Hypertension Past Paper PDF

HYPERTENSİON Question 1 A 65-year-old woman with type 2 diabetes, hypertension, osteoporosis, and atrial fibrillation has a BP of 150/96 mm Hg (150/90 mm Hg when repeated), heart rate of 68 beats/min, potassium of 3.2 mEq/L, and a serum creatinine of 2.3 mg/dL. She reports an allergy to hydrochloro...

HYPERTENSİON Question 1 A 65-year-old woman with type 2 diabetes, hypertension, osteoporosis, and atrial fibrillation has a BP of 150/96 mm Hg (150/90 mm Hg when repeated), heart rate of 68 beats/min, potassium of 3.2 mEq/L, and a serum creatinine of 2.3 mg/dL. She reports an allergy to hydrochlorothiazide (severe gout). Presently, she is on diltiazem CD 360 mg daily. Which of the following drug regimens would be the most appropriate to add to her regimen? A Chlorthalidone 12.5 mg daily B Amlodipine 5 mg daily C Atenolol 25 mg daily D Valsartan 160 mg daily The correct answer is D Question 2 A 37-year-old woman has a BP measurement of 190/120 mm Hg when she first arrives for a routine physical examination by a medical assistant. She has no previous history of hypertension, and the only other time she had been seen by her primary care physician, her BP was 120/80 mm Hg. She is extensively interviewed and examined, and has no signs of acute or chronic hypertension-associated target-organ damage. Her physician measures her BP again 20 minutes later, and it is 142/92 mm Hg (140/90 mm Hg when repeated). Based on her most recent fasting lipid panel, her Framingham risk score is 1%. Which of the following is the most accurate clinical assessment of her present situation? A Prehypertension B Elevated blood pressure C Stage 1 hypertension D White coat hypertension The correct answer is B. Which of the following is true regarding prehypertension? A All patients with BP values greater than 120/80 mm Hg are classified as prehypertension. B Guidelines recommend lifestyle modifications in all patients with prehypertension. C Less than 50% of patients with prehypertension develop hypertension within their lifetime. D Patients with prehypertension have equal CV risk compared to patients with normal BP values. The correct answer is B Question 4 A 78-year-old man has a past medical history of hypertension for 10 years. His BP today is 158/72 mm Hg (156/70 mm Hg when repeated), heart rate is 60 beats/min, serum creatinine is 1.2 mg/dL, and potassium is 4.3 mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73 kg, is 70″ tall, smokes one pack cigarettes daily, and consumes two to three ethanol-containing drinks weekly. Which of the following is the most appropriate recommendation to add to his antihypertensive regimen? A Amlodipine B Losartan C Indapamide D Metoprolol succinate The correct answer is C Question 5 A 78-year-old man has a past medical history of hypertension for 10 years. His BP today is 158/72 mm Hg (156/70 mm Hg when repeated), heart rate is 60 beats/min, serum creatinine is 1.2 mg/dL, and potassium is 4.3 mEq/L. He is currently on lisinopril 40 mg daily and verapamil SR 240 mg daily, weighs 73 kg, is 70″ tall, smokes one pack cigarettes daily, and consumes two to three ethanol-containing drinks weekly. Which of the following lifestyle modifications is/are most reasonable to recommend in this patient to lower his BP? A Weight loss B Smoking cessation C Adopting a DASH eating plan D Decreasing ethanol consumption The correct answer is C Question 6 A 60-year-old woman with hypertension and heart failure with preserved ejection fracture is seen 2 months after experiencing an acute myocardial infarction. She also has a history of dyslipidemia. Her present BP is 130/84 mm Hg (132/82 mm Hg when repeated) and her heart rate is 60 beats/min. Her serum creatinine is 1.1 mg/dL, serum potassium is 3.5 mEq/L, and spot urinalysis shows 20 mg albumin/g creatinine. She currently has no peripheral or pulmonary edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, enalapril 20 mg twice daily, and pravastatin 20 mg daily. Which of the following medical conditions is/are a compelling indication(s) for the use of carvedilol in this patient? A Heart failure B Recent MI C Chronic kidney disease D Dyslipidemia The correct answer is B. Question 7 A 55-year-old man with hypertension and no other chronic medical problems is currently treated with hydrochlorothiazide 50 mg daily, irbesartan 300 mg daily, carvedilol 25 mg twice daily, and amlodipine 10 mg daily. His BP is 144/96 mm Hg (146/94 mm Hg when repeated). He is adherent with all of these medications. Serum creatinine is 1.2 mg/dL, potassium is 4.2 mEq/L, and all other laboratory values are normal. Which of the following is the most appropriate to add to his regimen? A Terazosin 2 mg daily B Spironolactone 25 mg daily C Clonidine 0.1 mg twice daily D Chlorthalidone 12.5 mg daily The correct answer is B Question 8 Which of the following is preferred as add-on therapy for a patient who is post-MI (1 month ago) with a BP of 146/88 mm Hg (144/86 mm Hg when repeated) while treated with metoprolol succinate 200 mg daily? A Chlorthalidone B Verapamil C Amlodipine D Lisinopril The correct answer is D Question 9 A 70-year-old woman with hypertension and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and diltiazem extended release 240 mg daily for 6 years. She was on lisinopril several years ago, but it was stopped due to a dry cough. She was first diagnosed with hypertension when her blood pressure was 180/82 mm Hg. Today, her blood pressure is 158/78 mm Hg (160/76 mm Hg when repeated) and her heart rate is 100 beats/min. Her urinalysis shows 100 mg albuminuria/24 hours, serum creatinine is 1.6 mg/dL, potassium is 4.1 mEq/L, weight is 75 kg, and height is 66″. Her only complaint is headache. Which of the following is/are routine monitoring parameters for her antihypertensive drug therapy? A Heart rate B Serum potassium, sodium, and magnesium C Serum creatinine and BUN D All of the above The correct answer is D Question 10 A 70-year-old woman with hypertension and type 2 diabetes has been on hydrochlorothiazide 25 mg daily and diltiazem extended release 240 mg daily for 6 years. She was on lisinopril several years ago, but it was stopped due to a dry cough. She was first diagnosed with hypertension when her blood pressure was 180/82 mm Hg. Today, her blood pressure is 158/78 mm Hg (160/76 mm Hg when repeated) and her heart rate is 100 beats/min. Her urinalysis shows 100 mg albuminuria/24 hours, serum creatinine is 1.6 mg/dL, potassium is 4.1 mEq/L, weight is 75 kg, and height is 66″. Her only complaint is headache. Losartan 50 mg daily is added to her regimen. Four weeks later, her BP is 146/82 and 148/80 mm Hg, serum creatinine is 1.9 mg/dL, and potassium has increased to 4.4 mEq/L. Which of the following is the most appropriate option to treat this patient's hypertension? A Increase losartan to 100 mg daily. B Increase hydrochlorothiazide to 50 mg daily. C Add spironolactone 25 mg daily. D Decrease losartan to 25 mg daily. The correct answer is A Question 11 A 69-year-old woman with a history of angioedema (from lisinopril), hypertension, and type 2 diabetes is currently receiving hydrochlorothiazide 25 mg daily and carvedilol 25 mg twice daily. Today her blood pressure is 138/82 mm Hg (138/84 mm Hg when repeated) and heart rate is 56 beats/min. Urinalysis shows 400 mg albumin/24 hours, serum creatinine is 1.2 mg/dL, potassium is 3.8 mEq/dL, weight is 90 kg, and height is 65″. She complains of heartburn, a dry cough, constipation, and fatigue when she exercises. She normally exercises three times per week, and follows a DASH eating plan. The patient reports taking several nonprescription medications including aspirin 81 mg daily, a multivitamin daily, acetaminophen, and loratadine. She asks you if these are safe to take because of her hypertension. Which of the following is the most appropriate response? A You should stop taking these until you have discussed this with your primary care physician. B Acetaminophen can increase your blood pressure; you should use naproxen instead. C Loratadine can increase your blood pressure; you should use it only if needed. D These medications are generally safe to use in patients with hypertension. The correct answer is D. Question 12 A 69-year-old woman with a history of angioedema (from lisinopril), hypertension, and type 2 diabetes is currently receiving hydrochlorothiazide 25 mg daily and carvedilol 25 mg twice daily. Today her blood pressure is 138/82 mm Hg (138/84 mm Hg when repeated) and heart rate is 56 beats/min. Urinalysis shows 400 mg albumin/24 hours, serum creatinine is 1.2 mg/dL, potassium is 3.8 mEq/dL, weight is 90 kg, and height is 65″. She complains of heartburn, a dry cough, constipation, and fatigue when she exercises. She normally exercises three times per week, and follows a DASH eating plan. Which of her complaints is most likely from one of her antihypertensive medications? A Heartburn B Dry cough C Constipation D Fatigue The correct answer is D. You answered A. Related Topics: antihypertensive agents Question 13 Which of the following is preferred as initial antihypertensive therapy for a 63-year-old woman who is diagnosed with hypertension and has a history of ischemic stroke (6 months ago), with a BP of 186/108 mm Hg (184/106 mm Hg when repeated)? A A thiazide diuretic with an ACE inhibitor B A thiazide diuretic with a nonselective β-blocker C A thiazide diuretic alone D An ACE inhibitor with an ARB The correct answer is A Question 14 Which of the following is true regarding the use of arterial vasodilators (hydralazine or minoxidil) in the treatment of hypertension? A Severe bradycardia occurs when they are used in combination with a β-blocker. B Both can cause severe rebound hypertension when stopped abruptly. C Both are poorly tolerated because of anticholinergic side effects. D Both should be given in combination with a diuretic and a β-blocker. The correct answer is D Question 15 A 52-year-old man has a past history of chronic stable angina and hypertension. He is experiencing ischemic chest pain twice weekly while being treated with atenolol 100 mg daily. His BP is 146/90 mm Hg (144/92 mm Hg when repeated), and heart rate is 58 beats/min. Which of the following is the most appropriate agent to add in this patient? A Lisinopril 20 mg daily B Diltiazem SR 180 mg daily C Amlodipine 5 mg daily D Irbesartan 150 mg daily The correct answer is C Question 16 A 60-year-old woman with hypertension and heart failure with preserved ejection fracture is seen 2 months after experiencing an acute myocardial infarction. She also has a history of dyslipidemia. Her present BP is 130/84 mm Hg (132/82 mm Hg when repeated) and her heart rate is 60 beats/min. Her serum creatinine is 1.1 mg/dL, serum potassium is 3.5 mEq/L, and spot urinalysis shows 20 mg albumin/g creatinine. She currently has no peripheral or pulmonary edema. She is taking furosemide 40 mg twice daily, carvedilol 25 mg twice daily, enalapril 20 mg twice daily, and pravastatin 20 mg daily. Which of the following statements is most appropriate to include when counseling this patient regarding her antihypertensive therapy? A It will be possible to stop enalapril once your BP is at goal. B If you experience depression, stop taking carvedilol. C Long-term benefits of these medications are a reduced risk of CV events. D If you experience dry cough, stop taking lisinopril because this can lead to angioedema. The correct answer is C Question 17 A 69-year-old woman with a history of angioedema (from lisinopril), hypertension, and type 2 diabetes is currently receiving hydrochlorothiazide 25 mg daily and carvedilol 25 mg twice daily. Today her blood pressure is 138/82 mm Hg (138/84 mm Hg when repeated) and heart rate is 56 beats/min. Urinalysis shows 400 mg albumin/24 hours, serum creatinine is 1.2 mg/dL, potassium is 3.8 mEq/dL, weight is 90 kg, and height is 65″. She complains of heartburn, a dry cough, constipation, and fatigue when she exercises. She normally exercises three times per week, and follows a DASH eating plan. Which of the following is the most appropriate modification to her regimen? A Decrease carvedilol to 12.5 mg twice daily and add enalapril. B Decrease carvedilol to 12.5 mg twice daily and add valsartan. C Replace hydrochlorothiazide with spironolactone and felodipine. D Replace carvedilol with valsartan. The correct answer is B Question 18 A 37-year-old woman has a BP measurement of 190/120 mm Hg when she first arrives for a routine physical examination by a medical assistant. She has no previous history of hypertension, and the only other time she had been seen by her primary care physician, her BP was 120/80 mm Hg. She is extensively interviewed and examined, and has no signs of acute or chronic hypertension-associated target-organ damage. Her physician measures her BP again 20 minutes later, and it is 142/92 mm Hg (140/90 mm Hg when repeated). Based on her most recent fasting lipid panel, her Framingham risk score is 1%. Which of the following is the most appropriate BP goal in this patient? A