Autonomic/CV Drugs — MCQs

A 56-year-old man is brought to the clinic by his wife for complaints of progressive weakness for the past 3 months. He reports difficulty eating, especially when chewing foods like steak. The wife complains that he has been “out of it lately and has been forgetting my birthday." His past medical history is significant for celiac disease, for which he eats a gluten-free diet. He reports that he stepped on a nail last week, but the nail did not seem rusty so he just washed his feet afterward. His wife reports that he has been up to date on his tetanus vaccinations. Physical examination demonstrates weakness and fasciculations of the left upper extremity along with spastic clonus of the left ankle. The patient denies gait disturbances, vision or hearing changes, headaches, nausea/vomiting, gastrointestinal disturbances, or incontinence. What is best next step in terms of management for this patient?

A researcher is studying the circulating factors that are released when immune cells are exposed to antigens. Specifically, she is studying a population of CD2+ cells that have been activated acutely. In order to determine which factors are secreted by these cells, she cultures the cells in media and collects the used media from these plates after several days. She then purifies a small factor from this media and uses it to stimulate various immune cell types. She finds that this factor primarily seems to increase the growth and prolong the survival of other CD2+ cells. Which of the following is most likely the factor that was purified by this researcher?

A 20-year-old man comes to the physician because of recurrent episodes of shortness of breath and a nonproductive cough for the past 4 months. He has two episodes per week, which resolve spontaneously with rest. Twice a month, he wakes up at night with shortness of breath. His pulse is 73/min, respirations are 13/min, and blood pressure is 122/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. Spirometry shows an FVC of 95%, an FEV1:FVC ratio of 0.85, and an FEV1 of 81% of predicted. Which of the following is the most appropriate initial pharmacotherapy?

A 68-year-old woman comes to the physician for a follow-up examination. Three months ago, she underwent heart transplantation for restrictive cardiomyopathy and was started on transplant rejection prophylaxis. Her pulse is 76/min and blood pressure is 148/82 mm Hg. Physical examination shows enlargement of the gum tissue. There is a well-healed scar on her chest. Serum studies show hyperlipidemia. The physician recommends removing a drug that decreases T cell activation by inhibiting the transcription of interleukin-2 from the patient's treatment regimen and replacing it with a different medication. Which of the following drugs is the most likely cause of the adverse effects seen in this patient?

A 63-year-old African American man presents to the physician for a follow-up examination. He has a history of chronic hypertension and type 2 diabetes mellitus. He has no history of coronary artery disease. His medications include aspirin, hydrochlorothiazide, losartan, and metformin. He exercises every day and follows a healthy diet. He does not smoke. He consumes alcohol moderately. There is no history of chronic disease in the family. His blood pressure is 125/75 mm Hg, which is confirmed on a repeat measurement. His BMI is 23 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show: Serum HbA1C 6.9% Total cholesterol 176 mg/dL Low-density lipoprotein (LDL-C) 105 mg/dL High-density lipoprotein (HDL-C) 35 mg/dL Triglycerides 175 mg/dL The patient's 10-year risk of cardiovascular disease (CVD) is 18.7%. Lifestyle modifications including diet and exercise have been instituted. Which of the following is the most appropriate next step in pharmacotherapy?

A 60-year-old man comes to the physician for the evaluation of nausea over the past week. During this period, he has also had several episodes of non-bloody vomiting. Last month, he was diagnosed with stage II Hodgkin lymphoma and was started on adriamycin, bleomycin, vinblastine, and dacarbazine. His temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 105/70 mm Hg. Physical examination shows cervical lymphadenopathy. The liver is palpated 1 to 2 cm below the right costal margin, and the spleen is palpated 2 to 3 cm below the left costal margin. The remainder of the examination shows no abnormalities. The patient is started on an appropriate medication. Two weeks later, he develops headaches and states that his last bowel movement was 4 days ago. The patient was most likely treated with which of the following medications?

An 18-year-old woman presents to the emergency department with a complaint of severe abdominal pain for the past 6 hours. She is anorexic and nauseous and has vomited twice since last night. She also states that her pain initially began in the epigastric region, then migrated to the right iliac fossa. Her vital signs include a respiratory rate of 14/min, blood pressure of 130/90 mm Hg, pulse of 110/min, and temperature of 38.5°C (101.3°F). On abdominal examination, there is superficial tenderness in her right iliac fossa, rebound tenderness, rigidity, and abdominal guarding. A complete blood count shows neutrophilic leukocytosis and a shift to the left. Laparoscopic surgery is performed and the inflamed appendix, which is partly covered by a yellow exudate, is excised. Microscopic examination of the appendix demonstrates a neutrophil infiltrate of the mucosal and muscular layers with extension into the lumen. Which of the following chemical mediators is responsible for pain in this patient?

A 72-year-old man presents to the emergency department with a 1 hour history of bruising and bleeding. He says that he fell and scraped his knee on the ground. Since then, he has been unable to stop the bleeding and has developed extensive bruising around the area. He has a history of gastroesophageal reflux disease, hypertension, and atrial fibrillation for which he is taking an oral medication. He says that he recently started taking omeprazole for reflux. Which of the following processes is most likely inhibited in this patient?

A 55-year-old man comes to the physician because of a 2-month history of gradually worsening pain and burning in his feet that is impairing his ability to sleep. He also has a non-healing, painless ulcer on the bottom of his right toe, which has been progressively increasing in size despite the application of bandages and antiseptic creams at home. He has a 7-year history of type II diabetes mellitus treated with oral metformin. He also has narrow-angle glaucoma treated with timolol eye drops and chronic back pain due to a motorcycle accident a few years ago, which is treated with tramadol. Vital signs are within normal limits. Physical examination shows a 3-cm, painless ulcer on the plantar surface of the right toe. The ulcer base is dry, with no associated erythema, edema, or purulent discharge. Neurological examination shows loss of touch, pinprick sensation, proprioception, and vibration sense of bilateral hands and feet. These sensations are preserved in the proximal portions of the limbs. Muscle strength is normal. Bilateral ankle reflexes are absent. A diabetic screening panel is done and shows a fasting blood sugar of 206 mg/dL. An ECG shows a left bundle branch block. Which of the following is the most appropriate next step in the management of this patient's pain?

A 28-year-old woman presents with increased facial hair growth. She says she noticed a marked growth and darkening of hair on her face and feels embarrassed. Past medical history is significant for asthma, well-controlled by medication, and epilepsy diagnosed 6 months ago, managed with phenytoin. Her other medications are albuterol, beclomethasone, a daily multivitamin, and a garlic supplement. The patient denies any smoking history, alcohol or recreational drug use. Family history is significant for asthma in her father. Review of systems is positive for occasional diplopia. Her pulse is 75/min, respiratory rate is 15 /min, and blood pressure is 110/76 mm Hg. Her body mass index (BMI) is 24 kg/m2. On physical examination, she appears healthy in no apparent distress. There are excessive facial hair growth and enlarged gums. The remainder of the examination is unremarkable. Which of the following medications is most likely responsible for this patient's symptoms?