Autonomic/CV Drugs — MCQs

An experimental new drug (SD27C) is being studied. This novel drug delivers insulin via the intranasal route. Consent is obtained from participants who are diabetic and are taking insulin as their current treatment regimen to participate in a clinical trial. 500 patients consent and are divided into 2 groups, and a double-blind clinical trial was conducted. One group received the new formulation (SD27C), while the second group received regular insulin via subcutaneous injection. The results showed that the treatment outcomes in both groups are the same. SD27C is currently under investigation in which phase of the clinical trial?

A 52-year-old woman presents to her primary care provider with shortness of breath. She reports a 3-month history of difficulty breathing with exertion that has progressed to affect her at rest. She swims 45 minutes every day but has had trouble swimming recently due to her breathing difficulties. Her past medical history is notable for well-controlled mild intermittent asthma and generalized anxiety disorder. She has a 15 pack-year smoking history but quit 15 years ago. She does not drink alcohol. Her mother died at the age of 60 from heart failure and was a lifetime non-smoker. Her temperature is 99°F (37.2°C), blood pressure is 135/85 mmHg, pulse is 85/min, and respirations are 22/min. Her BMI is 23 kg/m^2. On exam, she has slightly increased work of breathing. Cardiac auscultation reveals a normal S1 and loud P2. An echocardiogram is performed demonstrating right ventricular hypertrophy. Her pulmonary artery pressure is 24 mmHg at rest and 40 mmHg with exercise. This patient’s condition is associated with a mutation in a gene that does which of the following?

A 58-year-old woman presents to the physician for a routine health maintenance examination. She has a history of dyslipidemia and chronic hypertension. Her medications include atorvastatin, hydrochlorothiazide, and lisinopril. She exercises every day and follows a healthy diet. She does not smoke. There is no family history of chronic disease. Her blood pressure is 130/80 mm Hg, which is confirmed on repeat measurement. Her BMI is 22 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show: Serum Total cholesterol 193 mg/dL Low-density lipoprotein (LDL-C) 124 mg/dL High-density lipoprotein (HDL-C) 40 mg/dL Triglycerides 148 mg/dL The patient's 10-year risk of cardiovascular disease (CVD) is 4.6%. Which of the following is the most appropriate next step in pharmacotherapy?

A 58-year-old man comes to the physician because of severe muscle aches and fatigue for 3 days. Last week he was diagnosed with atypical pneumonia and treated with clarithromycin. He has hyperlipidemia for which he takes lovastatin. Physical examination shows generalized tenderness of the proximal muscles in the upper and lower extremities. Serum studies show an elevated creatine kinase concentration. This patient's current symptoms are most likely caused by inhibition of which of the following hepatic enzymes?

A 66-year-old male with a history of deep venous thrombosis is admitted to the hospital with shortness of breath and pleuritic chest pain. He is treated with an anticoagulant, but he develops significant hematochezia. His BP is now 105/60 and HR is 117; both were within normal limits on admission. The effects of the anticoagulant are virtually completely reversed with the administration of protamine. Which of the following was the anticoagulant most likely administered to this patient?

A 21-year-old man with a recent history of traumatic right femur fracture status post open reduction and internal fixation presents for follow-up. The patient says his pain is controlled with the oxycodone but he says he has been severely constipated the past 4 days. No other past medical history. Current medications are oxycodone and ibuprofen. The patient is afebrile and vital signs are within normal limits. On physical examination, surgical incision is healing well. Which of the following is correct regarding the likely role of opiates in this patient’s constipation?

A 58-year-old male presents to his primary care doctor with the complaint of vision changes over the last several months. The patient's past medical history is notable for schizophrenia which has been well-controlled for the last 25 years on chlorpromazine. Which of the following is likely to be seen on ophthalmoscopy?

A 60-year-old Hispanic man presents to the office for a regular health checkup. He has been waiting for his hip replacement surgery for osteoarthritis, which he was diagnosed with for the past 5 years. He admits to having taken high doses of painkillers for hip pain management, but now they don't provide any pain relief. His vital signs include: blood pressure 110/70 mm Hg, pulse 78/min, temperature 36.7°C (98.1°F), and respiratory rate 10/min. On physical examination, there is a limited range of motion of his right hip. The laboratory results are as follows: Hemoglobin 12 g/dL Red blood cell 5.1 million cells/µL Hematocrit 45% Total leukocyte count 6,500 cells/µL Neutrophils 71% Lymphocytes 14% Monocytes 4% Eosinophils 11% Basophils 0% Platelets 240,000 cells/µL Urinalysis shows: pH 6.2 Color light yellow RBC 7–8/HPF WBC 10-12/HPF Protein 1+ Cast none Glucose absent Crystal none Ketone absent Nitrite negative 24-hr urine protein excretion 0.9 g Urine for culture: No growth noted after 48 hours of inoculation at 37.0°C (98.6°F) What is the most likely diagnosis?

A 48-year-old woman presents to her primary care physician for a wellness visit. She states she is generally healthy and currently has no complaints. She drinks 1 alcoholic beverage daily and is currently sexually active. Her last menstrual period was 1 week ago and it is regular. She smokes 1 pack of cigarettes per day and would like to quit. She describes her mood as being a bit down in the winter months but otherwise feels well. Her family history is notable for diabetes in all of her uncles and colon cancer in her mother and father at age 72 and 81, respectively. She has been trying to lose weight and requests help with this as well. Her diet consists of mostly packaged foods. Her temperature is 98.0°F (36.7°C), blood pressure is 122/82 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Her BMI is 23 kg/m^2. Physical exam reveals a healthy woman with no abnormal findings. Which of the following is the most appropriate initial intervention for this patient?

A 33-year-old woman with Crohn’s disease colitis presents to her physician after 2 days of photophobia and blurred vision. She has had no similar episodes in the past. She has no abdominal pain or diarrhea and takes mesalazine, azathioprine, and prednisone as maintenance therapy. Her vital signs are within normal range. Examination of the eyes shows conjunctival injection. The physical examination is otherwise normal. Slit-lamp examination by an ophthalmologist shows evidence of inflammation in the anterior chamber. Which of the following is the most appropriate modification to this patient’s medication at this time?