Autonomic/CV Drugs — MCQs

A 25-year-old man is brought to the emergency department by his fiancée for altered mental status. She states that they got in a fight that morning. She later got a text from him at work that said he was going to kill himself. She rushed back home and found him unconscious on the living room floor surrounded by his prescription pill bottles. The patient is sedated but conscious and states that he thinks he swallowed “a bunch of pills” about 2 hours ago. He also complains of nausea. The patient’s medical history is significant for bipolar disorder and chronic back pain from a motor vehicle accident. He takes lithium and oxycodone. The patient’s temperature is 99°F (37.2°C), blood pressure is 130/78 mmHg, pulse is 102/min, and respirations are 17/min with an oxygen saturation of 97% on room air. On physical exam, the patient is drowsy, and his speech is slurred, but he is fully oriented. He has horizontal nystagmus, is diffusely hyperreflexic, and has a mild tremor. His initial electrocardiogram shows sinus tachycardia. Labs are obtained, as shown below: Serum: Na: 143 mEq/L K+: 4.3 mEq/L Cl-: 104 mEq/L HCO3-: 24 mEq/L BUN: 18 mg/dL Creatinine: 1.5 mg/dL Glucose: 75 mg/dL Lithium level: 6.8 mEq/L (normal 0.6 mEq/L – 1.2 mEq/L) An intravenous bolus of 1 liter normal saline is given. Which of the following is the next step in management?

A 27-year-old male presents to his primary care physician with lower back pain. He notes that the pain started over a year ago but has become significantly worse over the past few months. The pain is most severe in the mornings. His past medical history is unremarkable except for a recent episode of right eye pain and blurry vision. Radiographs of the spine and pelvis show bilateral sacroiliitis. Which of the following is the most appropriate treatment for this patient?

An investigator is studying the regulation of adrenal hormone synthesis in rats. The investigator measures serum concentrations of different hormones before and after intravenous administration of metyrapone, which inhibits adrenal 11β-hydroxylase. The serum concentration of which of the following hormones is most likely to be increased after administration of this agent?

A 54-year-old male with a history of hypertension, coronary artery disease status post 3-vessel coronary artery bypass surgery 5 years prior, stage III chronic kidney disease and a long history of uncontrolled diabetes presents to your office. His diabetes is complicated by diabetic retinopathy, gastroparesis with associated nausea, and polyneuropathy. He returns to your clinic for a medication refill. He was last seen in your clinic 1 year ago and was living in Thailand since then and has recently moved back to the United States. He has been taking lisinopril, amlodipine, simvastatin, aspirin, metformin, glyburide, gabapentin, metoclopramide and multivitamins during his time abroad. You notice that he is constantly smacking his lips and moving his tongue in and out of his mouth in slow movements. His physical exam is notable for numbness and decreased proprioception of feet bilaterally. Which of the following medications most likely is causing his abnormal movements?

An 89-year-old woman is admitted to the neurology intensive care unit following a massive cerebral infarction. She has a history of hypertension, ovarian cancer, and lung cancer. Her medications include lisinopril and aspirin. She has smoked a few cigarettes each day for the last 60 years. She does not drink alcohol or use drugs. An arterial line and intraventricular pressure monitor are placed. You decide to acutely lower intracranial pressure by causing cerebral vasoconstriction. Which of the following methods could be used for this effect?

A 64-year-old man comes to the physician for a follow-up examination. Four months ago, he underwent a renal transplantation for end-stage renal disease. Current medications include sirolimus, tacrolimus, and prednisolone. Physical examination shows no abnormalities. Serum studies show a creatinine concentration of 2.7 mg/dL. A kidney allograft biopsy specimen shows tubular vacuolization without parenchymal changes. Which of the following is the most likely cause of this patient's renal injury?

A 58-year-old man presents to the emergency department with worsening shortness of breath, cough, and fatigue. He reports that his shortness of breath was worst at night, requiring him to sit on a chair in order to get some sleep. Medical history is significant for hypertension, hypercholesterolemia, and coronary heart disease. His temperature is 98.8°F (37.1°C), blood pressure is 146/94 mmHg, pulse is 102/min, respirations are 20/min with an oxygen saturation of 89%. On physical examination, the patient's breathing is labored. Pulmonary auscultation reveals crackles and wheezes, and cardiac auscultation reveals an S3 heart sound. After appropriate imaging and labs, the patient receives a non-rebreather facemask, and two intravenous catheters. Drug therapy is initiated. Which of the following is the site of action of the prescribed drug used to relieve this patient's symptoms?

A 48-year-old man presents to his primary care physician with a complaint of lower back pain that has developed over the past week. He works in construction but cannot recall a specific injury or incident that could have led to this pain. He denies any pain, weakness, or change/loss of sensation in his legs. The patient also reports no episodes of incontinence and confirms that he has not noted any changes in his bowel movements or urination. His temperature is 97.6°F (36.4°C), blood pressure is 133/82 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical examination reveals no focal spine tenderness and demonstrates 5/5 strength and intact sensation to light touch throughout the lower extremities. Which of the following is the most appropriate next step in management?

A 78-year-old man is brought to the emergency department by ambulance 30 minutes after the sudden onset of speech difficulties and right-sided arm and leg weakness. Examination shows paralysis and hypoesthesia on the right side, positive Babinski sign on the right, and slurred speech. A CT scan of the head shows a hyperdensity in the left middle cerebral artery and no evidence of intracranial bleeding. The patient's symptoms improve rapidly after pharmacotherapy is initiated and his weakness completely resolves. Which of the following drugs was most likely administered?

A 33-year-old comes to her dermatologist complaining of a rash that recently started appearing on her face. She states that over the past three months, she has noticed that her cheeks have been getting darker, which has been causing her psychological distress. She has attempted using skin lighteners on her cheeks, but recently noticed more dark spots on her forehead. Aside from a first-trimester miscarriage 5 years ago and a 15-year history of migraines, she has no other past medical history. She is currently taking ibuprofen and rizatriptan for her migraines, and is also on oral contraceptives. Her mother has a history of thyroid disease and migraines but was otherwise healthy. On exam, the patient’s temperature is 99.1°F (37.3°C), blood pressure is 130/88 mmHg, pulse is 76/min, and respirations are 12/min. The patient has Fitzpatrick phototype III skin and marked confluent hyperpigmented patches over her cheeks without scarring. Her forehead is also notable for hyperpigmented macules that have not yet become confluent. There are no oral ulcers nor any other visible skin lesion. The patient has a negative pregnancy test, and her ANA is negative. Which of the following is the most likely cause of this patient’s disease?