Medicine I Past Paper (KSAU-HS) Batch 7 PDF

Medicine I KSAU-HS BATCH 7 Batch 6-10 Questions Previous Batches Questions Correction File  Exam Contents Lectures Recurrent Falls Systemic Vasculitis Diabetes for Supervision Heart Faliure...

Medicine I KSAU-HS BATCH 7 Batch 6-10 Questions Previous Batches Questions Correction File  Exam Contents Lectures Recurrent Falls Systemic Vasculitis Diabetes for Supervision Heart Faliure Choice of imaging Abnormal electrolyte Pulmnory embolism High Cholesterol for Treatment Asthma/COPD Jaundice Acute monoarthitits Renal failure IBD Viral hepatitis Thyroid Swelling Unrelated question Hypertension Case discussion PBL PBL 1: COPD PBL 2: Amenorrhea PBL3: Murky Waters PBL4: A dragging pain PBL5: What Does this Mean? PBL6: Aching Joints PBL7: An Uphill Battle PBL8: Burning up  Recurrent Falls 1. Mr. Davidson, an 82-year-old man, presents to your clinic with a history of three falls in the past two months. He reports feeling light-headed and dizzy when he stands up from sitting. On examination, his blood pressure is 140/80 mmHg when seated and drops to 110/65 mmHg on standing. Which of the following medications is the likely culprit? A. Valsartan B. Amlodipine C. Tamsulosin D. Lisinopril 2. 80 years old with Parkinson has experienced several falls during past month. He does not report any dizziness or vertigo. His Parkinson is managed with levodopa and carbidopa. What is the most likely cause of his fall? A. Orthostatic hypotension B. Loss of vision C. Postural instability due to Parkinson D. Overmedication with levodopa and carbidopa 3. A 75-years-old male with history of recurrent falls. Choice next step in his long- term management? A. Withdrawal or minimization of other medications is not part of management B. Correct Management of postural hypotension will prevent falls. C. Advice against exercise and limit mobility so patient will not be exposed to falls D. Vision acuity is important only for reading and decrease vision will not affect falls. 4. A 75-year-old man with diabetes and osteoarthritis is evaluated in your clinic for recurring falls. Which of the following is most predictive of future dependence in his activities of daily living? A. A T score on his bone density test of –2.7 B. A greater than 20-point difference between sitting and standing systolic blood pressure C. 10 seconds in Get up and Go test down in that same chair D. Mini mental status of 28/30 1- C 2- C 3- B 4- B  Recurrent Falls 5. A 85 years old male came to the ED complaining of recurrent falls in the bathroom. He has multiple illnesses and on multiple drugs. Which drug increases the risk of falls? A. Metformin B. Atorvastatin C. Indapamide D. Montelukast 6. Which of these factors increases the risk of fall? A. Black B. Arthritis C. Age more than 70 D. Male gender 7. 77-year-old male with a 6-month history of recurrent falls. He is on furosemide for hypertension and insulin for diabetes. Which of the following reduces the risk of recurrent falls? A. Change medication B. Mobilize with a wheelchair. C. Restrict walking to 1 hour/ day. D. Add aspirin 8. Which of the following multifactorial interventions for falls has the strongest evidence (evidence A)? A. Modification of home environment B. Exercise and gait training C. Minimization of psychoactive medications D. Management of foot problems 9. An 87-year-old woman fell three days ago in her home while walking out of her bathroom. She has a past medical history of T2DM, peripheral neuropathy, hypertension, and osteoarthritis. She takes glipizide for her DM, lisinopril for her HTN, amitriptyline 100 mg for neuropathy, and acetaminophen, as needed for joint pain. On examination, her postural vital signs are unremarkable. Which of these would you do first to decrease the risk repeat falls? A. Recommend that the patient purchase hip protector B. Start an exercise program directed by physical therapist C. Increase her dose of glipizide D. Change amitriptyline to another drug for neuropathy 5- C 6- C 7- A 8- B 9- D  Recurrent Falls 10. A 70-year-old-male with diabetes, hypertension, dementia and benign prostatic hypertrophy with urinary incontinence. The patient was started on clonazepam and tolterodine (antimuscarinic) for his incontinence. Two weeks later, he comes to the ER with a hip fracture due to a fall. Choose the next step in management? A. Tolterodine increases the risk of fall even though it treats incontinence B. Clonazepam decreases risk of falls as it helps elders sleep well C. Urinary incontinence is an independent risk factor to fall D. Demented patients have a risk of falls similar to non-demented individuals 11. A 74-years-old woman with recurrent falls is seen in your clinic with her daughter. She has a history of mild dementia, congestive heart failure, coronary artery disease, and hypertension. She takes furosemide, lisinopril, aspirin, metoprolol, olanzapine, and simvastatin currently. She lives by herself in an apartment she has lived in for 40 years and is assisted with housekeeping once a week. Her physical strength is unremarkable for decreased proximal muscle strength. Which of the following is an intervention for decreasing her risk of falling? A. Continue furosemide B. Balance and gait training exercises C. Initiating donepezil D. Discontinuing olanzapine 12. 77 year old brought to ER by his son in law due to altered LOC. He is bedridden, has ecchymosis on both arms, and has sacral ulcers. His daughter and son in law reported that the patient is paranoid about being poisoned, what is most likely the cause of his findings? A. Dementia B. Elderly abuse C. Drugs side effect D. Alcohol withdrawal 13. Which medication increases the risk of falls? A. Metformin B. Atorvastatin C. Enalapril D. Montelukast 10-C 11- D 12- B 13- C  Diabetes for Supervision 1. A 70-year-old male with a long history of poorly controlled type 2 diabetes is brought to the hospital with altered mental status, polyuria, and severe dehydration. His blood glucose is 600 mg/dL, but ketones are absent in the urine. His serum osmolality is calculated to be 333 mOsm/kg. What is the most likely diagnosis? A. Diabetic ketoacidosis B. Hyperglycemic hyperosmolar state C. Uncontrolled hyperglycemia D. Cerebrovascular accident 2. A 40-ycar-old male with type 1 diabetes and recent poor glycemic control is experiencing frequent episodes of hypoglycemia, particularly late at night and early morning. His current regiment includes basal-bolus insulin therapy with insulin glargine and insulin aspart. Which of the following adjustments in his management is most appropriate? A. Increase the dose of insulin glargine. B. Decrease the dose of insulin aspart with evening meals. C. Switch from insulin glargine to insulin degludec. D. Add a dose of rapid-acting insulin before bedtime. 3. What is the most common neuropathic complication in DM? * A. Autonomic neuropathy B. Focal neuropathies C. Carpal Tunnel Syndrome D. Distal symmetrical polyneuropathy 4. A 54-year-old diabetic patient presented to the clinic with BP of 200/100 Hg mm, the rest of the question was forgotten……… What is the diagnosis? A. Amyloid B. Diabetic Nephropathy C. Nephrotic Syndrome D. Hypertensive Nephrosclerosis 1- B 2- C 3- D 4- B  Diabetes for Supervision 5.Diabetics have increased risk of heart diseases if they are also exposed to which of the following factors? A. Smoking Cigarettes B. High HDL cholesterol level C. Aspirin Usage D. High fiber diet 6.A 65 year old man with diabetes and hypertension presented to the ED with bp 140/90 and high creatinine. What medication will protect his kidneys? A. Lisinopril B. Verapamil C. Furosemide D. Hydrochlorothiazide 7.In fasting glucose level, what is the threshold to diagnose diabetes? A. 6.5 mmol/L B. 7 mmol/L C. 10 mmol/L D. 11 mmol/L 8.Which of the following is NOT used to screen for diabetes? A. 50 g glucose tolerance test B. 75 g glucose tolerance test C. Fasting blood glucose D. Random glucose level 5- A 6- A 7- B 8- A  Diabetes for Supervision Q9: Which of the following is the MOST evidence - based strategy to prevent or delay the onset of Type 2 diabetes? A. Weight reduction and daily exercise B. Weight reduction and an ACE - inhibitor C. Daily exercise and a low glycemic index diet D. Weight reduction and a low glycemic index diet Q10: Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? A. Sulfonylureas B. Meglitinides C. Biguanides D. Alpha - glucosidase inhibitors Q11: Which of the following is the most sensitive test to diagnose diabetic nephropathy? A. creatinine clearance measurement B. serum creatinine measurement C. ultrasonography of the kidneys D. urine microalbuminuria measurement Q12: A 49 - years - old male non - smoker diabetic patient has been on Rosuvastatin 20 mgs daily for primary prevention. His target serum LDL - C should be at least: A. < 2.6 mmol/L B. < 2.3 mmol/L C. < 2 mmol/L D. < 1.0 mmol/L Q13: For a 60 - year - old woman with uncomplicated T2DM for 10 years which of following is the most appropriate screening test for diabetic nephropathy?) A. Early morning urine for dipstick test B. Early morning urine for albumin/creatinine ratio C. Serum creatinine D. Serial ultrasound 9- A 10- C 11- D 12- A 13- B  Diabetes for Supervision Q14: Which medication is the most appropriate first line therapy for an obese patient with type 2 diabetes? A. Sulfonylurea B. Glipizide C. Metformin D. Insulin Q15 : A diabetic patient is controlled on insulin. He also takes aspirin, and statin for hyperlipidemia, which is also controlled. He has proteinuria and elevated BP148/90. All labs are normal except for a slight increase in creatinine. What is the next step i n management? A. Start Lisinopril B. Adjust insulin. C. Keep same meds D. Increase statin Q16 : A 32 y/o man with T2DM on metformin and sitagliptin. His renal, liver, functions are normal, what’s his glycemic target? A. HbA1c 6 - 6.5% B. HbA1c 7.5 - 8%. C. Pre - prandial PG 95% Which of the following is recommended to exclude Pulmonary embolism in this patient? A. D-dimer B. CT pulmonary angiogram C. V/Q scan D. Echocardiogram 21. A 35-year-old women came with acute unprovoked deep vein thrombosis in left lower limb extremity. She was on anti-coagulants, and she elects to stop 6 months ago. Now she comes with polyarthralgia, fatigue, malar rash and a first trimester abortion 3 months ago. Test results shows persistent high anti-phospholipid antibodies, including lupus anticoagulant, high titer anti-cardiolipin and high anti-b2 glycoprotein (reference range all negative). What is recommended in this patient?* A. Anticoagulants for 6 months and hydroxychloroquine B. Life long anticoagulants and hydroxychloroquine C. No anticoagulant, hydroxychloroquine D. Only anti-coagulants 18- B 19-B 20-A 21- B  Pulmnory embolism 22. A60-year-old female who had a knee surgery two weeks prior to her presentation to thee mergency department with acute pleuritic chest pain and dyspnea. Her vital signs are shown below; otherwise, her examination is unremarkable. What is the most appropriate investigation to establish her diagnosis? HR 115, BP 130/85, Oxygen saturation 91% A. High resolution CT of the chest B. Chest CT-angiogram C. Conventional pulmonary angiogram D. D-dimer 23- A 60-year-old patient presented to the emergency department with respiratory distress. The patient was hypotensive despite fluid resuscitation. CT angiogram was done, and pulmonary embolism was confirmed. Which of the following is most appropriate treatment in this case? A. Heparin infusion B. Warfarin C. Enoxaparin D. Thrombolysis 24. Most clinical sign suggestive of pulmonary embolism? A) Prolonged expiration B) wheeze on auscultation C) pleuritic chest pain D) bilateral leg swelling 25. A patient was given warfarin, what is the therapeutic INR? A) 1-2 B) 2-3 C) 3-4 D) 4-5 26. What is the most likely underlying cause of pulmonary emboli? A) pulmonary hypertension B) mural thrombosis of the heart C) systemic hypertension D) femoral venous thrombosis 22- B 23- D 24- C 25- B 26- D  Asthma/COPD 1.What is the preferred initial long-term control medication for moderate persistent asthma? A. Oral corticosteroids B. Low-dose inhaled corticosteroids C. Long-acting beta agonists alone D. Leukotriene receptor antagonists 2.A 20-year-old male patient complains of episodes cough and wheeze with dust exposure. Which of the following features supports the diagnosis of asthma? A. Increase in FEV1 by 200 mls OR 12% from baseline B. Increase in FEV1 by 200 mls AND 12% from baseline C. Post bronchodilator FEV1/FVC ratio of 70% D. Pre bronchodilator FEV1/FVC ratio of 70% 3.Which vaccination should be given in COPD patients? A. Respiratory syncytial virus B. Pneumococcal vaccine C. Hemophilus influenzae vaccine D. HIV 4.Which of the following is the most likely presentation of emphysema? A. Inspiratory stridor B. Clubbing of the fingers C. Diffuse expiratory wheeze D. Bibasilar inspiratory crackles 5.Which of the following cause increase in transfer factor for carbon monoxide (TLCO)? A. Emphysema B. Pulmonary embolism C. Pulmonary fibrosis D. Pulmonary hemorrhage 1- B 2- B 3- B 4- C 5- D  Asthma/COPD 6.A 65-year-old female presents to your office for evaluation of dyspnea. She has occasional dry cough but no chest pain. She complains of shortness of breath with exertion only. No nocturnal symptoms. She has occasional episodes of wheezing. She smokes 1 pack/day of cigarettes. Chest radiograph doesn’t reveal any abnormalities. Pulmonary function tests are ordered: FVC (L) 2.22 51% predicted FEV1 (L) 0.98 31% predicted FEV1/FVC 44% TLC (L) 7.15(L) 4.51 161% predicted DLCO 12.4 40% predicted The profile of the pulmonary function tests is most consistent with which of the following condition? A. Emphysema B. Restrictive lung disease C. Isolated diffusion capacity abnormality D. Normal pulmonary function test 7.56 years old patient admitted with COPD exacerbation. His oxygen saturation was 82% in room air and his PCO2 was 55mmg (35-45). The nurse started him on oxygen through nasal cannula and asked you about the target oxygen saturation. What would be the best answer? A. >95% B. 91-95% C. 88-92% D. 85 - 87% 8.A 26-year-old female diagnosed with asthma has day symptoms and one awakening during the night due to exacerbation and is currently taking controller medication. She presents to the ER with an asthma attack after exercising. What is the next appropriate step in management?* A. Inhaled albuterol B. Inhaled cromolyn sodium C. IV methylprednisolone D. Oral montelukast 6- A 7- C 8- A  Asthma/COPD 9.Which of the following interventions had benefit for mortality in severe COPD? A. Pulmonary rehabilitation exercise B. Short acting beta agonists C. Smoking cessation by half D.24 hours oxygen supplements as indicated (answer based on F6 is C HOWEVER the correct answer is D) 10.Which of the following drugs is a long-acting bronchodilator medication used in bronchial asthma? A- Salmeterol B- Salbutamol C- Prednisolone D- Ipratropium bromide 11.Which vaccination should be given in COPD patients? A- Respiratory vaccine B- Pneumococcal vaccine C- Hemophilus influenzae vaccine D-HIV 12.A 60-year-old male patient has a history of SOB. He stopped smoking recently since it worsened SOB. He has a history of smoking for 30 years. He now develops cough and sputum production. You are suspecting COPD. Which of the following is done to confirm the diagnosis? A- ABG B- Spirometer C- Sputum and culture D-CT chest 9- D 10- A 11- B 12- B  Asthma/COPD 13.A 65-year-old female presents to your office for evaluation of dyspnea. She has occasional dry cough but no chest pain. She complains of shortness of breath with exertion only. No nocturnal symptoms. She has occasional episodes of wheezing. She smokes 1 pack/day of cigarettes. Chest radiograph doesn’t reveal any abnormalities. Pulmonary function tests are orderd: FVC (L) 2.22 (51%) predicted FEV1 (L) 0.98 (31%) predicted FEV1/FVC (44%) TLC (L) 7.15(L) 4.51 (161%) predicted DLCO 12.4 (40%) predicted The profile of the pulmonary function tests is most consistent with which of the following condition? A- Emphysema B- Restrictive lung disease C- Isolated diffusion capacity abnormality D-Normal pulmonary function test 14.A 23 year old patient complaining of multiple attacks of cough and wheezing after dust and perfume exposure. Not complaining of any symptoms at the moment. Which of the following is the most sensitive test? A- FEV1 reversibility B- Diurnal variation C- Post-bronchodilator FEV1/FVC ratio D-Methacholine challenge 15.Recommended for outpatient management in asthma? A- ABG B- Body plethysmography C- Peak flow meter D-Oxygen spirometer 13- A 14- D 15- C  Asthma/COPD 16.Which of the following is a preventative measure to COPD? A- Weight reduction B- Avoid smoking C- Exercise D-Flu Vaccine 17.A 68 year old male known case of COPD, and 30 years smoker, dyspnea, what PFT finding support diagnosis of COPD? A- Low FRC B- Low TLC C- High residual volume (RV) D-High vital capacity 18.Acute asthma attack was on: 1 L/15 oxygen O2 sat 89 O2 pressure 55 PH 7.38 CO2:68 high RR what is the most appropriate next step? A- Continue treatment and repeat ABG after 30 minutes B- Call ICU to consider for intubation C- Reduce oxygen and repeat ABG after 30 min D-Give enoxaparin 19.long case of hypotensive COPD patient (don’t remember the readings) came with productive cough and he was treated with steroids, antibiotic and bronchodilators. He was connected to nasal cannula. Ph: 7.22 Paco2: 60 paO: 55 oxygen sat 92%? A- Positive pressure ventilator B- Oral enoxaparin C- Loop diuretic D-High flow nasal cannula E-Decreased oxygen saturation 16- B 17- C 18- B 19- A (Because the CO2>45+ acidosis)  Asthma/COPD 20.A 30 year old male patient visits the clinic for follow up with his bronchial asthma. He has day asthma symptoms no more than twice a week, fewer nocturnal awakening symptoms, and doesn’t interfere with daily activities. His FEV1 between exacerbation is normal. He hasn’t used oral steroid for the past year. A- Short acting beta 2 agonist as symptom relief B- use regular low dose ICS + formoterol C- start luekotrine modifiers D-use low dose oral prednisone Ans: A The, Q was deleted, the dr asked us to choose based on the old guidelines??? 21.Asthma is defined as which of the following in post bronchodilator? A- Increase in FEV1 by 200ml OR 12% from pre-bronchodilator value B- Increase in FEV1 by 200 ml AND 12% from pre-bronchodilator value C- Post bronchodilator fixed ratio of FEV1/FVC 0.7 22.Which of the following fit for the pathology of emphysema? A-Bronchial tubes inflamed and become narrowed B-Destruction of the fragile walls and elastic fibers of the alveoli C-Mucus production in the bronchial tube D-Destruction of cilia in the airways of the lungs 23. In COPD patients, not due to Smoking, which of the following is an associated factor? ** A-Pulmonary TB B-Hypertension C-Gallbladder stones D- Asthma explanation: pulmonary tuberculosis (TB) can cause scarring and damage to the lungs, leading to the development of COPD even in non-smokers. 24.Preventive precaution for COPD: A-Smoking cessation B-Weight reduction C-Exercise 3 times weekly D-Flu vaccine 20- B 21- B 22- B 23- A 24- A  Asthma/COPD 25.A 26 year old female diagnosed with Asthma, has day symptoms and 1 awakening during the night due to exacerbation and currently taking controller medication. She presented to the ER with an asthma attack after exercising. What is the next appropriate step in the management? **** A- Med Dose ICS-formoterol B- low-dose ICS C- As needed ICS-formoterol D- Oral systemic corticosteroids Answer: inhaled albuterol (original ans) for B3 females. explanation: not well-controlled, as she has: Daytime symptoms, Nighttime awakenings An exacerbation triggered by exercise despite being on a controller medication. 26.A 60 ys old pt with COPD For 12 years and smoker for 30 ys, smokes 1.5 pack per day. he is on ipratrupim and symbicort. Recently deteriorated with increased cough and sob his vitals are normal except for tachypnea and oxygen sat of 88% What will you do to increase his survival? * A- Smoking cessation B- home oxygen C- pulmonary rehab D- ICS 27.In what order should acute COPD be treated? A-Controlled oxygen therapy, nebulized bronchodilators, steroids, antibiotics (if infection is present), physio to aid sputum expectoration B-Nebulized bronchodilators, controlled oxygen therapy, steroids, antibiotics (if infection is present), physio to aid sputum expectoration C-Nebulized bronchodilators, controlled oxygen therapy, antibiotics (if infection is present, steroids, physio to aid sputum expectoration D-Controlled oxygen therapy, nebulized bronchodilators, antibiotics (if infection is present), steroids, physio to aid sputum expectoration 28.A 68 years old male patient who has been diagnosed with COPD complaining from exertional dyspnea that limits his usual activities at home. His FEV1 is 29% predicted (normal is 80%)/ What is the appropriate treatment(s)? A- Long-acting bronchodilator and inhaled steroid B- Short-acting bronchodilator and inhaled steroid C- Short-acting bronchodilator 25- A D-Long-acting bronchodilator 26- A based on our slides the correct answer is D, bc the pt is in A class “ABE” 27- B 28- A  Asthma/COPD 29.A 55-year old male smoker presented with persistent dyspnea. ABGs show ph 7:45, o2 60, co2 40, o2 sat 90 and decreased air entry. X-ray shows bilateral hyper-lucent lungs. He is taking theophylline and isoproterenol. What additional therapy might be used? A- Prednisolone B- Trimethoprim-sulfamethoxazole C- Oxygen therapy D-Exchange of albuterol for isoproterenol 30.A 60 years old male smoker presented to the clinic with two years history of exertional dyspnea and chronic productive cough. He was hospitalized once last year because of worsening of his respiratory condition. His spirometry shows FEV1 of 54% with no significant change after bronchodilators, and FEV1/FVC of 55%. What is the most appropriate treatment? A-Short-acting beta 2 agonist B-Long-acting beta 2 agonist C-Long-acting beta 2 agonist +ICS D-Long-acting anticholinergic + Long-acting beta 2 agonist 31.A patient complains of cough and wheeze when exposed to dust and perfumes. Most sensitive test for asthma? A- FEV1 reversibility B- Diurnal variation C- Reversibility of PEF D-Methacholine challenge 32.Which of the following is characteristic for COPD? A-pre-bronchodilator FEV1 70 and your goal is < 70. This patient is on medium intensity statin so you can give high intensity. 9. A 45-year-old male is told that he has high cholesterol. His father died from MI at age 40. He was advised to follow an exercise program and diet. After 3 months, his LDL is 200 mg/dL. What do you recommend? B9A final A. Continue the same exercise program and repeat LDL after 2 months B. Start niacin C. Start statin D. Start fibrate 7- A 8-A 9-C  High Cholesterol for Treatment 10. A 45-year-old patient is known to have high cholesterol and his father died from an MI at 40 after being advised to exercise and eat healthy his LDL is still elevated 220. what to do? Batch 8 A. Start statin B. Start fibrates C. Start niacin D. No treatment 11. In a patients with elevated LDL cholesterol level, which of the following conditions must be treated before initiating lipid therapy? B9B Midterm A. Anemia B. Hypothyroidism C. Hypertension D. Diabetes Mellitus 12. You are seeing a 63-year-old man in your clinic for routine check-up. He is known for hypertension on treatment. His father died of heart attack at the age of 68 years old. His labs are in the table below. You calculated his 10-year risk of devolving a cardiovascular event using the pooled ASCVD score, and it was 12%. His Lp(a) is within normal range, and his cardiac CT showed a coronary artery calcium, score of 0. What would be your recommendation be at this time? B9B Midterm A. Lifestyle Modifications B. Lifestyle Modifications + atorvastatin C. Lifestyle Modifications + Fenofibrate D. Lifestyle Modifications + Ezetimibe 10 - A 11 - B 12 - B  High Cholesterol for Treatment 13. A 58 years-old man is seen in clinic. He is known for dyslipidemia with history of stroke and ischemic heart disease. He is currently on atorvastatin and ezetimibe and has muscle aches. His most recent labs are in the below. What is the best next step in the management of this patient? B9B Midterm A. Stop atorvastatin and continue ezetimibe B. Stop ezetimibe and continue atorvastatin C. Stop both medications D. Add Evolocumab Batch 9B Answer: was C; but since he has history of stroke and IHD (high risk) and the increase in CK and ALT is only mild, statins should’t be stopped, but rather changed to another better tolerated statin or used in lower doses. Since the question doesn’t provide us with such options, then we can start ezetimibe monotherapy because this patient should be treated with a lipid-lowering agent of some sort; his LDL target < 70 Reference: UpToDate 14. A 55-years-old lady, who is known for hypercholesterolemia was recently discharged after an episode of pancreatitis. She is currently on Simvastatin. Her lab results (in mmol/L,(mg/dl)): LDL: 1.7 (77) Triglyceride: 12 (1063) What medication would be best to add next? Batch 9B A. Gemfibrozil B. Fenofibrates C. Evolocumab D. Cholestyramine 15. Which of the following is recommended in patient who appear intolerant to statin or develop myalgia? Batch 9B A. Begin statin-niacin co-therapy. 13 - A B. Permanently discontinue all statin-based therapy. 14 - B C. Try other statins in reduced doses before ruling out all statins. 15 - C D. Begin vitamin D therapy.  High Cholesterol for Treatment 16. A patient presented to the clinic with LDL (borderline), cholesterol (170), and TG (381). He reported that his father died of MI at age 41, and his coronary calcium score is 300. What is your management plan? Batch 5F final A. Lifestyle modification + Start statin B. Lifestyle modification + Start fibrates C. Lifestyle modification + Start niacin D. No treatment 17. Elderly female patient on atorvastatin, developed generalized myopathy, what to do? Batch 4F final A. Do CPK test and stop statin B. Do lab work C. Increase the dose D. Do Electromyogram (EMG) Explanation: based on Dr. Raad’s slides there’s no need stop statin if there’s myalgia or even mild increase in CK and liver enzymes, but instead decrease the dose, skip days, or switch to a different statin. 18. Hypertensive patient on antihypertensive medication and statins LDL is normal TG is high. What medication to use? Batch 4F mid * A. Fenofibrate B. Glifibrate C. Statin D. Evolocumab 19. A healthy young female patient wants to check on her risk of having ASCVD. Her parents are both diabetic. Her history, physical examination, and labs reveal a completely healthy female. Which of the following increases risk of ASCVD? Batch 4F final * A. Age 40 years B. Father died of MI at 65 y/o C. BP 145/90 16 - A D. Stress 17 - A 18 - A 19 - C  High Cholesterol for Treatment 20. A 52-year-old healthy female come for an advice about dyslipidemia treatment, she has LDL of 163 What the management plan for her? Batch 7B final A. Reassure and no need for treatment B. Calculate 10 year risk for Atherosclerosis C. start statin D. Start fenofibrate 21. A 35-year-old female, known to be hypotensive and dyslipidemic, presents to your clinic with lab findings that showed LDL of 200 mg/dL although she was started on atorvastatin 40 mg a long time ago. What is your action plan? Batch 2F final+5A,6A mid REPEATED * A. Fenofibrate can be safely added to a statin to decrease risk of myositis B. Statin in the safest drug used in pregnant ladies C. Add ezetimibe to atorvastatin D. Decrease the dose of statin 22. What is the mechanism of action of Statin lipid-lowering agents? Batch 6A mid * A. HMG-CoA reductase inhibitor B. Increases VLDL clearance C. Block NPC1L1 D. Increase lipoprotein lipase activity 23. A 60-year-old man known to have type 2 diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease comes for his regular clinic visit. He is on Insulin, Metformin, Rosuvastatin, Aspirin and perindopril. You decided to intensify his lipid therapy as his LDL levels are still above target on high intensity statin. Which of the following medications can be added? Batch 7A quizII * A. Ezetimibe B. Fenofibrate C. Niacin D. Evolocumab 20 - B 21 - C 22 - A 23 - A  High Cholesterol for Treatment 24. A young female adult comes to your clinic being worried about a mass over one of her joints. She reports her father died at the age of 51 because of a heart attack. On physical examination, she has tendon xanthomas, is hypertensive (134/90) and obese (BMI of 30). Labs shows high total cholesterol, very high LDL (210 mg/dL), normal TG and low HDL cholesterol. What medication will you start her on to achieve the lipid target? Batch B5A mid,2F REPEATED. * A. Atorvastatin B. Ezetimibe C. PCSK9 inhibitors D. Colesevelam 25. What is the mechanism of action for fibrates? Batch 2F A. Bile acid chelating B. Inhibit HMG coA reductase inhibitor C. Increase lipoprotein lipase activity D. Decrease free fatty acid release 26. A patient known to have diabetes, hypertension and dyslipidemia is currently on medications: insulin, simvastatin. He/ she now has elevated serum creatinine kinase with muscle weakness. Which drug might be the cause of this presentation? Batch 5B mid * A. Statin B. Nifedipine C. ACE-I D. Indapimide 27. A 60 year old male patient, known tobacco smoker and diabetic undergoes a lipid panel. It reveals him to be dyslipidaemic (high LDL, normal TG, low HDL). Most appropriate treatment is: * A) Omega-3 fatty acids B) Niacin (Vitamin B3) C) Fibrates D) Statin therapy 24 - A 25 - C 26 - A 27 - D  High Cholesterol for Treatment 28. A 45 year old patient with DM and LDL of 210 mg/dl, MOST appropriate treatment is: Batch 5B mid * A. Statin therapy B. Ezetimibe C. Fibrates D. Niacin 29. A 50-year-old male is a known case of diabetes mellitus. Which of the following factors increases the risk of him developing an IHD or an MI? Batch 5A mid+7A Quiz I REPEATED * A. High HDL B. Smoking C. High TG D. Low LDL 30. A 50-year-old male is a known case of diabetes and HTN. He is non-compliant to DM meds. Therefore he has poorly controlled DM. He is currently on ARBs, statin and DM meds. BP and LDL were controlled. Currently he has elevated TG of 350. What is your next step to decrease the risk of ASCVD and optimize TG level? Batch 1F final+5A mid REPEATED * A. Optimize DM control B. Add Gemfibrozil C. Add Ezetimibe D. Add alirocumab 31. You want to start a patient on statin therapy. Before that which of the following are you going to order? Batch 4A mid, 5A final REPEATED * A. CBC B. Liver profile C. Renal function D. ESR 28 - A 29 - B 30 - A 31 - B  High Cholesterol for Treatment 32. According to ACC/AHA 2018 guidelines, which of the following is indicated regarding statin therapy and disease prevention? Batch 7A Quiz II, 5B final REPEATED A. All statins have the same intensity B. Statin therapy is indicated when the patient has LDL of >190 in patients aged 40-75 C. Ezetimibe is the initial choice for primary prevention D. Cardiovascular risk calculators cannot be used for primary prevention in the updated guideline 33. Which sign is most suggestive of familial hyperlipidaemia (FH)? Batch 5B final * A. Corneal arcus B. Tendon xanthomas C. Xanthelasma D. Lipemia retinalis Batch 5B Answer: A; however the presence of tendon xanthomas is more highly suggestive of FH, although corneal arcus is also a sign but it’s not as specific. 34. According to NICE, patient with 10-year-risk of CVD of 10%. What to do? Batch 4A mid, 1F final REPEATED * A. Initiate statin B. Start PCSK9-inhibitors C. Add Ezetimibe D. Start Gemfibrozil 32 - B 33 - B 34 - A  High Cholesterol for Treatment 35. Young patient come for cholesterol medication consultation. He is fit and following a healthy lifestyle, not known of any medical condition. His father has DM and his mother has HTN (table with LDL, TG, HDL, HbA1c, BP and all within normal ranges), what to do? Batch 1F final, 4A mid REPEATED * A. Start medication B. Low fat diet C. Reassure D. Refer to endocrinology 36. High Cholesterol & LDL can be seen in? Batch 4A mid * A. Hypothyroidism B. Anemia C. Acute infections D. Viral hepatitis 37. Modifiable risk factor for CVD: * A. Obesity B. Age C. Gender D. Ethnicity 38. Most common known side effect of statin: Batch 4A mid * A. Pancreatitis B. GI upset C. Renal failure D. Myopathy 39. Before starting statin check: Batch 4B final * A. WBCs B. Renal functions C. TSH D. Inflammatory markers 40. Patient with dyslipidemia started statin and has high TG level, best drug to add: Batch 4B final * A. Fenofibrate B. Switch to another statin 35 - C C. Ezetimibe 36 - A D. Colestipol 37 - A 38 - D 39 - C 40 - A  High Cholesterol for Treatment 41. A patient came w/ epigastric pain, part of her work-up was the lipid profile The results: Normal cholesterol; Normal LDL; VERY high Triglyceride What medication to use? Batch 5F final – 9A A. Ezetimibe B. Fenofibrate C. Atorvastatin/Rosuvastatin D. Cholestyramine 42. What to treat first before managing LDL levels? A. DM B. Hypothyroidism C. Hypertension D. Obesity 43. A 58 years-old man is seen in clinic. He is known for dyslipidemia with history of stroke and ischemic heart disease. He is currently on atorvastatin and ezetimibe and has muscle aches. His most recent labs are in the below. Lab Result Normal Range LDL in mmol/L (mg/dl) 3.3 (128)