Autonomic/CV Drugs — MCQs

A 32-year-old man comes to the physician because of a 2-week history of diarrhea. During this period, he has had about 10 bowel movements per day. He states that his stools are light brown and watery, with no blood or mucus. He also reports mild abdominal pain and nausea. Over the past year, he has had 6 episodes of diarrhea that lasted several days and resolved spontaneously. Over this time, he also noticed frequent episodes of reddening in his face and neck. He returned from a 10-day trip to Nigeria 3 weeks ago. There is no personal or family history of serious illness. He has smoked a pack of cigarettes daily for the past 13 years. His temperature is 37°C (98.6°F), pulse is 110/min, and blood pressure is 100/60 mm Hg. Physical examination shows dry mucous membranes. The abdomen is tender with no rebound or guarding. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 136 mEq/L Cl- 102 mEq/L K+ 2.3 mEq/L HCO3- 22 mEq/L Mg2+ 1.7 mEq/L Ca2+ 12.3 mg/dL Glucose (fasting) 169 mg/dL Nasogastric tube aspiration reveals significantly decreased gastric acid production. Which of the following is the most likely underlying cause of this patient's symptoms?

A 25-year-old man is rushed to the emergency department following a motor vehicle accident. After an initial evaluation, he is found to have bilateral femoral fractures. After surgical fixation of his fractures, he suddenly starts to feel nauseated and becomes agitated. Past medical history is significant for a thyroid disorder. His temperature is 40.0°C (104°F), blood pressure is 165/100 mm Hg, pulse is 170/min and irregularly irregular, and respirations are 20/min. On physical examination, the patient is confused and delirious. Oriented x 0. Laboratory studies are significant for the following: Thyroxine (T4), free 5 ng/dL Thyroid stimulating hormone (TSH) 0.001 mU/L The patient is started on propranolol to control his current symptoms. Which of the following best describes the mechanism of action of this new medication?

A 31-year-old man presents with a headache, myalgias, nausea, irritability, and forgetfulness. He developed these symptoms gradually over the past 3 months. He is a motor mechanic, and he changed his place of work 4 months ago. He smokes a half a pack of cigarettes per day. His vaccinations are up to date. On presentation, his vital signs are as follows: blood pressure is 145/70 mm Hg, heart rate is 94/min, respiratory rate is 17/min, and temperature is 36.8℃ (98.2℉). Physical examination reveals diffuse erythema of the face and chest and slight abdominal distention. Neurological examination shows symmetrical brisk upper and lower extremities reflexes. Blood tests show the following results: pH 7.31 Po2 301 mm Hg Pco2 28 mm Hg Na+ 141 mEq/L K+ 4.3 mEq/L Cl- 109 mEq/L HCO3- 17 mEq/L Base Excess -3 mEq/L Carboxyhemoglobin 38% Methemoglobin 1% Serum cyanide 0.35 mcg/mL (Reference range 0.5–1 mcg/mL) Which of the following statements about the patient’s condition is true?

A 79-year-old man presents to a physician’s office for a routine appointment. He had a myocardial infarction 3 years ago and was started on aspirin, carvedilol, captopril, and high-dose atorvastatin. He denies shortness of breath or cough. He exercises regularly and is on a healthy diet that is good for his heart. The vital signs include: pulse 80/min, respirations 16/min and blood pressure 122/80 mm Hg. The physical examination reveals an overweight male with a body mass index (BMI) of 28 kg/m2. The fasting lipid profile is as follows: Total cholesterol 200 mg/dL High-density lipoprotein (HDL) 35 mg/dL Low-density lipoprotein (LDL) 140 mg/dL Triglycerides 120 mg/dL Which of the following drugs should be added to his regimen?

A 21-year-old primigravid woman comes to the physician at 10 weeks' gestation because of progressive fatigue for the past 3 weeks. She reports that she has had a 3.2-kg (7-lb) weight loss after conceiving despite an increase in appetite. She has become increasingly anxious and has trouble falling asleep. There is no personal or family history of serious illness. Medications include folic acid and a multivitamin. She is 165 cm (5 ft 5 in) tall and weighs 55 kg (120 lb); BMI is 20 kg/m2. Her temperature is 37.4°C (99.4°F), pulse is 120/min, respirations are 18/min, and blood pressure is 150/70 mm Hg. The globes of the eyes are prominent. The thyroid gland is firm and diffusely enlarged. Neurologic examination shows a fine resting tremor of the hands. There is a midsystolic click at the apex and a grade 2/6 early systolic murmur at the upper left sternal border. Serum thyroid-stimulating hormone concentration is 0.1 μU/mL. An ECG is normal except for sinus tachycardia. Which of the following is the most appropriate next step in management?

A 55-year-old woman with type 2 diabetes mellitus presents to her physician with intermittent nausea for the past 2 months. Her symptoms are exacerbated within one hour after eating. She has no other history of a serious illness. She takes metformin and injects insulin. Her vitals are normal. Abdominal examination is normal. An ECG shows normal sinus rhythm with no evidence of ischemia. Hemoglobin A1c is 7%. A gastric emptying scan shows 60% of her meal in the stomach 75 minutes after eating. Which of the following is the most appropriate pharmacotherapy at this time?

A 50-year-old man comes to the emergency department because of a severely painful right eye. The pain started an hour ago and is accompanied by frontal headache and nausea. The patient has vomited twice since the onset of the pain. He has type 2 diabetes mellitus. He immigrated to the US from China 10 years ago. He works as an engineer at a local company and has been under a great deal of stress lately. His only medication is metformin. Vital signs are within normal limits. The right eye is red and is hard on palpation. The right pupil is mid-dilated and nonreactive to light. The left pupil is round and reactive to light and accommodation. Which of the following agents is contraindicated in this patient?

A 25-year-old man is brought to the emergency department after his girlfriend discovered him at home in a minimally responsive state. He has a history of drinking alcohol excessively and using illicit drugs. On arrival, he does not respond to commands but withdraws all extremities to pain. His pulse is 90/min, respirations are 8/min, and blood pressure is 130/90 mm Hg. Pulse oximetry while receiving bag-valve-mask ventilation shows an oxygen saturation of 95%. Examination shows cool, dry skin, with scattered track marks on his arms and legs. The pupils are pinpoint and react sluggishly to light. His serum blood glucose level is 80 mg/dL. The most appropriate next step in management is intravenous administration of which of the following?

A 23-year-old male presents to the emergency room following a gunshot wound to the leg. On arrival his temperature is 99°F (37.2°C), blood pressure is 90/60 mmHg, pulse is 112/min, respirations are 21/min, and pulse oximetry is 99% on room air. Two large bore IVs are placed and he receives crystalloid fluid replacement followed by 2 units of crossmatched packed red blood cells. Immediately following transfusion, his temperature is 102.2°F (39°C), blood pressure is 93/64 mmHg, pulse is 112/min, respirations are 21/min, and pulse oximetry is 99% on room air. There is oozing from his IV sites. You check the records and realize there was a clerical error with the blood bank. What is the mechanism for his current condition?

A 61-year-old man presents to the emergency department for the evaluation of polyuria, polydipsia, and confusion. He has a history of the psychiatric disease but is unable to provide additional details. He is admitted to the hospital and his home medications are continued. Routine testing is unrevealing for the etiology of his symptoms. Desmopressin acetate (DDAVP) is given, but no effect is seen on urine output or urine osmolarity. Which of the following medications could have induced this syndrome?