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You examine a 38-year-old woman who has presented for an initial examination and Papanicolaou test. She has no complaint. Her blood pressure (BP) is 154/98 mm Hg bilaterally and her body mass index (BMI) is 31 kg/m2. The rest of her physical examination is unremarkable. Your next best action is to: A. initiate antihypertensive therapy. B. arrange for at least two additional BP measurements during the next 2 weeks. C. order blood urea nitrogen, creatinine, and potassium ion measurements and urinalysis. D. advise her to reduce her sodium intake. - Correct Answer B You see a 68-year-old woman as a patient who is transferring care into your practice. She has a 10-year history of hypertension, diabetes mellitus, and hyperlipidemia. Current medications include hydrochlorothiazide (HCTZ), glipizide, metformin, simvastatin, and daily low-dose aspirin. Today's BP reading is 158/92 mm Hg, and the rest of her history and examination are unremarkable. Documentation from her former healthcare provider indicates that her BP has been in the range for the past 12 months. Your next best action is to: A. prescribe an angiotensin-converting enzyme inhibitor (ACE)). B. have her return for a BP check in 1 week. C. advise that her current therapy is adequate. D. add therapy with an aldosterone antagonist. - Correct Answer A You examine a 78-year-old woman with long-standing, poorly controlled hypertension. When evaluating her for hypertensive target organ damage, you look for evidence of: A. lipid abnormalities. B. insulin resistance. C. left ventricular hypertrophy. D. clotting disorders. - Correct Answer C 7. diltiazem 8. trandolapril 9. telmisartan 10. pindolol A. beta-adrenergic receptor antagonist B. nondihydropyridine calcium channel blocker C. dihydropyridine calcium channel blocker D. angiotensin receptor antagonist E. ACEI - Correct Answer 6. C. iB 8.E. 9. D. 10. A. You see a 38-year-old African American male with hypertension who is currently being treated with thiazide-type diuretic. His current blood pressure reading is 156/94 mm Hg and he has no history of diabetes mellitus or chronic kidney disease. Following current best evidence, you consider adding which of the following medications? A. ACEI B. angiotensin receptor blocker (ARBs) C. beta-adrenergic receptor antagonist D. calcium channel blocker - Correct Answer D Nondihydropyridine calcium channel blockers are contraindicated in patients with: A. type 1 diabetes mellitus. B. a history of venous thromboembolism. C. severe left ventricular dysfunction. D. concomitant treatment with an ACEI. - Correct Answer C In obtaining an office BP measurement, which of the following is most reflective of the best practice? A. The patient should sit in a chair with feet flat on the floor for at least 5 minutes before obtaining the reading. B. The BP cuff should not cover more than 50% of the the person with this condition. - Correct Answer B You start a patient with hypertension who is already receiving an ACEI on spironolactone. You advise the patient to return in 4 weeks to check which of the following laboratory parameters? A. sodium B. calcium C. potassium D. chloride - Correct Answer C A 68-year-old woman presents with hypertension and BP of 152-158/92-96 mm Hg documented over 2 months on three different occasions. Electrocardiogram (ECG) and creatinine are normal, and she has no proteinuria. Clinical findings include the following: BMI 26.4 kg/m2; no $3, $4, or murmur; and point of maximal impulse at fifth intercostal space, mid-clavicular line. Which of the following represents the best intervention? A. Initiate therapy with metoprolol. B. Initiate therapy with hydrochlorothiazide. C. Initiate therapy with methyldopa. D. Continue to monitor BP, and start drug therapy if evidence of target organ damage. - Correct Answer B Which of the following can have a favorable effect on a comorbid condition in a person with hypertension? A. chlorthalidone in gout B. propranolol with airway disease C. aldosterone antagonist in heart failure D. methyldopa in an older adult - Correct Answer C According to JNC-8 guidelines, all of the following medications are first-line agents for use in a middle-aged white man without diabetes mellitus except: A. lisinopril. B. hydrochlorothiazide. C. metoprolol. D. amlodipine. - Correct Answer C You see a 59-year-old man with poorly controlled hypertension. On physical examination, you note intake B. absence of microalbuminuria plus use of a thiazolidinedione C. absence of microalbuminuria plus chronic physical inactivity D. presence of microalbuminuria plus cigarette smoking - Correct Answer D When compared with Caucasians, African Americans tend to have a reduced effect with monotherapy with all of the following blood pressure medications except: A. ACEls. B. ARBs. C. CCB. D. beta blockers. - Correct Answer C Match the recommended blood pressure goal for each patient according to JNC-8 guidelines. (An answer can be used more than once.) A. <130/80 mm Hg B. <140/80 mm Hg C. <140/90 mm Hg D. <150/90 mm 24. a 57-year-old white male with no history of diabetes mellitus (DM) or chronic kidney disease (CKD) 25. a 62-year-old African American male with diabetes mellitus 26. a 67-year-old female with CKD 27. a 62-year-old female with no history of DM or CKD 28. an 82-year-old male with no history A. It increases the risk of falls and syncope. B. It is characterized by a drop in blood pressure when going from a standing to a sitting position. C. It increases the risk of cardiovascular events. D. It is associated with the use of vasodilating medications. - Correct Answer B According to American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines, when treating elderly patients with hypertension, which of the following medications have a compelling indication for use in the following patient conditions? (The medications listed can be used more than once. A given condition can have more than one medication indicated.) A. thiazide diuretic B. beta blocker C. ACEI D. ARB E. aldosterone antagonist F. calcium channel blocker 32. heart failure 33. diabetes mellitus 34. angina pectoris B 35. coronary artery disease 36. aortic aneurysm 37. recurrent stroke prevention - Correct Answer 32. A, B, C, D, E, F. 33..A, B, C, D, F. 34. B, F. 35. A, B, C, F. 36. A, B, C, F. 37. A, €,.D,; F. 38. You examine a 24-year-old woman with mitral valve prolapse (MVP). Her physical examination findings may also include: A. pectus excavatum. B. obesity. C. petite stature. D. hyperextensible joints. - Correct Answer A advice about which of the following? A. restricted activity because of low cardiac output B. control of fluid intake to minimize risk of volume overload C. routine use of beta-adrenergic antagonists to control palpitations D. encouragement of a regular program of aerobic activity - Correct Answer D 43. When a heart valve fails to open to its normal orifice size, it is said to be: A. stenotic. B. incompetent. C. sclerotic. D. regurgitant. - Correct Answer A 44. When a heart valve fails to close properly, it is said to be: A. stenotic. B. incompetent. C. sclerotic. D. regurgitant. - Correct Answer B 45. Upon detection of a suspected pathologic cardiac murmur, the next step in obtaining a diagnostic procedure usually includes a: A. ventilation perfusion scan. B. echocardiogram. C. pulmonary artery angiography. D. cardiac computerized tomography (CT) scan. - Correct Answer B 46. You are evaluating a patient who has rheumatic heart disease. When assessing her for mitral stenosis, you auscultate the heart, anticipating finding the following murmur: A. systolic with wide radiation over the precordium. B. localized diastolic with little radiation. C. diastolic with radiation to the neck. D. systolic with radiation to the axilla. - Correct Answer B 47. In evaluating mitral valve incompetency, you expect to find the following murmur: A. systolic with radiation to the axilla. B. diastolic with little radiation. C. diastolic with radiation to the axilla. D. myocardial biopsy. - Correct Answer B 51. Of the following patients, who is in greatest need of endocarditis prophylaxis when planning dental work? A. a 22-year-old woman with MVP with trace mitral regurgitation noted on echocardiogram B. a 54-year-old woman with a prosthetic aortic valve C. a 66-year-old man with cardiomyopathy D. a 58-year-old woman who had a three-vessel coronary artery bypass graft with drug-eluting stents 1 year ago - Correct Answer B 52. Of the following people, who has no significant increased tisk for developing bacterial endocarditis? A. a 43-year-old woman with a bicuspid aortic valve B. a 55-year-old man who was diagnosed with a Still's murmur during childhood C. a 45-year-old woman with a history of endocarditis D. a 75-year-old man with dilated cardiomyopathy - Correct Answer B 53. You are examining an 85-year-old woman and find a grade 3/6 crescendo-decrescendo systolic murmur with radiation to the neck. This is most likely caused by: A. aortic stenosis. B. aortic regurgitation. C. anemia. D. mitral stenosis. - Correct Answer A 54. Aortic stenosis in a 15-year-old male is most likely: A. a sequela of rheumatic fever. B. a result of a congenital defect. C. calcific in nature. D. found with atrial septal defect. - Correct Answer B 55. A risk factor for acquired aortic stenosis is: A. history of pulmonary embolism. B. chronic obstructive pulmonary disease (COPD). C. type 2 diabetes. D. prior rheumatic fever. - Correct Answer D 56. Management of mild aortic stenosis in a 12-year-old 
