Autonomic/CV Drugs — MCQs

A 64-year-old woman otherwise healthy presents with acute onset severe rectal bleeding. The patient says that 2 hours ago bleeding began suddenly after a difficult bowel movement. She says the blood is bright red, and, initially, bleeding was brisk but now has stopped. The patient denies having any similar symptoms in the past. She has noticed that she bled more easily while having her regular manicure/pedicure for the past 3 months but thought it was nothing serious. No significant past medical history and the patient does not take any current medications. Family history is unremarkable. Review of systems is positive for mild dyspnea on exertion the past 2-3 months. Her vital signs include: temperature 37.0°C (98.6°F), blood pressure 100/65 mm Hg, pulse 95/min, respiratory rate 15/min, and oxygen saturation 97% on room air. A cardiac examination is significant for a 2/6 systolic murmur loudest at the right upper sternal border. Rectal exam shows no evidence of external hemorrhoids, fissures, or lesions. No active bleeding is noted. The stool is guaiac positive. Deficiency of which of the following is most likely the cause of this patient’s condition?

A 21-year-old man undergoes orthopedic surgery for a leg fracture that he has sustained in a motorbike accident. After induction of anesthesia with desflurane, the patient's respiratory minute ventilation decreases notably. Which of the following additional effects is most likely to occur in response to this drug?

A 64-year-old woman with osteoarthritis is brought to the emergency room because of a 2-day history of nausea and vomiting. Over the past few weeks, she has been taking acetaminophen frequently for worsening knee pain. Examination shows scleral icterus and tender hepatomegaly. She appears confused. Serum alanine aminotransferase (ALT) level is 845 U/L, aspartate aminotransferase (AST) is 798 U/L, and alkaline phosphatase is 152 U/L. Which of the following is the most likely underlying mechanism of this patient's liver failure?

A 14-year-old girl with a history of severe persistent asthma presents to her pediatrician after a recent hospital discharge for asthma exacerbation. Her mother is concerned that her daughter continues to wheeze and cough multiple nights per week. She is also concerned that her daughter frequently uses the bathroom to urinate despite no recent change in her diet. She has allergies to pollen and shellfish, but her mother denies any recent exposure. The patient's medications include albuterol, salmeterol, and both inhaled and oral prednisone. What alternative drug can the pediatrician recommend for this patient?

A 19-year-old woman comes to the physician because of episodic, bilateral finger pain and discoloration that occurs with cold weather. Her fingers first turn white, then blue, before eventually returning to a normal skin color. The symptoms have been occurring daily and limit her ability to work. She has no history of serious illness and takes no medication. She does not smoke. Physical examination shows normal capillary refill of the nail beds. The radial pulse is palpable bilaterally. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy for this patient?

A 5-year-old African-American boy is brought to the physician because of fatigue and night sweats for the past month. During this time, he has also lost 3 kg (6.6 lbs). Before the onset of symptoms, he had been healthy except for a febrile seizure as an infant. His brother had chickenpox 2 months ago. He is at the 75th percentile for height and 50th percentile for weight. He appears markedly fatigued. His temperature is 38°C (100.4°F), pulse is 95/min, respirations are 19/min, and blood pressure is 100/60 mm Hg. Lung and cardiac examination is normal. There are enlarged, nontender lymph nodes bilaterally in the neck. The abdomen is soft and nontender. A complete blood count shows: Leukocyte count 8,000/mm³ Hemoglobin 9.1 g/dL Hematocrit 26.9% Platelet count 34,000/mm³ Serum Na+ 135 mEq/L K+ 4.5 mEq/L Cl- 101 mEq/L HCO3- 27 mEq/L Urea nitrogen 9 mg/dL Creatinine 0.7 mg/dL Ca2+ 8.8 mg/dL PCR testing demonstrates a 9:22 chromosomal translocation. The patient is diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia. Which of the following is the most appropriate targeted therapy component?

A 65-year-old man with decompensated cirrhosis secondary to hepatitis C is brought to the emergency department with 2 episodes of massive hematemesis that started 2 hours ago. He is a liver transplant candidate. The blood pressure is 110/85 mm Hg in the supine position and 90/70 mm Hg after sitting for 3 minutes. The pulse is 110/min, the respirations are 22/min, and the temperature is 36.1°C (97.0°F). The physical examination shows spider angiomata, palmar erythema, and symmetric abdominal distension with positive shifting dullness. The lung and heart examination shows no abnormalities. Two large-bore intravenous lines are obtained. Saline (0.9%) is initiated. Laboratory tests are pending. The most important next step is to administer which of the following intravenous therapies?

Two-hours into recovery from general anesthesia for an orthopedic fracture, a 34-year-old woman develops fever and masseter muscle rigidity with lockjaw. She has no history of a similar episode. She has no history of serious illness and takes no medications. She appears confused. In the recovery room, her blood pressure is 78/50 mm Hg, the pulse is 128/min, the respirations are 42/min, and the temperature is 40.3°C (104.5°F). Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Serum Na+ 145 mEq/L K+ 6.5 mEq/L Arterial blood gas on room air pH 7.01 PCO2 78 mm Hg HCO3− 14 mEq/L PO2 55 mm Hg The patient is reintubated. Which of the following is the most appropriate next step in pharmacotherapy?

A 45-year-old-man presents to the physician with complaints of intermittent episodes of severe headaches and palpitations. During these episodes, he notices that he sweats profusely and becomes pale in complexion. He describes the episodes as coming and going within the past 2 months. His temperature is 99.3°F (37.4°C), blood pressure is 165/118 mmHg, pulse is 126/min, respirations are 18/min, and oxygen saturation is 90% on room air. Which of the following would be the first medication given to treat this patient’s most likely diagnosis?

A 63-year-old man with a history of hypertension and atrial fibrillation is brought into the emergency room and found to have a ventricular tachyarrhythmia. Ibutilide is discontinued and the patient is switched to another drug that also prolongs the QT interval but is associated with a decreased risk of torsades de pointes. Which drug was most likely administered in this patient?