Cardio vascular system EXIT exam mcq .pptx

Cardio vascular system Exit Exam questions and answers

1. Well-come to Exit and licensure exam practice tutorial class

2. Today’s focus area Heart failure,DM , hypertension and pharmaceutical care With different question

3. Exit and COC exam…2012 89 . A 64-year-old woman with a history of non-ischemic cardiomyopathy, came to an emergency department for shortness of breath. Physical examination confirms findings associated with acute decompensated heart failure . Her extremities are warm, and blood pressure is 110/78 mmHg with a heart rate of 75 beats per minutes. Her laboratory studies return with sodium of 128 mEq /L and creatinine of 2.5 mg/ dL (which is increased from her prior level of 1.2 mg/ dL ). Chest x-ray shows a diffuse alveolar filling pattern consistent with pulmonary edema . What is the most appropriate drug therapy for this patient? (A) Administer digoxin 250 µg IV (B) Administer furosemide 40 mg IV (C) Initiate metoprolol 25mg PO daily (D) Start dobutamine at 5 µg/kg/min

4. 90. A 38 year-old male patient with chronic kidney disease (CKD) for the past six months visited a hospital. Currently the BP of the patient is 155/95 mmHg. The clinician wants to start anti- hypertensive medication that has been shown to slow progression of CKD. Which drug is the most appropriate to be initiated in this patient? (A) Amlodipine (B) Enalapril (C) Hydrochlorothiazide, (D) Metoprolol

5. 91. A 56-years-old gentle man came to the hospital with a diagnosis of primary hypertension. His attending physician approached a pharmacist to select appropriate drug from calcium channel blockers (CCBs). On medication history assessment, he has no contraindications to calcium channel blockers. Which medication should be avoided for this patient? (A) Immediate-release of Nifedipine 20 mg TID (B) Sustained-release of Verapamil 180 mg daily (C) Immediate-release of Amlodipine 5 mg daily (D) Sustained-release of Diltiazem 120 mg daily

6. 92. A 53 year-old woman came to a hospital with complaints of dyspnea on exertion and palpitations for the last 2 weeks. Cardiac examination reveals an irregularly irregular rhythm; 4 cm distended jugular veins, and grade II pitting edema. The electrocardiogram finding shows atria fibrillation. An echocardiogram result reveals a left ventricular ejection fraction of 35%. The patients started on Furosemide, Enalapril , Digoxin, and Aspirin. On her next follow up, she reported that she developed hazy vision and difficulties in both reading and red-green color perception. What drug is the mostly responsible for her visual disturbances? (A) Furosemide (B) Enalapril (C) Digoxin (D) Aspirin

7. 93. A 63-year-old female patient was diagnosed with Stage. C heart failure and an ejection fraction of 25%, is currently taking lisinopril 20 mg daily, furosemide 40 mg twice daily, digoxin 0.125 mg daily, and carvedilol 3.125 mg twice daily. Today, she reported increased shortness of breath, fatigue, and ankle swelling. She also reports a 10 kg weight gain over the past week. The lab values are significant for serum potassium of 5.2 mEq /L (5.2 mmol /L) and serum creatinine of 2.2 mg/ dL (194 µ mol /L ). What is the most appropriate initial intervention for this patient? (A) Increase dose of lisinopril to 20 mg twice daily (B) Add Spironolactone 25 mg daily, (C) Increase dose of furosemide to 80 mg twice daily (D) Increase dose of digoxin to 0.25 mg daily

8. 95. A 71-year-old woman weighing 53kg, was admitted to hospital. She had been treated for chronic heart failure for three years and had a history of atrial fibrillation and hypertension. Now she has been referred to hospital with a suspected deterioration in her condition. She reported episodes of discomfort in the chest, which she described as 'palpitations' rather than tightness or pain. Her medication on admission was: Hydrochlorothiazide 25 mg daily, Furosemide 40 mg daily, Enalapril 10 mg daily, Digoxin 0.125 mg daily, Simvastatin 40 mg at night, Warfarin 2.5 mg daily. What additional drug do you recommend for this patient? (A) Metoprolol 50 mg daily (C) Amlodipine 5 mg daily (B) Valsartan 80 mg daily (D) Clonidine 0.1 mg twice daily

9. 96. A 65-year-old male patient with a history of hypertension was recently diagnosed with Stage C heart failure and echocardiogram shows an ejection fraction of 30%. His current medications include sustained-release diltiazem 180 mg daily, digoxin 0.125 mg daily, and furosemide 40 mg daily. Currently the patient's vital signs are: BP 145/90 and pulse 82 beats/min. What is the appropriate drug therapy for this patient? (A) Add Enalapril 10 mg daily and Metoprolol 50 mg daily to current regimen ( B) Add Metoprolol 50 mg daily to current regimen (C) Discontinue diltiazem and add Enalapril 10 mg and Metoprolol.50 mg daily (D) Discontinue diltiazem and add valsartan 80 mg daily to current regimen

10. EXIT EXAM 2013 9. A 62-year-old woman who has a family history of hypertension visits a pharmacy being concerned about her blood pressure. The pharmacist carries out the measurement using sphygmomanometer. What is the most likely approach that provides maximum quality and precision? A. Measuring at sitting position after 5 minutes B . Measuring at standing position after 5-minute C . Taking single reading from a single arm D . Placing the cuff on the lower arm

11. 20. A 64-year-old man, who has been on Hydrochlorothiazide and Losartan for hypertension treatment for the past two months, presented to a follow-up clinic. Upon evaluation, he still has elevated blood pressure. The physician decided to add a third drug that works principally by reducing sympathetic outflow. What symptom is most likely to happen in this patient after few days of treatment? A. Palpitations B . Angioedema C . Salivation D . Sedation

12. 21 . A 50-year-old man, who was on Atorvastatin, Amiodarone, Enalapril and Hydrochlorothiazide for his hypertension and tachyarrhythmia, presented to an emergency department with easy fatigability and shortness of breath of one day. A clinical team found that the patient has developed pulmonary fibrosis with the drugs he was taking. What is the most likely drug associated with the above emergency condition? Hydrochlorothiazide Amiodarone Atorvastatin Enalapri

13. 22. A 68-year-old man with chronic obstructive lung disease was found to have a blood pressure of 159/92 mm Hg. He has also history of myocardial infarction. He regularly smokes cigarette. The clinical team agreed to work against the adrenergic pushes over the cardiovascular system and urged the pharmacist for possible drug therapy recommendations. What is the most appropriate drug for this patient? A . Propranolol B . Acebutolol C . Atenolol D . Nadolol

14. 23 . A 35-year-old woman with Stage 2 hypertension is being treated with Hydrochlorothiazide and Enalapril . She expresses her desire to become pregnant. As per the patient's plan, the clinical team decided to revise her treatment. What is the most likely decision of the team made? A . Substitute Enalapril with Atenolol B . Substitute Nifedipine with Hydrochlorothiazide C . Substitute both of the drugs with Metyldopa and long acting Nifedipine D . Discontinue both of the drugs and follow with non-pharmacologic approaches

15. 24. A 68-year-old man was diagnosed with Stage 1 hypertension. His past medical history is remarkable for diabetes mellitus and gouty arthritis. Laboratory analysis for uric acid is 12 mg per dL . What is the most likely recommended drug for this patient? Atenolol Captopril Propranolol Hydrochlorothiazide

16. 36 . A 56-year-old woman is recently diagnosed with GERD by endoscopy. The patient's medical history includes hypertension, bronchial asthma and peptic ulcer disease and she is taking Propranolol 10mg daily, Nifedipine 20mg daily, Omeprazole 20mg twice daily, inhaled Salbutamol puff as needed, and inhaled Beclomethasone 200mcg twice a day. What could be the possible drug that is responsible for the patient's current condition? Nifedipine Salbutamol Propranolol Beclomethasone

17. 59. A 46-year-old man with a long history of hypertension and recently diagnosed heart failure presents to the emergency department with a BP of 200 /110 mm Hg. He states that he felt a little light-headed, but now he is feeling okay. He ran out of his BP medications (including hydrochlorothiazide, carvedilol, and lisinopril ) 3 days ago. Current laboratory values are within normal limits. What is the recommended medication for this patient? Labetalol 80 mg IV; repeat until BP is less than 120 by 80 mm Hg and follow for 2 days Continuation of home medications and refer for follow-up within 2 days Sodium nitroprusside 0.25 mcg per kg per minute and follow for 2 days Amlodipine 10 mg daily; refer for follow-up in 3days

18. 78. A 40 year-old known cardiac female patient on Spironolactone is bedridden at home because of poverty and economic hardships to seek a medical care. Her retired father is recently diagnosed with chronic kidney disease. As her father complains of significant reduction of urine output, she gives him spironolactone to improve his urine output. Although her father takes the drug for two days, his condition is worsened. What is the main reason for worsened condition in the patient's father? The patient shared her medicines The father took contraindicated medicine The patient's medical problem is quite different from her father's problem The father took the medicine for a lesser anticipated period to see the effect

19. 91. A 58-year-old woman with a history of Type 2 diabetes and hypertension presented to ambulatory clinic for follow- up. The physician wants to know if the patient is a candidate for aspirin or statin. The pharmacist referred a guideline and it recommends aspirin for patients with a history of cardiovascular disease (CVD) or equivalent, for patient with age greater than 50 in men with at least one additional major CVD risk factor. High-intensity statins are also recommended for patients with diabetes aged 40-75 years with additional risk factors. What would be the pharmacist's most appropriate recommendation for this patient? A. Patient is candidate for aspirin alone B. Patient is candidate for Atrovastatin alone C. Patient is not candidate for aspirin and statins D. Patient is candidate for asprin and Atrovasatin

20. 34. A 49-year-old male, who is a known heart failure patient with persistent atrial fibrillation and on Digoxin 0.125mg daily, Furosemide 40mg daily and Warfarin 5mg daily, comes to a hospital with complaints of heat intolerance and diaphoresis. He is currently diagnosed with thyrotoxicosis which has accompanying adrenergic symptoms. Before antithyroid drugs take effect, the clinical team added Propranolol to control those symptoms. What is the most important approach to be included in the revised order for this patient? Digoxin dose should be increased Long term warfarin use is important Warfarin dose should be increased Levothyroxine should be initiated

21. 25. A 37-year-old patient was diagnosed with paroxysmal atrial fibrillation and started a chronic oral dose of Amiodarone. What is the most appropriate long-term monitoring plan for this patient? Chest radiography every 12 months Renal function test every 6 weeks Serum electrolyte every week Red blood count daily

22. 26. A 65-year-old man with hypertension has been treated with Hydrochlorothiazide and Atenolol for the past 3 months. The drug therapy, however, failed to adequately control his blood pressure. Recently, he was diagnosed with Benign Prostatic Hyperplasia. The physician considers adding a third drug that addresses both conditions. What is the most appropriate drug therapy at this time? Clonidine Captopril Prazosin Nifedipine

23. 8. A 62-year-old obese man with PUD and TII DM came for his monthly refill. He reports nausea and vomiting of two episodes since last visit. He has no other comorbidities. His current medications are Metformin BID, Pantoprazole 20 mg BID and Atorvastatin 20 mg daily at night. The senior physician requests your recommendation to add drugs for cardiovascular risk prevention. What is the most appropriate drug you recommend for this patient? Aspirin Warfarin Clopidogrel Heparin

24. 18. A 60-year-old man was presented to an emergency department with complaints of easy fatigability and palpitation. With thorough history, physical examination and laboratory investigations, the physician in charge set the diagnosis as tachyrhythmia as the ECG sheet dietates PR-segment of 0.15see, P wave 0.10sec, Oits rate 120/min and QTc 0.40sec. Which ECG finding is most likely in line with diagnosis? (A) PR-segment duration ( B) P wave duration ( C) QT duration (D) QRS rate

25. 29. A 67-year-old man was presented to an emergency department with a complaint of excessive bleeding from minor bruising and cuts while shaving his face. The patient medication history shows that he has been taking Warfarin for atrial fibrillation for three years, Beclomethasone and Salbutamol for his asthma for six months. In addition, he started an oral Theophylline three weeks back because of increasing in frequency and severity of asthma symptoms. The laboratory result indicates that international normalized ratio (INR) of 3.5 (normal range: 2.5 -3.5). What is the most appropriate management for this patient? A ) Monitor INR (B) Discontinue with Warfarin (C) Administer vitamin K (D) Discontinue with Theophylline

26. 95. A 44-year-old patient with history of deep vein thrombosis has been taking Warfarin 2.5 mg for 6 months with good laboratory control presented to your hospital for routine follow up. Laboratory investigation, shows that the international normalization (INR) value of 4.5. What is the most appropriate next step for this patient? (A) Withhold administration of Warfarin ( B) Administer Vitamin K via slow intravenous injection (C ) Continue with the same therapy (D) Administer Prothrombin complex concentrates

27. 96. A 68-year-old man with stable angina, who is currently receiving Simvastatin 40mg daily with well controlled lipid levels (TC 3.8mmol/L; LDL-C 1.8mmol/L; HDL-C 0.9mmol/L, triglycerides 1.3mmol/L). He has been on Simvastatin for the past 7 years, and has complained previously about muscle aches, but on this visit he states that his muscle pain has become more troublesome. He asks, if there is something else he can take to control his cholesterol. What is the best management option you recommend for this patient? ( A) Replace Simvastatin 40 mg daily with Atorvastatin 40 mg daily (B) Discontinue Simvastatin (C) Decrease dose of Simvastatin to 20 mg daily (D) Continue with Simvastatin 40 mg daily

28. 16. A 50-year-old man, who had a long-standing hypertension and renal failure, was being treated with Enalapril 5mg daily and Amilodipine 10 mg BID during the last two months. His blood pressure was found to be 158/108 mmHg and serum biochemistry revealed serum creatinine levels of 110 mmol /L er (50-120 µ mol /L, Na of 136mmol/L (135-145mmmol/l) and K of 5.1mmol/L (3.5-5.0 mmol /L). Which electrolyte abnormality needs priority management ? (A ) Hyperkalemia (B) Hypernatremia ( C) Hypokalemia ( D) Hyponatremia

29. 17. A 60-year-old man with chronic renal failure, hypertension and dyslipidemia admitted to internal medicine in patient floor with a chief compliant of generalized body swelling. He started on Enalapril 10mg daily, Amlodipine 10 mg daily, Eurosemide 40mg IV BID and Simvastatin 10mg at night. His laboratory investigations show serum creatinine ol 110 mmol /L a (50-120 µ mol /L), serum sodium of 135mmol/L (135 115mmol/l) and serum potassium of 6.2mmol/L (3.5-5.0 mmol /L). What is the appropriate next step to resolve the drug therapy problem in this patient? Decrease the dose of Enalapril Decrease the dose of Amilodipine Decrease the dose of Simvastatin Decrease the dose of Furosemide

30. 19. A 45-year-old man with history of acute coronary syndrome came to an emergency department with complaints of respiratory depression, confusion and inability to arise from bed . He was on Clopidogrel , warfarin, low dose Aspirin and Morphine. The clinical team associated the complaints with the drugs he has taken. What drug is the most likely cause for his complaints ? (A) Morphine ( B) Warfarin ( C) Aspirin ( D) Clopidogrel