Autonomic/CV Drugs — MCQs

A 65-year-old man with hypertension and paroxysmal atrial fibrillation presents to his cardiologist for follow-up after recently starting metoprolol for rate control. His EKG shows an atrial rate of 260/min with ventricular rate of 50/min on an irregular baseline. An echocardiogram from his previous visit revealed no evidence of hypokinesis or hypertrophy with functionally intact valves. The patient does not drink alcohol and had no evidence of liver dysfunction in prior studies. What is the best medication for rhythm control in this patient?

A 35-year-old woman comes to the physician for the evaluation of fatigue over the past 6 months. During this period, she has also had fever, joint pain, and a recurrent skin rash on her face. She has smoked one pack of cigarettes daily for the past 15 years. Her temperature is 38.5°C (101.3°F), pulse is 90/min, and blood pressure is 130/80 mm Hg. Physical examination shows a facial rash that spares the nasolabial folds and several oral ulcers. Joints of the upper and lower extremities are tender with no reddening or swelling. Laboratory studies show anti-dsDNA antibodies. The patient is diagnosed with systemic lupus erythematosus and treatment of choice is initiated. Eight months later, the patient has weakness in her shoulders and hips. Examination shows slight weakness of the proximal muscles. Deep tendon reflexes are 2+ bilaterally. Laboratory studies show normal erythrocyte sedimentation rate and creatine kinase. Which of the following is the most likely underlying cause of this patient's symptoms?

A 71-year-old male is brought to the emergency room by his caretaker and presents with difficulty breathing, muscle rigidity in the face, neck, back and upper extremities, and profuse sweating. The intern notes a large wound on his head near the back of his right ear which his caretaker had bandaged up. The caretaker explains that the wound was the result of a fall while walking in his backyard. The intern performs a quick physical exam and observes increased reflexes. The patient was intubated to assist in his breathing and was given diazepam, metronidazole, and an immunoglobulin after the blood work came back. Which of the following neurotransmitters is affected in this patient?

A 44-year-old female is admitted to the neurological service. You examine her chart and note that after admission she was started on nimodipine. Which of the following pathologies would benefit from this pharmacologic therapy?

A 23-year-old active college student has a sudden loss of consciousness 40 minutes after he was playing basketball with his team. Cardiopulmonary resuscitation is administered by bystanders. On arrival of emergency medical professionals, he regains his consciousness. He has no past medical history. He does not smoke or drink alcohol. His family history is positive for a cousin who died suddenly in his youth. On physical examination, a systolic ejection murmur is audible on the left lower sternal border. ECG shows left ventricular hypertrophy and echocardiography shows asymmetric septal hypertrophy. Which of the following decreases the pressure gradient between the aorta and the left ventricle in this patient?

A 42-year-old man is brought to the emergency department by the police after he was involved in a physical altercation at a friend’s home. Upon physical examination, the patient is disheveled. He is very agitated and actively strikes out at nurses and other hospital staff. A decision is made to place him in restraints. Head, eyes, ears, nose, and throat exam reveals temporal wasting, marked tooth decay, and healing and new ulcers in his mouth and on his lips. His pupils are dilated and minimally reactive to light. His skin shows dramatic diaphoresis as well as excoriations over his arms. Vital signs show pulse of 120/min, respirations of 12/min, temperature of 39.0°C (102.2°F), and blood pressure of 150/100 mm Hg. Urine drug screen is positive for an amphetamine. Which of the following is a life-threatening complication of the toxicity seen in this patient?

A 35-year-old patient is brought into the emergency department post motor vehicle crash. Stabilization of the patient in the trauma bay requires endotracheal intubation. The patient has a laceration on the femoral artery from shrapnel and seems to have lost large quantities of blood. The patient is transfused with 13 units of packed red blood cells. His vitals are T 96.5, HR 150, BP 90/40. Even with the direct pressure on the femoral artery, the patient continues to bleed. Results of labs drawn within the last hour are pending. Which of the following is most likely to stop the bleeding in this patient?

A 42-year-old woman comes to the physician because of urinary leakage over the last year. She reports involuntarily losing small amounts of urine after experiencing a sudden need to void. She has difficulty making it to the bathroom in time, and only feels comfortable going out into public if she has documented the location of all nearby restrooms. She also has begun to wake up at night to urinate. These symptoms have persisted despite 6 months of bladder training and weight loss and reducing soda and coffee intake. Physical examination shows no abnormalities. The most appropriate pharmacotherapy for this patient is a drug that has which of the following mechanisms of action?

A 4-year-old boy is brought by his mother to the emergency room after the child was bitten by a rattlesnake one hour prior to presentation. The child was reportedly playing in the backyard alone when his mother heard the child scream. She rushed out to her child and found a snake with a rattle on its tail slithering away from the child. On examination, the child has a bleeding bite mark and significant swelling over the dorsal aspect of his right hand. He is in visible distress and appears pale and diaphoretic. The child undergoes fluid resuscitation and is placed on supplemental oxygen. He is administered rattlesnake antivenom and is admitted for observation. He is subsequently discharged 24 hours later feeling better. However, 6 days after admission, he presents again to the emergency department with a temperature of 102°F (38.9°C), diffuse wheals, and knee and hip pain. This patient’s condition is caused by which of the following?

A 10-year-old boy is brought to the emergency room after a fall from a horse. He has severe pain in his right forearm. He has a history of asthma and atopic dermatitis. His current medications include an albuterol inhaler and hydrocortisone cream. Examination shows an open fracture of the right forearm and no other injuries. The patient is given a parenteral infusion of 1 L normal saline, cefazolin, morphine, and ondansetron. The right forearm is covered with a splint. Informed consent for surgery is obtained. Fifteen minutes later, the patient complains of shortness of breath. He has audible wheezing. His temperature is 37.0°C (98.6°F), heart rate is 130/min, respiratory rate is 33/min, and blood pressure is 80/54 mm Hg. Examination shows generalized urticaria and lip swelling. There is no conjunctival edema. Scattered wheezing is heard throughout both lung fields. Which of the following is the most appropriate next step in management?