ACE inhibitors — MCQs

A 51-year-old woman presents to the emergency department with a 2-day history of bilateral lower extremity swelling. She says that her legs do not hurt, but she noticed she was gaining weight and her legs were becoming larger. Her past medical history is significant for morbid obesity, hypertension, and hypercholesterolemia. She says the swelling started after she was recently started on a new medication to help her blood pressure, but she does not remember the name of the medication. Which of the following is most likely the mechanism of action for the drug that was prescribed to this patient?

A 58-year-old male with a history of congestive heart failure and hypertension comes to you with the chief complaint of new-onset cough as well as increased serum potassium in the setting of a new medication. Which of the following medications is most likely responsible for these findings?

A 49-year-old man is diagnosed with hypertension. He has asthma. The creatinine and potassium levels are both slightly elevated. Which of the following anti-hypertensive drugs would be appropriate in his case?

A new drug X is being tested for its effect on renal function. During the experiments, the researchers found that in patients taking substance X, the urinary concentration of sodium decreases while urine potassium concentration increase. Which of the following affects the kidneys in the same way as does substance X?

A 62-year-old man comes to the physician for a follow-up examination. One month ago, therapy with lisinopril was initiated for treatment of hypertension. His blood pressure is 136/86 mm Hg. Urinalysis shows a creatinine clearance of 92 mL/min. The patient's serum creatinine concentration is most likely closest to which of the following values?

A 52-year-old man presents to the emergency department with chest pain radiating to his left jaw and arm. He states that he had experienced similar symptoms when playing basketball. The medical history is significant for diabetes mellitus, hypertension, and GERD, for which he takes metformin, hydrochlorothiazide, and pantoprazole, respectively. The blood pressure is 150/90 mm Hg, the pulse is 100/min, and the respirations are 15/min. The ECG reveals ST elevation in leads V3-V6. He is hospitalized for an acute MI and started on treatment including lisinopril. The next day he complains of dizziness and blurred vision. Repeat vital signs were as follows: blood pressure 90/60 mm Hg, pulse 72/min, and respirations 12/min. The laboratory results were as follows: Serum chemistry Sodium 143 mEq/L Potassium 4.1 mEq/L Chloride 98 mEq/L Bicarbonate 22 mEq/L Blood urea nitrogen 26 mg/dL Creatinine 2.3 mg/dL Glucose 120 mg/dL Which of the following drugs is responsible for this patient's lab abnormalities?

A 70-year-old man presents to his primary care physician for a general checkup. He states that he has been doing well and taking his medications as prescribed. He recently started a new diet and supplement to improve his health and has started exercising. The patient has a past medical history of diabetes, a myocardial infarction, and hypertension. He denies any shortness of breath at rest or with exertion. An ECG is performed and is within normal limits. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 6.7 mEq/L HCO3-: 25 mEq/L Glucose: 133 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most likely cause of this patient's presentation?

A 58-year-old man presents for a follow-up appointment. He recently was found to have a history of stage 2 chronic kidney disease secondary to benign prostatic hyperplasia leading to urinary tract obstruction. He has no other medical conditions. His father died at age 86 from a stroke, and his mother lives in an assisted living facility. He smokes a pack of cigarettes a day and occasionally drinks alcohol. His vital signs include: blood pressure 130/75 mm Hg, pulse 75/min, respiratory rate 17/min, and temperature 36.5°C (97.7°F). His physical examination is unremarkable. A 24-hour urine specimen reveals the following findings: Specific gravity 1,050 pH 5.6 Nitrites (-) Glucose (-) Proteins 250 mg/24hrs Which of the following should be prescribed to this patient to decrease his cardiovascular risk?

A 38-year-old man presents to his physician with recurrent episodes of facial swelling and abdominal pain. He reports that these episodes started when he was approximately 16 years of age. His mother also has similar episodes of swelling accompanied by swelling of her extremities. The vital signs include: blood pressure 140/80 mm Hg, heart rate 74/min, respiratory rate 17/min, and temperature 36.6℃ (97.8℉). His physical examination is unremarkable. The laboratory work-up shows the following findings: Test Result Normal range C1 esterase inhibitor 22% > 60% Complement C4 level 9 mg/dL 14–40 mg/dL Complement C2 level 0.8 mg/dL 1.1–3.0 mg/dL Complement component 1q 17 mg/dL 12–22 mg/dL Which of the following anti-hypertensive medications is contraindicated in this patient?

A 63-year-old African American man presents to the emergency department with edema over his face and difficulty breathing. Past medical history is significant for hypertension and dyslipidemia. He recently began lisinopril and atorvastatin several weeks ago. His father died at 80 years from complications of a stroke and his mother lives in a nursing home. His blood pressure is 135/92 mm Hg, the heart rate is 101/min, the respiratory rate is 21/min, the temperature is 37.0°C (98.6°F). Clinical pathology results suggest a normal C1 esterase inhibitor level. Of the following options, which is the most likely diagnosis?