Autonomic/CV Drugs — MCQs

A 54-year-old woman comes to the emergency department because of sharp chest pain and shortness of breath for 1 day. Her temperature is 37.8°C (100°F), pulse is 110/min, respirations are 30/min, and blood pressure is 86/70 mm Hg. CT angiography of the chest shows a large embolus at the right pulmonary artery. Pharmacotherapy with a tissue plasminogen activator is administered. Six hours later, she develops right-sided weakness and slurred speech. Laboratory studies show elevated prothrombin and partial thromboplastin times and normal bleeding time. A CT scan of the head shows a large, left-sided intracranial hemorrhage. Administration of which of the following is most appropriate to reverse this patient's acquired coagulopathy?

A 6-year-old boy is presented to a pediatric clinic by his mother with complaints of fever, malaise, and cough for the past 2 days. He frequently complains of a sore throat and has difficulty eating solid foods. The mother mentions that, initially, the boy’s fever was low-grade and intermittent but later became high grade and continuous. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The past medical history is noncontributory. The boy takes a multivitamin every day. The mother reports that he does well in school and is helpful around the house. The boy’s vital signs include blood pressure 110/65 mm Hg, heart rate 110/min, respiratory rate 32/min, and temperature 38.3°C (101.0°F). On physical examination, the boy appears uncomfortable and has difficulty breathing. His heart is mildly tachycardic with a regular rhythm and his lungs are clear to auscultation bilaterally. Oropharyngeal examination shows that his palatine tonsils are covered with pus and that there is erythema of the surrounding mucosa. Which of the following mediators is responsible for this patient’s elevated temperature?

A 55-year-old man presents after an episode of severe left ankle pain. The pain has resolved, but he decided to come in for evaluation as he has had pain like this before. He says he has experienced similar episodes of intense pain in the same ankle and his left knee in the past, which he associates with eating copious amounts of fatty food during parties. On one occasion the pain was so excruciating, he went to the emergency room, where an arthrocentesis was performed, revealing needle-shaped negatively birefringent crystals and a high neutrophil count in the synovial fluid. His past medical history is relevant for essential hypertension which is managed with hydrochlorothiazide 20 mg/day. His vital signs are stable, and his body temperature is 36.5°C (97.7°F). Physical examination shows a minimally tender left ankle with full range of motion. Which of the following is the most appropriate long-term treatment in this patient?

A 42-year-old woman comes to her primary care physician because of an irritating sensation in her nose. She noticed recently that there seems to be a lump in her nose. Her past medical history is significant for pain that seems to migrate around her body and is refractory to treatment. She has intermittently been taking a medication for the pain and recently increased the dose of the drug. Which of the following processes was most likely responsible for development of this patient's complaint?

A 35-year-old man who works in a shipyard presents with a sharp pain in his left big toe for the past 5 hours. He says he has had this kind of pain before a few days ago after an evening of heavy drinking with his friends. He says he took acetaminophen and ibuprofen for the pain as before but, unlike the last time, it hasn't helped. The patient denies any recent history of trauma or fever. No significant past medical history and no other current medications. Family history is significant for his mother who has type 2 diabetes mellitus and his father who has hypertension. The patient reports regular drinking and the occasional binge on the weekends but denies any smoking history or recreational drug use. The vital signs include pulse 86/min, respiratory rate 14/min, and blood pressure 130/80 mm Hg. On physical examination, the patient is slightly overweight and in obvious distress. The 1st metatarsophalangeal joint of the left foot is erythematous, severely tender to touch, and swollen. No obvious deformity is seen. The remainder of the examination is unremarkable. Joint arthrocentesis of the 1st left metatarsophalangeal joint reveals sodium urate crystals. Which of the following drugs would be the next best therapeutic step in this patient?

A 60-year-old homeless man presents to the emergency department with an altered mental status. He is not answering questions. His past medical history is unknown. A venous blood gas is drawn demonstrating the following. Venous blood gas pH: 7.2 PaO2: 80 mmHg PaCO2: 80 mmHg HCO3-: 24 mEq/L Which of the following is the most likely etiology of this patient's presentation?

A 38-year-old male is admitted to the hospital after a motor vehicle accident in which he sustained a right diaphyseal femur fracture. His medical history is significant for untreated hypertension. He reports smoking 1 pack of cigarettes per day and drinking 1 liter of bourbon daily. On hospital day 1, he undergoes open reduction internal fixation of his fracture with a femoral intramedullary nail. At what time after the patient's last drink is he at greatest risk for suffering from life-threatening effects of alcohol withdrawal?

A 23-year-old woman is brought to the emergency department by her friend because of strange behavior. Two hours ago, she was at a night club where she got involved in a fight with the bartender. Her friend says that she was smoking a cigarette before she became irritable and combative. She repeatedly asked “Why are you pouring blood in my drink?” before hitting the bartender. She has no history of psychiatric illness. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 19/min, and blood pressure is 158/95 mm Hg. Examination shows muscle rigidity. She has a reduced degree of facial expression. She has no recollection of her confrontation with the bartender. Which of the following is the most likely primary mechanism responsible for this patient's symptoms?

A 16-year-old girl is brought to the physician because of generalized fatigue and an inability to concentrate in school for the past 4 months. During this period, she has had excessive daytime sleepiness. While going to sleep, she sees cartoon characters playing in her room. She wakes up once or twice every night. While awakening, she feels stiff and cannot move for a couple of minutes. She goes to sleep by 9 pm every night and wakes up at 7 am. She takes two to three 15-minute naps during the day and wakes up feeling refreshed. During the past week while listening to a friend tell a joke, she had an episode in which her head tilted and jaw dropped for a few seconds; it resolved spontaneously. Her father has schizoaffective disorder and her parents are divorced. Vital signs are within normal limits. Physical examination is unremarkable. Which of the following is the most appropriate initial pharmacotherapy?

A 24-year-old man is brought to the emergency department because of violent jerky movements of his arms and legs that began 30 minutes ago. His father reports that the patient has a history of epilepsy. He is not responsive. Physical examination shows alternating tonic jerks and clonic episodes. There is blood in the mouth. Administration of intravenous lorazepam is begun. In addition, treatment with a second drug is started that alters the flow of sodium ions across neuronal membranes. The second agent administered was most likely which of the following drugs?