Autonomic/CV Drugs — MCQs

A 4-year-old boy presents to the ED with a one day history of severe right eye pain accompanied by nausea, vomiting, and headache. He is afebrile and he appears to be alert despite being irritable. Three days ago an ophthalmologist prescribed eye drops for his right eye but his parents do not know the name of the medication. On exam, his right eye is hard to palpation and moderately dilated. His left eye is unremarkable. What is the mechanism of action of the medication that most likely provoked this acute presentation?

A 30-year-old man presents with heartburn for the past couple of weeks. He says he feels a burning sensation in his chest, at times reaching his throat, usually worse after eating spicy foods. He is overweight and actively trying to lose weight. He also has tried other lifestyle modifications for the past couple of months, but symptoms have not improved. He denies any history of cough, difficulty swallowing, hematemesis, or melena. The patient says he often drinks a can of beer in the evening after work and does not smoke. His blood pressure is 124/82 mm Hg, pulse is 72/min and regular, and respiratory rate is 14/min. Abdominal tenderness is absent. Which of the following is the next best step in the management of this patient?

A 65-year-old veteran with a history of hypertension, diabetes, and end-stage renal disease presents with nausea, vomiting, and abdominal pain. The patient was found to have a small bowel obstruction on CT imaging. He is managed conservatively with a nasogastric tube placed for decompression. After several days in the hospital, the patient’s symptoms are gradually improving. Today, he complains of left leg swelling. On physical exam, the patient has a swollen left lower extremity with calf tenderness on forced dorsiflexion of the ankle. An ultrasound confirms a deep vein thrombus. An unfractionated heparin drip is started. What should be monitored to adjust heparin dosing?

A 28-year-old woman presents to a physician with complaints of fever, cough, and cold for the last 2 days. She does not have any other symptoms and she has no significant medical history. She has recently started using combined oral contraceptive pills (OCPs) for birth control. On physical examination, the temperature is 38.3°C (101.0°F), the pulse is 98/min, the blood pressure is 122/80 mm Hg, and the respiratory rate is 14/min. The nasal mucosa and pharynx are inflamed, but there is no purulent discharge. Auscultation of the chest does not reveal any abnormalities. She mentions that she has been a heavy smoker for the last 5 years, smoking about 15–20 cigarettes per day. The physician suggests she should discontinue using combined OCPs and choose an alternative contraception method. Which of the following best explains the rationale behind the physician's suggestion?

A 26-year-old man undergoing surgical correction of his deviated septum experiences excessive bleeding on the operating room table. Preoperative prothrombin time and platelet count were normal. The patient’s past medical history is significant for frequent blue blemishes on his skin along with easy bruising since he was a child. He indicated that he has some sort of genetic blood disorder running in his family but could not recall any details. Which of the following is the most appropriate treatment for this patient’s most likely condition?

A 75-year-old woman is being treated for atrial fibrillation. She presents to the clinic with complaints of nausea, vomiting, photophobia, and yellow-green vision with yellow halos around the lights. She has a heart rate of 64/min, blood pressure is 118/76 mm Hg, and respiratory rate is 15/min. Physical examination reveals regular heart sounds with clear lung sounds bilaterally. Liver function tests are normal. Toxicity of which of the following anti-arrhythmic drugs would best fit this clinical picture?

A 20-year-old woman presents to the emergency department after developing a widespread rash when she was playing in the park. She states she feels somewhat light-headed. She is otherwise healthy and has no significant past medical history. Her temperature is 97.0°F (36.1°C), blood pressure is 84/54 mmHg, pulse is 130/min, respirations are 22/min, and oxygen saturation is 95% on room air. Physical exam is notable for bilateral wheezing and a diffuse urticarial rash. Which of the following is the next best step in management?

A 47-year-old woman presents to the emergency department in a frantic state and demands immediate treatment for an allergic reaction, which started soon after she had lunch (approximately 1 hour ago). She had her usual meal consisting of homemade salad and lemonade. She was recently started on niacin because she could not tolerate statins. The only other medication she takes is captopril for hypertension. She has no respiratory difficulty and denies rhinorrhea, epiphora, and diarrhea. She is complaining of a stinging sensation on her face. She has no history of allergies and no family history of allergies. The vital signs include: pulse 90/min, respirations 16/min, blood pressure 120/80 mm Hg, and oxygen saturation, 98% on room air. On physical examination, the face and trunk have a flushed appearance. The rest of the physical examination is unremarkable. The attending physician reassures her that she is not in any immediate danger, and in fact, her symptoms subsided over the next hour. She is advised to take aspirin 30 minutes before her other medications and sent home. Which of the following is the etiology of her symptoms?

A 64-year-old woman presents to the emergency department with a 1-hour history of shortness of breath and chest pain. She said that the symptoms came on suddenly and that the chest pain is worse when she tries to take a deep breath. Her past medical history is significant for a previous deep venous thrombosis for which she was taking a blood thinner. She also has diabetes, hypertension, hyperlipidemia, and partial seizures which are treated with metformin, lisinopril, atorvastatin, and carbamazepine and valproic acid, respectively. Which of these drugs is most likely responsible for causing this patient's blood thinner medications to fail?

A 72-year-old man with a 4-year history of Parkinson disease comes to the physician for evaluation of his medication. Since his last visit one year ago, he has had increased tremor and bradykinesia up to an hour before his next scheduled dose and sometimes feels like he does not respond to some doses at all. One week ago, he was entirely unable to move for about a minute when he wanted to exit an elevator. The physician prescribes a drug that increases the bioavailability of levodopa by preferentially preventing its peripheral methylation. This patient was most likely prescribed which of the following drugs by the physician?