Answer 5

5.   Choice D is the correct answer.  According to the JNC guidelines diuretics a and beta blockers are considered first line for stage I hypertension.  Medications such as clonidine that are centrally acting alpha blockers have some rebound effect if stopped abruptly.  Calcium channel blockers such as norvasc and cardizem are considered second line.

Question 5

5.  Your patient is a 59 year old female newly diagnosed with primary hypertension.  Her blood pressure is 158/96.  She has no other medical problems.  Which of the following is the best choice for first line management for her?

A.  Clonidine
B.  Norvasc
C.  Cardizem
D.  Hydrocholorthiazide

Answer 4

4.  Answer D is the correct answer.  This patient has A-Fib with RVR.  Defibrillation is reserved for Ventricular Tachycardia, Ventricular Fibrillation, or unstable A-Fib.  This is a narrow complex tachycardia that is irregular.  Adenosine or Labetolol would be appropriate for supraventricular tachycardia or sinus tachycardia.

Question 4

4.  Your patient is a 64 year old male that presents with the EKG listed below.  Which of the following is best therapeutic intervention?




A.  Defibrillation
B.  Labetolol
C.  Adenosine
D.  Cardizem

Answer 3

3.  Choice C is the correct answer.  Cardiogenic shock is defined as widespread failure of inadequate tissue perfusion resulting in metabolic demands not being met.  Myocardial ischemia is the primary cause.  These patients will likely need to be placed on vasopressors.  The main treatment is to treat the underlying myocardial ischemia first. Volume depletion can cause tachycardia and hypotension but typically will not cause you to have chest pain.  Patients in septic shock will usually be febrile.  A CVA typically will not be hypotensive or tachycardic.

Question 3

3.  Your patient is a 43 year old male that presents with chest pain, dizziness and shortness of breath.  His past medical history is remarkable for CAD with 2 stents placed 6 months ago.  His vital signs are 52/32, HR-154, SpO2 is 98%, RR-24 Temp-97.3.  Which of the following is likely the cause of this patients symptoms?

A.  Volume Depletion
B.  Cardiogenic Shock
C.  Septic Shock
D.  CVA

Answer 2

2.  Choice A is the correct answer.  An ABI greater than 1.0 is considered normal and an ABI less than 1.0 is consider abnormal and suggestive of peripheral artery disease.  ABI is fairly accurate.  No clinical data suggests that smokers need angiography.  It is a highly invasive procedure with complications and should be reserved for those high risk individuals are those with acute arterial occlusion or those where surgery may be necessary.  Starting patients empirically on Cilostazol is not appropriate.  These medications can cause bleeding and have side effects.

Question 2

2.  Your patient is a 54 year old male who presents with bilateral leg pain that has been present for several months.  He is a smoker so your consider peripheral artery disease as a potential etiology of his symptoms.  His ABI comes back at 1.5.  Which of the following is true about this patients findings?

A.  This is a normal ABI
B.  This ABI is abnormal.
C.  This ABI is inaccurate.  Smokers characteristically will have higher ABI's.  This patient needs more sensitive studies such as angiography
D.  We treat patients and not diagnostic tests.  This patient should be started on Cilostazol empirically

Answer 1

1.  B is the correct answer.  Patients with their initial diagnosis of DVT need to be anti coagulated and have a goal INR of between 2.0-3.0 if coumadin is used.  They should be anti coagulated for 3-6 months.  Consider repeating the vascular study before discontinuing therapy.  The second DVT should be anti-coagulated for life and/or get a Greenfield filter.

Question 1

1.  Your patient is a 45 year old male with a newly diagnosed right lower extremity DVT.  Which of the following is the goal INR for him?

A.  1.5-2.5
B.  2.0-3.0
C.  3.0-4.0
D.  3.5-4.5