Antihypertensives — MCQs

A 57-year-old woman presents to the emergency room with complaints of severe headache, vomiting, neck stiffness, and chest pain that have developed over the last several hours. Her past medical history is notable for diabetes, hypertension, and dyslipidemia. Her temperature is 99.0°F (37.2°C), blood pressure is 197/124 mm Hg, pulse is 120/min, respirations are 19/min, and oxygen saturation is 98% on room air. Physical examination is significant for papilledema. Urinalysis reveals gross hematuria and proteinuria. Which of the following is the next best step in management for this patient?

A 78-year-old Caucasian male actor presents to your office complaining of a dry, non-productive cough. He has a history of hypertension, diabetes, and coronary artery disease and he follows a complicated regimen of medications to treat his multiple co-morbidities. Which of the following medications is most likely to be associated with his chief complaint?

A 55-year-old man presents to the emergency department with a headache, blurry vision, and abdominal pain. He states that his symptoms started several hours ago and have been gradually worsening. His temperature is 99.3°F (37.4°C), blood pressure is 222/128 mmHg, pulse is 87/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical exam is notable for an uncomfortable and distressed man. The patient is started on an esmolol and a nitroprusside drip thus lowering his blood pressure to 200/118 mmHg. The patient states that he feels better, but complains of feeling warm and flushed. An hour later, the patient seems confused and states his headache has resurfaced. Laboratory values are ordered as seen below. Serum: Na+: 138 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 17 mEq/L BUN: 31 mg/dL Glucose: 199 mg/dL Creatinine: 1.4 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best treatment for this patient?

A 59-year-old female is brought to the emergency department with an acute onset of weakness in her left hand that started 3 hours ago. She has not had numbness or tingling of the hand. Other than recent episodes of blurry vision and headaches, her medical history is unremarkable. She has one daughter who was diagnosed with multiple sclerosis at age 23. Her temperature is 36.7°C (98°F), pulse is 80/min, and blood pressure is 144/84 mm Hg. Examination shows facial erythema. There are mild scratch marks on her arms and torso. Left hand strength is slightly decreased and there is mild dysmetria of the left hand finger-to-nose testing. The remainder of the neurological examination shows no abnormalities. Her laboratory studies shows: Hematocrit 55% Leukocyte count 14,500/mm3 Segmented neutrophils 61% Eosinophils 3% Lymphocytes 29% Monocytes 7% Platelet count 690,000/mm3 Her erythropoietin levels are decreased. CT scan of the head without contrast shows two focal areas of hypo-attenuation in the right parietal lobe. Which of the following is the most appropriate treatment to prevent complications of this patient's underlying condition?

A 44-year-old man comes to the emergency department because of a severe headache and blurry vision for the past 3 hours. He has hypertension treated with hydrochlorothiazide. He has missed taking his medication for the past week as he was traveling. He is only oriented to time and person. His temperature is 37.1°C (98.8°F), pulse is 92/min and regular, and blood pressure is 245/115 mm Hg. Cardiopulmonary examination shows no abnormalities. Fundoscopy shows bilateral retinal hemorrhages and exudates. Neurologic examination shows no focal findings. A complete blood count and serum concentrations of electrolytes, glucose, and creatinine are within the reference range. A CT scan of the brain shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?

A 62-year-old man presents to the emergency department with chest pain. He was at home watching television when he suddenly felt chest pain that traveled to his back. The patient has a past medical history of alcoholism, obesity, hypertension, diabetes, and depression. His temperature is 98.4°F (36.9°C), blood pressure is 177/118 mmHg, pulse is 123/min, respirations are 14/min, and oxygen saturation is 97% on room air. Physical exam reveals a S4 on cardiac exam and chest pain that seems to worsen with palpation. The patient smells of alcohol. The patient is started on 100% oxygen and morphine. Which of the following is the best next step in management?

A 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation is admitted to the hospital for the management of elevated blood pressures. On admission, her pulse is 81/min, and blood pressure is 165/89 mm Hg. Treatment with an intravenous drug is initiated. Two days after admission, she has a headache and palpitations. Her pulse is 116/min and regular, and blood pressure is 124/80 mm Hg. Physical examination shows pitting edema of both lower extremities that was not present on admission. This patient most likely was given a drug that predominantly acts by which of the following mechanisms?

A 73-year-old woman is brought to the emergency department because of a 1-day history of skin lesions. Initially, she experienced pain in the affected areas, followed by discoloration of the skin and formation of blisters. Four days ago, the patient was started on a new medication by her physician after failed cardioversion for intermittent atrial fibrillation. She lives alone and does not recall any recent falls or trauma. She has hypertension treated with metoprolol and diabetes mellitus treated with insulin. Her temperature is 37°C (98.6°F), pulse is 108/min and irregularly irregular, and blood pressure is 145/85 mm Hg. Examination of her skin shows well-circumscribed purple maculae, hemorrhagic blisters, and areas of skin ulceration over the breast, lower abdomen, and gluteal region. Which of the following is the strongest predisposing factor for this patient's condition?

A 37-year-old man comes to the physician for a follow-up examination. He is being evaluated for high blood pressure readings that were incidentally recorded at a routine health maintenance examination 1 month ago. He has no history of serious illness and takes no medications. His pulse is 88/min and blood pressure is 165/98 mm Hg. Physical examination shows no abnormalities. Serum studies show: Na+ 146 mEq/L K+ 3.0 mEq/L Cl- 98 mEq/L Glucose 77 mg/dL Creatinine 0.8 mg/dL His plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is 36 (N = < 10). A saline infusion test fails to suppress aldosterone secretion. A CT scan of the adrenal glands shows bilateral adrenal abnormalities. An adrenal venous sampling shows elevated PACs from bilateral adrenal veins. Which of the following is the most appropriate next step in management?

A 64-year-old female presents with acute right wrist pain after she lost her balance while reaching overhead and fell from standing height. Her right wrist radiographs show a fracture of her right distal radius. A follow-up DEXA bone density scan is performed and demonstrates a T-score of -3.5 at the femoral neck and spine. Her medical history is significant for hypertension, for which she is not currently taking any medication. She has not had a previous fracture. Which of the following antihypertensive agents would be preferred in this patient?