer 20

Minoxidil

Question 21

Which of the following is very short-acting and acts by releasing nitric oxide?

E
Hydrochlorothiazide

F
Losartan

G
Minoxidil

H
Nitroprusside

I
Prazosin

Answer 21

Nitroprusside

Question 22

When nitrates are used in combination with other drugs for the treatment of angina, which one of the following combinations results in additive effects on the variable specified?

A
Beta blockers and nitrates on end-diastolic cardiac size

B
Beta blockers and nitrates on heart rate

C
Beta blockers and nitrates on venous tone

D
Calcium channel blockers and β blockers on cardiac force

E
Calcium channel blockers and nitrates on heart rate

Answer 22

Calcium channel blockers and B blockers on cardiac force

Question 23

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin.

If a β blocker were to be used for prophylaxis in this patient, what is the most probable mechanism of action in angina?

A
Block of exercise-induced tachycardia

B
Decreased end-diastolic ventricular volume

C
Increased double product

D
Increased cardiac force

E
Decreased ventricular ejection time

Answer 23

Block of exercise-induced tachycardia

Question 24

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin.

Which of the following is a common direct or reflex effect of nitroglycerin?

A
Decreased heart rate

B
Decreased venous capacitance

C
Increased afterload

D
Increased cardiac force

E
Increased diastolic myocardial fiber tension

Answer 24

Increased Cardiac Force

Question 25

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin. In advising the patient about the adverse effects she may notice, you point out that nitroglycerin in moderate doses often produces certain symptoms. Which of the following effects might occur due to the mechanism listed? A Constipation due to reduced colonic activity B Dizziness due to reduced cardiac force of contraction C Diuresis due to sympathetic discharge D Headache due to meningeal vasodilation E Hypertension due to reflex tachycardia

Answer 25

Hypertension due to reflex tachycardia

Question 26

Another patient is admitted to the emergency department after a drug overdose. He is noted to have hypotension and severe bradycardia. He has been receiving therapy for hypertension and angina. Which of the following drugs in high doses causes bradycardia? A Amlodipine B Isosorbide dinitrate C Nitroglycerin D Prazosin E Verapamil

Answer 26

Verapamil

Question 27

A new 60-year-old patient presents to the medical clinic with hypertension and angina. He is 1.8 meters tall with a waist measurement of 1.1 m. Weight is 97 kg, blood pressure is 150/95 mm Hg, and pulse is 85. In considering adverse effects of possible drugs for these conditions, you note that an adverse effect that nitroglycerin and prazosin have in common is A Bradycardia B Impaired sexual function C Lupus erythematosus syndrome D Orthostatic hypotension E Weight gain

Answer 27

Orthostatic hypotension

Question 28

A 45-year-old woman with hyperlipidemia and frequent migraine headaches develops angina of effort. Which of the following is relatively contraindicated because of her migraines? A Amlodipine B Diltiazem C Metoprolol D Nitroglycerin E Verapamil

Answer 28

Nitroglycerin

Question 29

A 57-year-old woman presents to her primary care physician with a complaint of severe chest pain when she walks uphill in cold weather. The pain disappears when she rests. She has a 40-pack-year history of smoking but her plasma lipids are within the normal range. After evaluation and discussion of treatment options, a decision is made to treat her with nitroglycerin. One year later, the patient returns complaining that her nitroglycerin works well when she takes it for an acute attack but that she is now having more frequent attacks and would like something to prevent them. Useful drugs for the prophylaxis of angina of effort include A Amyl nitrite B Esmolol C Sublingual isosorbide dinitrate D Sublingual nitroglycerin E Verapamil

Answer 29

Verapamil

Question 30

Certain drugs can cause severe hypotension when combined with nitrates. Which of the following interacts with nitroglycerin by inhibiting the metabolism of cGMP? A Atenolol B Hydralazine C Isosorbide mononitrate D Nifedipine E Ranolazine F Sildenafil G Terbutaline

Answer 30

Sildenafil

Question 31

Which of the following diuretics would be most useful in the acute treatment of a comatose patient with traumatic brain injury and cerebral edema? A Acetazolamide B Amiloride C Chlorthalidone D Furosemide E Mannitol

Answer 31

Mannitol

Question 32

A 70-year-old retired businessman with a history of chronic heart failure has been taking digoxin and furosemide. He is now admitted with vomiting, acute decompensated heart failure, and metabolic derangements. He has marked peripheral edema and metabolic alkalosis (pH, 7.50 [normal 7.4]; pCO2, 45 [37–45]; HCO3, 36 [22–26]; Na+, 140 [135–145]). Which of the following drugs is most appropriate for the treatment of his edema? A Acetazolamide B Digoxin C Eplerenone D Hydrochlorothiazide E Tolvaptan

Answer 32

Acetazolamide

Question 33

A 62-year-old man with advanced prostate cancer is admitted to the emergency department with mental obtundation. An electrolyte panel shows a serum calcium of 16.5 (normal 8.5–10.5 mg/dL). Which of the following therapies would be most useful in the management of severe hypercalcemia? A Acetazolamide plus saline infusion B Furosemide plus saline infusion C Hydrochlorothiazide plus saline infusion D Mannitol plus saline infusion E Spironolactone plus saline infusion

Answer 33

Furosemide plus saline infusion

Question 34

A 50-year-old man has a history of frequent episodes of renal colic with calcium-containing renal stones. A careful workup indicates that he has a defect in proximal tubular calcium reabsorption, which results in high concentrations of calcium salts in the tubular urine. The most useful diuretic agent in the treatment of recurrent calcium stones is A Chlorthalidone B Diazoxide C Ethacrynic acid D Mannitol E Spironolactone

Answer 34

Chlorthalidone

Question 35

A 60-year-old patient complains of dizziness on standing and some hearing impairment associated with one of the drugs she is taking. She has severe hypertension and early signs of heart failure. She is probably taking A Acetazolamide B Amiloride C Furosemide D Hydrochlorothiazide E Mannitol

Answer 35

Furosemide

Question 36

Which of the following is an important effect of chronic therapy with loop diuretics? A Decreased urinary excretion of calcium B Elevation of blood pressure C Elevation of pulmonary vascular pressure D Metabolic alkalosis E Teratogenic action in pregnancy

Answer 36

Metabolic alkalosis

Question 37

A graduate student is planning to make a high-altitude climb in South America while on vacation. He will not have time to acclimate slowly to altitude. A drug that is useful in preventing high-altitude sickness is A Acetazolamide B Amiloride C Demeclocycline D Desmopressin E Ethacrynic acid

Answer 37

Acetazolamide

Question 38

Which one of the following drugs is associated with clinically useful or physiologically important positive inotropic effects? A Captopril B Dobutamine C Enalapril D Losartan E Nesiritide

Answer 38

Dobutamine

Question 39

A 73-year-old man with an inadequate response to other drugs is to receive digoxin for chronic heart failure. He is in normal sinus rhythm with a heart rate of 88 bpm and blood pressure of 135/85 mm Hg. After your patient has been receiving digoxin for 3 weeks, he presents to the emergency department with an arrhythmia. Which one of the following is most likely to contribute to the arrhythmogenic effect of digoxin? A Increased parasympathetic discharge B Increased intracellular calcium C Decreased sympathetic discharge D Decreased intracellular ATP E Increased extracellular potassium

Answer 39

Increased intracellular calcium

Question 40

Which of the following has been shown to prolong life in patients with chronic congestive failure in spite of having a negative inotropic effect on cardiac contractility? A Carvedilol B Digoxin C Dobutamine D Enalapril E Furosemide

Answer 40

Carvedilol

Question 41

A 73-year-old man with an inadequate response to other drugs is to receive digoxin for chronic heart failure. He is in normal sinus rhythm with a heart rate of 88 bpm and blood pressure of 135/85 mm Hg. Which of the following is the best-documented mechanism of beneficial action of cardiac glycosides? A A decrease in calcium uptake by the sarcoplasmic reticulum B An increase in a late transmembrane sodium current C A modification of the actin molecule D An increase in systolic cytoplasmic calcium levels E A block of cardiac β adrenoceptors

Answer 41

An increase in systolic cytoplasmic calcium levels

Question 42

A 65-year-old African-American man has long-standing hypertension and moderate heart failure with reduced ejection fraction. His treatment has included furosemide plus digoxin but he continues to have symptoms of shortness of breath and easy fatigue. Which of the following combinations has been shown to be useful in this type of patient? A Digoxin + spironolactone B Furosemide + nesiritide C Hydralazine + isosorbide dinitrate D Isosorbide dinitrate + propranolol E Spironolactone + potassium supplements

Answer 42

Hydralazine + isosorbide dinitrate

Question 43

A 72-year-old woman has long-standing heart failure. Which one of the following drugs has been shown to reduce mortality in chronic heart failure? A Atenolol B Digoxin C Furosemide D Nitroprusside E Spironolactone

Answer 43

Spironolactone

Question 44

A 68-year-old man with a history of chronic heart failure goes on vacation and abandons his low-salt diet. Three days later, he develops severe shortness of breath and is admitted to the local hospital emergency department with significant pulmonary edema. The first-line drug of choice in most cases of acute decompensation in patients with chronic heart failure is A Atenolol B Captopril C Carvedilol D Digoxin E Diltiazem F Dobutamine G Enalapril H Furosemide I Nesiritide J Spironolactone

Answer 44

Furosemide

Question 45

A patient who has been taking digoxin for several years for atrial fibrillation and chronic heart failure is about to receive atropine for another condition. A common effect of digoxin (at therapeutic blood levels) that can be almost entirely blocked by atropine is A Decreased appetite B Headaches C Increased atrial contractility D Increased PR interval on ECG E Tachycardia

Answer 45

Increased atrial contractility

Question 46

A 5-year-old child was vomiting and was brought to the emergency department with sinus arrest and a ventricular rate of 35 bpm. An empty bottle of his uncle’s digoxin was found where he was playing. Which of the following is the drug of choice in treating a severe overdose of digoxin? A Digoxin antibodies B Lidocaine infusion C Magnesium infusion D Phenytoin by mouth E Potassium by mouth

Answer 46

Digoxin antibodies