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Medical Management Mastery Quiz

Test your knowledge with our comprehensive quiz designed for aspiring healthcare professionals! This 69-question quiz covers a wide range of medical management scenarios, providing a valuable opportunity to enhance your clinical reasoning skills and decision-making process.

Perfect for students, educators, or anyone interested in medicine, this quiz will help reinforce your learning and prepare you for real-world situations. Key features include:

Detailed case studies
Diverse medical topics
Immediate feedback on your answers

69 Questions17 MinutesCreated by LearningDoctor482

A 60-year-old man who works for an oil company presents with a lesion on the temple that is bothering him as it is growing. It bled once when he knocked it. On examination, the lesion is 8 mm in diameter and is a flat, mildly erythematous patch with a few scales and a larger keratotic horn in the centre. There are no other lesions on inspection of his skin and no personal or family history of skin cancer. Which of the following is the most appropriate management plan?

Cryotherapy

Curettage

Excisional biopsy

Topical 5-fluorouracil

Wide local excision

A 55-year-old Asian man with known thalassaemia trait registers with a new GP and is found to have a mild microcytic anaemia on routine testing. He does not complain of any symptoms. What is the most appropriate treatment?

Blood transfusion

Folate supplementation

Iron chelators

Iron supplementation

No treat1nent required

A 76-year-old man presents with a vesicular eruption on the left side of his forehead only. It is severely painful and the vesicles have started to crust over. On examination, the area affected is well-demarcated. You also note a red eye with apparent conjunctivitis. Given the most likely diagnosis, which of the following treatments is the most appropriate?

Intravenot1s aciclovir

Oral acyclovir

Topical aciclov

Topical antibiotic

Topical steroids

A 55-year-old woman is seen in clinic, she has a ten-year history of type 2 diabetes treated with glibenclamide. Her blood pressure is 148/93 with new onset proteinuria, her serum results show elevated lipid levels, glycated haemoglobin of 5.5 per cent and fasting glucose of 6.0 mmol/L. A renal biopsy shows the presence of Kimmelstiel-Wilson lesions. The most appropriate management is:

Increase oral hypoglycaemic dosage

ACE II antagonists

Start cholesterol lowering therapy

Start ACE inhibitors

Sta1t renal dialysis

A 24-year-old woman presents with increasing breathlessness on exertion, which has been developing over several months. There are no abnormal physical signs on examination. On the ECG, there is right axis deviation and an R wave in Vl, with peaked P waves. Chest x-ray showed prominent hilar vessels with sparse vasculature peripherally in the lungs. Doppler echocardiography revealed a pulmonary artery pressure of 60 mmHg and primary pulmonary hypertension was diagnosed. Which of the foil owing medications would not be appropriate in managing this patient?

Sildenafil

Bosentan

Warfarin

Doxazosin

Prostacyclin

You are told by your registrar that a 66-year-old woman from a residential home has been admitted with a right mid-zone community-acquired pneumonia. She is very drowsy and her CURB-65 score is 4. On admission, the patient's oxygen saturations are 91-92 per cent on room air, respiratory rate of 20, temperature of 37.7°C, P02 7.1 kPa and PC02 4.7 kPa. Her oxygen saturations have improved to 95 per cent on 15 L 02 via a non-rebreather oxygen mask. From the list below, which is the most appropriate management plan for this patient?

Oral a11tibiotics a11d aler·t the ITU SpR

Intravenous antibiotics and transfer to respiratory ward

Intravenous antibiotics and alert the ITU SpR

Oral antibiotics and transfer to the respiratory ward

Alert ITU SpR

A 45-year-old man who is a heavy smoker is recently diagnosed with chronic obstructive pulmonary disease (COPD). He has no documented acute exacerbations in the past. Which of the following treatment is NOT suitable in the management of COPD in this patient?

Annt1al influenza and pneumococcal vaccination

Inhaled corticosteroids

Short-acting b2-agonist

Shott-acting anti-cholinergic

Smoking cessation

Intravenot1s aciclovir

Oral acyclovir

Topical aciclovir

Topical antibiotic

Topical steroids

A 45-year-old asthmatic patient presents with palpitations. An ECG shows supraventricular tachycardia, with narrow QRS complexes. Carotid sinus massage is not successful. What would you do next?

Administer intravenous ade11osine

Administer intravenous verapamil

Administer intravenous digo

Administer intravenot1s sotolol

DC cardioversion

A SO-year-old man presents with a 1-hour history of severe central chest pain. There is no significant past medical history. He is haemodynamically stable with pulse rate of 90 bpm and blood pressure of 120/70 mm Hg. ECG shows 5 mm of ST-segment elevation in the anterior leads (V2-V4). He received aspirin 300 mg in the ambulance and 5 mg diamorphine. What would be the next line of treatment?

Clopidogrel

Enoxaparin

GIIb/Ila blocker

S treptokinase

Tissue plasminogen activator

A 73-year-old woman is admitted for pacemaker insertion because of a number of syncopes and periods of complete heart block identified on 72hr ECG. She receives a DDDR pacemaker. What does the R stand for?

Rate limiting

Rate modulated

Repolarising

Rate enhancing

Rate reducin.g

A 55-year old man fractures his ankle attempting to replicate the latest dance fad he has seen his children do. He is otherwise fit and well and is haemodynamically stable. The fracture requires open reduction and internal fixation. The trauma registrar has said that he needs to be nil-by- mouth from midnight, however the operating list is always changing and new emergencies may come in. There are at least three cases that are likely to get done before him. Your request that he have breakfast as he is likely to be done later in the day is met with derision. He will need physiological fluid replacement when he is nil-by-mouth. He weighs 70 kg. Which of the following regimens is closest to physiologic.al needs?

1 L 0.9% normal saline with 20 m111ol potassium and 2 x 1 L 5% dextrose in 24 hours

1 L 0.9% normal saline with 20 mmol potassium and 2 x 1 L So/o dextrose with 20 mmol potassium in 24 hours

2 x 1 L 0.9% normal saline with 20 111mol potassiu111 and 1 L 5% dextrose in 24 hours

2 x 1 L 0.9% normal saline with 20 mmol potassium and 1 L 5% dextrose with 20 mmol potassium in 24 hours

3 L Ha1imam1' s in 24 hours

A 46-year-old woman has been diagnosed with rheumatoid arthritis and has been on methotrexate for over a year, but sadly her disease is not under control. She wants to know about the new drugs used for rheumatoid arthritis that she heard about at a patients' association. Which of the following statements about biological disease-modifying antirheumatic drugs (DMARDs) is NOT true?

A chest X -ray should be taken before starting to rule out latent tuberculosis (which could be reactivated)

If the patient's disease gets worse whilst on biological therapy, switching from one biological DMARD to anotl1er is unlikely to produce an improvement

Injection site reactions for subcutaneously injected agents are common

The more commonly used agents target and inhibit tumour necrosis factor alpha (TNF-alpha)

They can be used in combination with methotrexate

A 58-year-old man with multiple dental problems presents to the Emergency department. Apart from an abscess on his toe for which he has been receiving flucloxacillin he has been relatively well. On examination he has splinter haemorrhages and looks anaemic. You detect an aortic systolic murmur. Echocardiogram is suggestive of aortic valve endocarditis and blood cultures confirm Streptococcus viridans. In addition to IV benzylpenicillin which antibiotic would you prescribe?

Ceftriaxone

Gentamicin

Azithro1nycin

Vancomycin

Ciprofloxacin

A 55-year-old man has presented to the medical admissions unit with chest pain. You have diagnosed acute coronary syndrome (ACS) and are about to write up his drug chart. Your most suitable prescription would be?

75 mg aspirin, clopidogrel, treatment dose heparin stat with glyceryl trinitrite (GTN) spray and morphine PRN

75 mg aspirin, clopidogrel, treatment dose heparin and beta-blocker stat with GTN spray and morphine PRN

300 mg aspi1in, clopidogrel, prophylactic dose hepai·in stat with GTN spray and 1norphine PRN

300 mg aspirin, clopidogrel, treatment dose heparin and beta-blocker stat with GTN spray and 1norphine PRN

300 mg aspi1in, prophylactic hepai·in and beta-blocker stat with GTN spray and 1norphine PRN

A 48-year-old man presents to the emergency department in a reduced state of consciousness. He was brought in by his son, who says he has been more confused over the past few days. A collateral history suggests 2 weeks of polyuria and polydipsia. There was no history of head injury, trauma or ingestion of illegal drugs. He has no other significant past medical history. He has a 21 U/week alcohol history. On examination, he is unresponsive to pain. The liver edge is felt on abdominal examination. His blood tests show: Na+ 168 mmol/L, K+ 3.8 mmol/L, Glucose 68 mmol/L, Serum osmolality 350 mmol/kg, Urea 14.3 mmol/L, Creatinine 203 μmol/L. A urine dipstick test revealed glycosuria but no ketones. What is the most appropriate approach to the management of this patient?

Aim. For blood glucose concentration fall by IO mmol/L per hour

Fluid restiiction

Give treatment dose of low-molecular-weight heparin

Infuse 1 L of 0.9% NaCl fluid iI1fusion with added 40 mmol potassium at a rate of 1 L/hour

Start insulin infusion at 3 U/hour initially

A 16-year-old boy presents with a 1-year history of acne affecting his face and upper back. He has tried over-the-counter creams and ''a few creams prescribed by his GP'', which turn out to be benzoyl peroxide and an antibiotic cream. None have worked and the lesions have been getting worse. His friend had treatment with roaccutane (isotretinoin), which sorted it out, and he is keen to try this. On examination he has acne on his face and upper back but without large pustules or scarring. Which therapy might you recommend trying before isotretinoin?

Oral cyproterone acetate

Oral flucloxacillin

Oral 1 ymecycline

Oral prednisolone

Topical steroids

The patient in Question 18 adhered to your recommendations, but his blood pressure remains elevated to the same degree. He is interested in controlling his blood pressure but is worried about the cost of medications. What should be the first-line pharmacologic therapy for this patient?

Lisinopril, 5 mg/day

Extended-release diltiazem, 120 mg/day

Amlodipine, 5 mg/day

Hydrochlorothiazide, 25 mg/day

None of the above

Three months after starting therapy, the patient in Question 18 returns for follow-up. His blood pressure is 145/92 mm Hg, and blood pressure values that he has obtained outside the clinic are similar. He says that he has been taking hydrochlorothiazide as directed and has noted no unpleasant side effects. He is doing his best to adhere to the lifestyle modifications that you recommended. What is the best step to take next in the management of this patient?

Continue present management

Add atenolol, 25 mg/day

Double the dose of hydrochlorothiazide to 50 mg/day

Add amlodipine, 5 n1g/day

None of the above

Continue present management

Add atenolol, 25 mg/day

Double the dose of hydrochlorothiazide to 50 mg/day

Add amlodipine, 5 n1g/day

None of the above

A 72-year-old woman comes to see you to establish care, after her previous physician retired. Her medical history is significant for diet-controlled diabetes and a myocardial infarction. She is taking aspirin, simvastatin, and amlodipine. On examination, her blood pressure is 170/95 mm Hg. She has an S4 gallop and 1 + pretibial edema. What should be the target blood pressure in the long term for this patient?

< 150/90 mm Hg

< 140/90 mm Hg

< 130/85 mm Hg

< 120/70 mm Hg

None of the above

Your nurse alerts you that a patient in your clinic has severely elevated blood pressure. The patient is a 45-year-old man without other significant medical history. The patient's blood pressure is 220/125 mmHg; blood pressure measurements are essentially the same in both arms. The patient says that he is feeling fine. He has had no symptoms of flushing, sweating, or headache, nor has he had visual changes, focal weakness, numbness, chest pain, dyspnea, or decreased urine output. On examination, neurologic status is normal. An S4 gallop and trace pretibial edema are noted. The lungs are clear to auscultation. An ECG shows sinus rhythm with L VH. There is no evidence of ischemia or infarction. How should you manage this patient?

Administer sublingual nifedipine, 10 mg

Administer atenolol, 50 mg, and follow up in 24 hours

Prescribe atenolol, 50 mg, and follow up in 1 week

Ad1nit him to the intensive care unit for cardiac and blood pressure monitoring and intravenous nitroprusside therapy

None of the above

A 29-year-old white woman presents to the emergency department with the complaint that her heart is ''racing away.'' The patient reports that this symptom began 1 hour ago and that it is associated with mild shortness of breath. She also reports having had similar episodes in her life, but she says they never lasted this long and that they usually abated with a simple cough. On examination, the patient's pulse is regular at 175 beats/min. Her lungs are clear, and she is in mild distress. Electrocardiography reveals atrioventricular nodal reentry tachycardia (A VNRT). Which of the following statements regarding A VNRT is false?

Most cases of AVNRT begin with a premature ventricular contraction (PVC)

Acute therapy i11cludes carotid sinus massage and I. V. adenosine

Long-term therapy includes beta blockers, calcium channel blockers, and digoxin

Catheter ablation for AVNRT is clearly the procedure of choice for patients in whom diug therapy fails

None of tl1e above

A 61-year-old woman was recently admitted to the hospital with acute coronary syndrome. She was found to have coronary artery disease that is not amenable to revascularization procedures. She is hypertensive and has hyperlipidemia. She smokes approximately 1 pack of cigarettes a day. She currently has stable angina. Medical therapy and lifestyle changes are recommended for this patient. Which of the following statements is true regarding the management of this patient?

Clopidogrel and ticlopidi11e are equally effective in reducing future cardiovascular events

Smoking cessation is as effective as or 1nore effective than any current medical therapy in reducing the risk of future cardiovascular events

Patients with chronic stable angina should be placed on statin therapy only if their low-density lipoprotein (LDL) cholesterol level is greater than 100 mg/dl

It is clear that patients who walk for at least 1 hour five to seven times a week derive more benefit than patients who walk only for 30 minutes five to seven times a week

None of the above

A 23-year-old man presented with fever and sore throat; physical examination revealed an erythematous oropharynx and cervical lymphadenopathy. The patient had no known history of drug allergy. He was started on an empirical regimen of amoxicillin for streptococcal pharyngitis. Three days later, he returned to your office complaining that his symptoms had continued and that he had developed a rash. An erythematous maculopapular rash was noted on physical examination. A monospot test was performed. The results come back positive. Which of the following statements regarding this patient's exanthematous drug eruption is true?

Persistence of fever is not helpful in determining whether the symptoms are the result of an allergic reaction, becat1se fever is conunon in simple exanthematous en1ptions

Systemic corticosteroids are always required to treat this chug eruption

After the patient's infectious process resolves, he will be able to tolerate all 􀝦-lactam antibiotics, including ampicillin

In patients with vil·al infections, the mechanism of exanthematous en1ption caused by ampicilli11 is IgEmediated mast cell degranulation

This patient's rash can be expected to progress to a vesiculai· stage before resolution

A 19-year-old female college student is taking ampicillin and clavulanate for pharyngitis. After 5 days of treatment, she develops a generalized erythematous maculopapular rash. She is given a monospot test, and the result is positive. For this patient, which of the following statements is true?

Exanthematous rashes may occur in up to 80% of patients with infectious mononucleosis that is treated with ampicillin

The patient should undergo skin testing with penicilloyl polylysine and graded desensitization before any treatment with penicillins

Treatment should include changing to a macrolide antibiotic

The patient is experiencing a type II, or cytotoxic, hypersensitivity reaction

The rash will worsen until ampicillin is stopped

A 34-year-old man comes to your office complaining of a skin ulcer. He first noticed a skin lesion 6 or 7 days ago. It started as a small, painless papule on his right arm. Over the next few hours, the lesion enlarged, and the patient noticed significant swelling around the lesion. After a few days, he developed a black eschar, which sloughed the day before the visit, leaving a painless ulcer. On physical examination, the patient has a painless ulcer measuring 2 x 2 cm that is surrounded by significant edema and that has a tender, epitrochlear node. A Gram stain of the ulcer shows broad gram-positive rods. The patient is not allergic to penicillin. You have heard of similar cases in a local hospital. What is the next step in the treatment of this patient?

Start penicillin V, 500 mg p.o., q.i.d., for 60 days and send cultures and serology to confirm your clinical diagnosis; change antibiotics according to the culture results

Start ciprofloxacin, 500 1ng p.o., q.d., for 10 days and send cultures and serology to confirm your clinical diagnosis; change antibiotics according to the culture results

Start amoxicillin, 500 mg p.o., t.i.d., for 10 days and send cultures and serology to confi1·m your clinical diagnosis; change antibiotics according to the culture results

Sta1t ciprofloxacin, 500 1ng p.o., q.i.d., for 60 days and send cultures and serology to confirm your clinical diagnosis; change antibiotics according to the culture resul

None of the above

A 17-year-old boy living at home with his parents presents with an intensely pruritic papulovesicular eruption involving the hands and wrists. Skin scrapings identify eggs and waste products of Sarcoptes scabiei. Which of the following management options is most appropriate?

Treat the patient and symptomatic household me1nbers with permethrin 5% cream, and tell them to wash all clothing and linens with which they have come in contact over the past 2 days

Treat the patient and all household members with permethrin 5% cream, and tell them to wash all clothing and linens with which they have come in contact over the past 2 days

Treat the patient and symptomatic household me1nbers with permethrin 5% cream, and tell them to wash all clothing and linens with which they have come in contact over the past 10 days

Treat the patient and all household members with permethrin 5% crea1n, and tell them to wash all clothing and linens with which they have come in contact over the past 10 days

Treat the patient and sympto1natic ho11sehold members with lindane lotion, and tell them to wash all clothing and linens with which they have come in contact over the past 10 days

A 16-year-old female patient comes to your office complaining of acne, which she has had for 3 years. The lesions have been small in size, not painful, and not swollen, and they have not progressed over this period. She says the acne is bothering her, and she would like to be treated. On physical examination, the patient is found to have multiple comedones measuring 0.5 to 1 mm that are open and closed on the face. Her arms, chest, and shoulders are not involved. There are no inflammatory lesions and no cysts. She is not sexually active. Which of the following is the most appropriate treatment for this patient?

Educate the patient about diet and about tryi11g to avoid chocolate and fatty meals

Start oral doxycycline

Start topical retinoids

Start oral isotretinoin

Start oral contraceptives

A 22-year-old woman requests birth control pills. She has just moved to the United States from Poland with her new husband. She has no history of illness or current illness and has not seen a doctor in a long time. On examination, multiple flat, brown, uniformly pigmented 1 to 3 cm macules, as well as several fleshy, almost pedunculated, nodules are seen on her left leg, hip, and buttock. These lesions stop abruptly at midline on her back. None of these lesions are seen elsewhere on her body. She recalls having these all her life. Which of the following steps will be useful in the management of this patient's skin lesions?

No further interventions are required

Refen·al for genetic cot1nseling

Ophthalmologic screening

Diagnostic skin biopsy

Topical steroid therapy

A 21-year-old man is on his way home from a party when he experiences the sudden onset of rapid palpitations. He feels uncomfortable but not short of breath and has no chest pain. He goes to the nearest accident and emergency department, where he is found to have a supraventricular tachycardia (SVT) at a rate of 170/minute. Carotid sinus massage produced transient reversion to sinus rhythm, after which the tachycardia resumed. What would be the next step in your management?

Repeat carotid sinus massage

IV verapamil

IV propranolol

IV adenosine

Synchronized DC cardioversion

A 51-year-old man with a recent diagnosis of pancreatic carcinoma with metastases to the liver and omentum is about to commence gemcitabine chemotherapy. Prior to his first cycle he mentions that he is getting increasing severe abdominal pains. He is currently taking paracetemol for this, which eases the pain but is now becoming less effective. The most appropriate analgesia for this patient is:

Fentanyl patch

Oral morphine sulphate solution as required

Morphine sulphate tablets

Codeine phosphate

Codeine phosphate plus paracetamol

A 32-year-old man with Wolff-Parkinson-White syndrome presents with a 2-hour history of palpitations and breathlessness. On examination, his heart rate is 190 beats/min with blood pressure of 100/60 mmHg. ECG shows broad-complex tachycardia. What would be your first
line of treatment?

Intravenous amiodaro11e

Intravenous flecainide

Intravenous adenosine

DC cardioversion

Intravenous verapamil

A 45-year-old asthmatic patient presents with palpitations. An ECG shows supraventricular tachycardia, with narrow QRS complexes. Carotid sinus massage is not successful. What would you do next?

Administer intravenous ade11osine

Administer intravenous verapamil

Administer intravenous digoxin

Administer intravenot1s sotolol

DC cardioversion

A 75-year-old man with isolated systolic hypertension, who also has urinary incontinence, gout and asthma, attends outpatients with a blood pressure reading of 190/86 mmHg. Which of the following drugs would you initiate for this patient?

Amlodipine

Atenolol

Bendrofluazide

Doxazosin

Valsartan

A SO-year-old woman who is already on ramipril, frusemide and bisoprolol for heart failure, decompensates and presents to AE with pulmonary oedema. Her heart rate is 120 bpm and her blood pressure is 100/65 mmHg. She is given oxygen and diamorphine. Which of the following actions is indicated in her further management?

Increase diuretics and maintain the current dose of B-blocker

Increase diuretics, reduce the 8-blocker dose

Increase diuretics, increase the 8-blocker dose

Increase diuretics, stop B-blockers and later increase the B-blocker dose when her lungs are dry

Increase diuretics, stop B-blockers and restart B -blockers when her lungs are dry

30-year-old woman presents with pleuritic chest pain and haemoptysis. Her blood pressure is stable at 130/80 mmHg. A ventilation/perfusion scan shows minor mismatch at the lung bases. There is no evidence of RV dysfunction, clinically and on echocardiography. In addition to oxygen, which of the following is the appropriate management for this patient?

Heparin and consideration for surgery

Heparin and paracetamol

Heparin plus mechanical intervention

Heparin plus thrombolytic therapy

Supportive

A 52-year-old woman, with a prior history of rheumatic fever, presents with shortness of breath on strenuous exertion while working as a landscape gardener. She is in permanent atrial fibrillation and is on long-term warfarin and digoxin (125 mg once daily). Clinical examination reveals her to be in atrial fibrillation at a rate of around 150 bpm. Echo demonstrates preserved left ventricular function, a heavily calcified mitral valve with moderate mitral stenosis (mitral valve area 1.5 cm2) and moderate mitral regurgitation. Her left atrium is dilated. What is the most appropriate initial treatment option?

Amiodarone

Atenolol

DC shock

Mitral valve replacement

Percutaneous mitral valvotomy

A 70-year-old man is referred by his GP for advice regarding optimisation of secondary prevention. He has a history of angina, with excellent control of symptoms on a combination of aspirin, dipyridamole MR, atenolol 50 mg od, simvastatin 40 mg od and isosorbide mononitrate 20 mg bd. His pulse rate is 70 bpm and blood pressure is 144/86 mmHg. The only other relevant past history includes an ischaemic stroke 2 years ago from which he made a complete recovery. What additional therapy would you consider adding?

Bendro:flL1methiazide

Diltiazem

Doxazosin

Nicorandil

Perindopril

A 78-year-old woman presents to AE with three episodes of syncope in the last 24 hours. There is no history of chest pain. She is taking frusemide 80 mg od and ramipril 10 mg od for known hypertension. She is conscious with a blood pressure of 100/40 mmHg. Potassium is 5.3 mmol/1. Her ECG shows complete heart block with rate of 40 bpm. QRS duration is 150 ms with a right bundle-branch block configuration. What is the optimum initial management?

Dobuta.mine

Isoprenaline

Intravenous calcium chloride

Temporary transvenous pacing

Withhold medication and observe

Clopidogrel

Enoxaparin

GIIb/Ila blocker

S treptokinase

Tissue plasminogen activator

A 72-year-old Caucasian woman is referred to out-patients for advice regarding her hypertension management. She has been on treatment in the form of perindopril 4 mg od for the past 3 years. However, on repeated measurements, her readings have been> 160 mmHg systolic, with diastolic readings being in the order of 80-85 mmHg. Renal function is normal as is urine dipstick testing. There is no evidence of left ventricular hypertrophy on ECG. She is obese with a BMI of 33. What would you consider adding as your next drug?

Atenolol

Bench·ofluazide

Doxazosin

Amlodipine

Spironolactone

A 69-year-old man presents with a 3-hour history of chest pain. ECG shows an inferior wall infarction with ST elevation of 3 mm. There is no history of diabetes mellitus, injury or previous surgery. Blood pressure is 132/70 mmHg with a pulse of 58/min. Which of the following treatments would be most appropriate?

Tissue plasminogen activator

Aspilin

2b3a inhibitor

Heparin

Metoprolol

A 65-year-old male patient with stable angina complains of shortness of breath after walking two flights of stairs. He has normal left ventricular function on the echocardiogram and a positive exercise tolerance test (3 mm ST depression at stage Ill). What is the most appropriate therapy?

Atenolol

Simvastatin

Isosorbide 1nononitrate

Angiote11sin-converting e11zy1ne (ACE) inhibitor

Nicardipine

A 32-year-old woman who is known to be 17 weeks' pregnant presents for review. She has periods of paroxysmal supraventricular tachycardia (SVT) and on this occasion bas a ventricular rate of 165/min and a blood pressure of 90/50 mmHg, feeling faint and unwell. Which of the following anti-arrhythmics would be the most appropriate prophylaxis for her?

Flecainide

Amiodarone

Digoxin

Phenytoin

Propafe11one

A 64-year-old woman suffers from frequent and painful urinary tract infections. After her third course of antibiotics in the past 6 months she is advised by the GP to take cranberry juice supplements. Significant past medical history of note includes hypertension for which she takes ramipril and bendroflumethiazide and hypercholesterolaemia for which she takes simvastatin. There is also a history of paroxysmal atrial fibrillation for which she takes warfarin and amiodarone. Which of her medications is most likely to interact with the cranberry juice?

Si111vastatin

Amiodarone

Bendroflumethiazide

Wa1farin

Ramipril

A 62-year-old woman is admitted having collapsed at her local supermarket complaining of palpitations. On examination she is very unwell with a BP of 90/50 mmHg and very rapid palpitations. Investigations; ECG - Ventricular tachycardia with moving axis - torsade de pointes. Which of the following drugs is not associated with this arrhythmia?

Sotalol

Verapamil

Flecainide

Digoxin

Risperidone

A 60-year-old woman with a long history of manic depressive psychosis managed with lithium therapy is sent to see you for review. She has a BP of 152/93 mmHg, and the GP is keen to commence anti-hypertensive therapy. Investigations : Hb 12.3 g/dl, WCC 5.4 x109/l, PLT 195 x109/l, Na+ 143 mmol/1, K+ 4.0 mmol/1, Creatinine 145 μmol/1, Total cholesterol 5.9 mmol/1, HDL 0.8 mmol/1. Which antihypertensive would be most appropriate for her to start?

Ramipril

V alsartan

Indapa1nide

Amlodipine

Atenolol

An 18-year-old man comes to the Emergency room because he has suffered a severe syncopal attack whilst playing a game of squash. His opponent tells you that he collapsed and took a few minutes to recover. Apparently this was the second episode, the first having occurred after a strenuous period of exercise at the swimming pool. Of note is the fact that his father died of a cardiac arrest at the age of 32. O n examination he looks fit, his BP is 132/78 mmHg, his pulse is 70/min, sinus rhythm. Investigations; Hb 12.8 g/dl, WCC 5.0 x109/l, PLT 182 x109/l, Na+ 139 mmol/1, K + 4.8 mmol/1, Creatinine 120 μmol/1. ECG Sinus rhythm but QT interval 0.51s. 24hr tape paroxysmal AF on 2 occasions. Which of the following agents should be given for rhythm control in this case?

Adenosine

Flecainide

Verapamil

Amiodarone

Metoprolol

A 55 year-old man with a history of mitral regurgitation and atrial fibrillation is warfarinised. His INR is therapeutic at 2.0. He needs to undergo pre-planned tooth extraction under local anaesthesia. How would you manage him prior to the procedure?

Stop waifarin for 2 days

Stop wai·farin, stai·t LMWH

Stop warfaiin, stai·t unfractionated heparin

Stop waifarin stai·t aspi1in

Maintain wai·farin at the therapeutic dose

Rate limiting

Rate modulated

Repolarising

Rate enhancing

Rate reducin.g

An 83-year-old man is admitted with acute confusion. He has an extensive medical history including atrial fibrillation, type 2 diabetes, osteoarthritis, hypertension and some mild congestive cardiac failure, for which he takes several medications. He appears clinically dry, with a pulse of 115/min, dry mucous membranes and a capillary refill rate of 4 seconds. He is noted to have a reduced urine output with concentrated urine. His creatinine is 235 μmol/L. Which of the following medications does not need be reduced or stopped?

Amlodipine

Diclofenac

Digoxin

Furosemide

Metformin

You are the designated driver on Saturday night and are soberly walking to your car with your friends. You spot an elderly man lying on the ground. He is not breathing and has no pulse although he is warm. You ask a friend to call 999. His airway is clear. Your praecordial thump fails. The most likely way for his heart to resume beating is:

Adrenaline

Defibrillation

Cerebral reoxygenation

Chest compressions

Recovery position

A 60-year-old man presents to the emergency department with shortness of breath for 3 hours and chest pain. He also complains of a right calf pain that he has had for 2 weeks. He has a past medical history of hypertension, recent stroke and disseminated lung cancer. His observations include temperature 37.0°C, pulse rate 112 bpm, blood pressure 100/54 mmHg, respiratory rate 26/min and saturations 87°/o on room air. There is no significant finding on chest examination. An electrocardiogram (ECG) shows sinus tachycardia and new right bundle branch block. A computed tomography (CT) pulmonary angiography confirmed massive pulmonary embolism. What is the most appropriate initial treatment?

Intravenous caval filters

Oral warfarin

Prophylactic dose of low-molecular-weight hepaiin

Thrombolysis

Treatment dose of low-molecular-weight heparin

A 55-year-old man presents to his GP with increasing lethargy and polyuria. He has a past medical history of ischaemic heart disease and congestive cardiac failure. He smokes 30 cigarettes per day and drinks alcohol occasionally. He has a body mass index (BMI) of 32. His random blood glucose is 14.0 mmol/L and fasting blood glucose level is 9.0 mmol/L. Which of the following management is NOT appropriate in this patient?

Advise the patient to cl1ange Ins diet and stop smoking

Metfonnin should be considered as the first-line oral treatment option for overweight patients

Sulphonylureas and metformin could be considered as a combined therapy if glycaemic control is not optimal

S11lphonylureas should be considered if patient is intolerant to 1netformin

Thiazolidinediones can be added to metfor1nin and sulphonylurea combination therapy if control is not optimal

A 56-year-old patient with stage D ischemic cardiomyopathy comes to you for a second opinion. He is already receiving furosemide, an angiotensin-converting enzyme (ACE) inhibitor, a beta blocker, and spironolactone. He has been told by a specialist that he needs a device to avoid dying from an irregular heart rhythm. What nonpharmacologic treatments are available for the prevention of sudden cardiac death in patients with ischemic cardiomyopathy?

Ventricular assist device (V AD)

Implantable cardioverter defibrillator (ICD)

Bivent.Iicular pacemaker

Intra-aortic balloon p11mp (IABP)

Adrenalin

A 38-year-old man with stage C CHF remains symptomatic in spite of diuretic therapy. You are considering adding a second and perhaps even a third agent to his regimen. Which of the following pharmacologic agents used in the management of heart failure lacks trial data indicating a mortality benefit and does not prevent maladaptive ventricular remodeling?

ACE inhibitors

Spironolactone

Beta blockers

Digoxin

Angiotensin receptor blockers (ARBs)

A 65-year-old woman with long-standing hypertension has dyspnea associated with the classic symptoms and physical findings of CHF. Her chest x-ray shows signs of pulmonary edema. Her echocardiogram, however, shows slightly thickened myocardium and a normal left ventricular ejection fraction. A diagnosis of diastolic dysfunction is made. Which of the following would improve this patient's symptoms?

Digoxin

Furosemide

Enalap1il

Metoprolol

None of the above

An 80-year-old man presents with dyspnea and is found to have CHF caused by systolic dysfunction. He also has mild renal insufficiency, with a creatinine level of 1.4. Which of the following statements is true regarding ACE inhibitor therapy in this patient?

It I s contraindicated because of his age

It is contraindicated beca11se of his renal insufficiency

Angiotensin II receptor blockers are prefen·ed for CHF in elderly patients

ACE inhibitor therapy can be sta1ted, provided it is accompanied by careful monitoring of his creatinine and potassium levels

ACE inhibitor therapy can be struted but must be discontinued if his creatinine level rises above its current level

A 55-year-old white man presented to the emergency department with crushing substernal chest pain of 1 hour's duration that radiated to his left arm; associated with this pain were dyspnea, diaphoresis, nausea, and vomiting. The patient's cardiac risk factors include hypertension of 10 years' duration, current tobacco use, and a strong family history of CAD. Examination findings were as follows: BP, 158/87 mm Hg; pulse, 105 beats/min; and lung crackles at bases. ECG showed an ST segment elevation of 3 mm in leads V2 through VS with reciprocal ST segment depression in leads II, III, and a VF. Laboratory results showed normal CK and troponin I levels and an LDL level of 120. After administration of 02, aspirin, nitrates, and morphine, the chest pain subsided, but the ECG still shows an ST segment elevation in leads V2 through VS. Which of the following would you consider for initial treatment of this patient?

Reperfusion therapy

Statin therapy

ACE inhibitor

Glycoprotein llb-Illa inhibitor

None of the above

A 56-year-old man presents to the emergency department with complaint of chest pain of 20 minutes' duration. The pain is severe, crushing, substernal, and without radiation. He has associated nausea and diaphoresis without vomiting. He has had no previous episodes of chest discomfort. He has not seen a doctor for over 20 years and takes no medications. He bas smoked two packs of cigarettes a day for the past 35 years and has lived a sedentary lifestyle. His family history is remarkable for an MI in his father at 49 years of age. Physical examination reveals a thin man, sitting upright, breathing rapidly on 2 L of oxygen. His vital signs include the following: temperature, 98.8° F (37.1 ° C); pulse, 98 beats/min; respiratory rate, 22 breaths/min; blood pressure, 150/95 mm Hg. Cardiac examination reveals normal rate and rhythm without murmur, and neck veins are not elevated. Lungs are clear to auscultation. ECG shows normal sinus rhythm with occasional premature ventricular contractions and ST segment elevations of 0.2 m V in leads II, III, and a VF. Which of the following

Morphine sulfate I.V.

Aspirin

Lidocaine

Metoprolol

Su·eptokinase

A 77-year-old woman presents with 2 hours of chest pain, which varies in intensity from mild to severe. Her pain is described as ''pressure'' felt over the left chest, with radiation to the left arm. It occurred at rest and is worsened by any activity. She has nausea without vomiting. Her medical history is remarkable for an inferior MI 5 years ago, diabetes, and hypertension. Her medications include lisinopril and metformin. Physical examination reveals a moderately obese woman in apparent discomfort. Vital signs include pulse, 84 beats/min; BP, 130/80 mm Hg; respiratory rate, 16; oxygen saturation, 96% on room air. Cardiac and lung examinations are normal. Her ECG shows Q waves in ID and a VF; 2 m V ST segment depression in leads V3 to V 6; and 1 m V ST segment elevation in Vl. She is treated initially with oxygen, sub lingual nitroglycerin, aspirin, metoprolol, and morphine, and her symptoms improve. She still rates her pain as moderate, and repeat ECG is unchanged. Which of the following would NOT be an appropriate intervention for this patient?

Low-molecul a r -weight heparin

Cardiac catheterization

Abcixi1nab

Thrombolytics

Eptifibatide

A 70-year-old man presents to establish care. His medical history is remarkable for hypertension and a myocardial infarction 3 years ago. His medications include aspirin, 325 mg daily; metoprolol, 100 mg twice daily; and isosorbide mononitrate, 120 mg daily. He reports that when walking more than one block he has substernal chest pressure, which is relieved by rest. He had a cardiac catheterization 2 months ago that showed a left main coronary artery stenosis of 80 % , a proximal left anterior descending artery stenosis of 60 % , and a 70 o/o stenosis of the first obtuse marginal branch. The left ventricular ejection fraction (L VEF) was estimated at 45 o/o. Which of the following therapies would be most beneficial for this patient?

Continuing the patient's current medication regimen without modification

Percutaneous transluminal angioplasty (PCT A)

Coronary artery bypass graft (CABG)

Enhanced external counterpulsation therapy (EECP)

Transmyocardial revascularization procedure (TMR)

A 65-year-old woman presents to the emergency department with anterior chest pain that has been radiating to her left arm for the past 10 minutes. She had just run one block to catch a bus before she called the paramedics. Her pain was quickly relieved by two sublingual
nitroglycerin tablets given by the paramedics. She said she has had similar pain with exertion
over the past 3 years and has been using her husband's nitroglycerin occasionally. Her medical
history is remarkable for diabetes. Her only medication is glyburide, 5 mg daily. Her blood
pressure is 110/60 mm Hg; pulse, 80 beats/min; and respirations, 20 breaths/min. Examination
reveals a moderately obese woman in no apparent distress. Heart rate and rhythm are regular,
without murmur, and the lungs are clear to auscultation. Which of the following medications
should not be used to treat this patient's angina?

Metoprolol extended release, 100 mg p.o., q.d.

Aspi1in, 325 mg p.o., q.d.

Nifedipine, 20 mg p.o., t.i.d.

Isosorbide dinitrate, 10 mg p.o., t.i.d.

Nitroglyce1in sublingual, 0.4 mg, q. 5 min, p.r.n. Chest discomfort

A 60-year-old man with complaints of substernal chest pressure, brought on only by vigorous activity and relieved by rest, returns for a follow-up appointment. He takes no medications and has smoked one pack of cigarettes a day for 40 years. His blood pressure is 120/70 mm Hg; pulse, 75 beats/min; and respirations, 16. Examination reveals a thin man in no distress. Heart examination reveals a regular rhythm, with no murmurs. Jugular venous pressure is estimated at 5 cm, lungs are clear to auscultation, and extremities are without edema. The patient had an exercise treadmill thallium study that showed a small reversible defect, which prompted cardiac catheterization. This revealed a 70 % stenosis of the circumflex artery. His ejection fraction was estimated at 60%. His serum LDL cholesterol is 120 mg/dl, and HDL cholesterol is 35 mg/di. Which of the following measures would not be appropriate in this setting?

Atorvastatin, 80 mg p.o., q.d.

Nitroglycerin, 0.4 mg sublingual, p.r.n. Chest pain

Coronary ai·tery bypass graft (CABG

Ramipril, 10 mg p.o., q.d.

Atenolol, 50 mg p.o., q.d.

A 40-year-old man comes to your office as a new patient to establish primary care. He is asymptomatic. His physical examination reveals an early systolic click and a 2/6 murmur in the aortic area. An ECG is normal. An echocardiogram shows a bicuspid aortic valve without significant flow obstruction. His ventricle size and function are normal. Which of the foil owing is the most appropriate therapeutic intervention for this patient at this time?

Instructions about endocarditis prophylaxis

Aortic valve replacement

Balloon valvuloplasty

No intervention is required

None of the above

Persistence of fever is not helpful in determining whether the symptoms are the result of an allergic reaction, becat1se fever is conunon in simple exanthematous en1ptions

Systemic corticosteroids are always required to treat this chug eruption

After the patient's infectious process resolves, he will be able to tolerate all 􀝦-lactam antibiotics, including ampicillin

In patients with vil·al infections, the mechanism of exanthematous en1ption caused by ampicilli11 is IgEmediated mast cell degranulation

This patient's rash can be expected to progress to a vesiculai· stage before resolution

Exanthematous rashes may occur in up to 80% of patients with infectious mononucleosis that is treated with ampicillin

The patient should undergo skin testing with penicilloyl polylysine and graded desensitization before any treatment with penicillins

Treatment should include changing to a macrolide antibiotic

The patient is experiencing a type II, or cytotoxic, hypersensitivity reaction

The rash will worsen until ampicillin is stopped

A 49-year-old white woman was admitted last night with an acute ST segment elevation MI. She underwent left heart catheterization with restoration of blood flow to her left circumflex artery and is currently in the CCU. She has received anticoagulation therapy and has been started on an ACE inhibitor, aspirin, and a beta blocker. Which of the following statements regarding possible complications of acute MI is true?

The Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial showed that rhythmcontrol strategies provided a significant survival advantage when compared with rate-control strategies

Beta bloc.kers may reduce the early occurren.ce of ventricular fibrillation

Severe mitral regurgitation is 10 times more likely to occur with anterior MI than with inferior MI

When patients have right ventricular infarction, the left ventricle is almost always spared of any damage Key Concept/Objective: To know the complications associated

None of the above

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