Autonomic/CV Drugs — MCQs

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?

A 45-year-old man presents to the emergency department with complaint of dizziness and nausea for the past hour. He says that he can feel his heartbeat racing. He also reports of generalized weakness that began in the morning. He was diagnosed with end-stage renal disease 2 years ago and currently on dialysis, but he missed his last dialysis session. He has also been diabetic for the past 15 years and managed with insulin, and was also diagnosed with celiac disease 8 years ago. He does not smoke or drink alcohol. The family history is insignificant. The temperature is 36.7°C (98.0°F), blood pressure is 145/90 mm Hg, pulse is 87/min, and respiratory rate is 14/min. On physical examination, the patient looks fatigued and exhausted. The muscle strength in the lower limbs is 4/5 bilaterally. An ECG is ordered which shows peaked and narrow T waves and prolongation of PR interval. The lab test results are as follows: Serum Sodium 132 mEq/L Serum Potassium 8 mEq/L Serum Creatinine 5 mg/dL Blood urea nitrogen (BUN) 25 mg/dL What is the mechanism of action of the most likely initial treatment for the patient's condition?

A 4-day-old boy is monitored in the well baby nursery. He was born to a G1P1 mother at 36 weeks gestation. The child is doing well, and the mother is recovering from vaginal delivery. On physical exam, there is an arousable infant who is crying vigorously and is mildly cyanotic. A red reflex is noted bilaterally on ophthalmologic exam. The infant's fontanelle is soft, and his sucking reflex is present. A positive Babinski sign is noted on physical exam bilaterally. A continuous murmur is auscultated on cardiac exam. Which of the following would most likely have prevented the abnormal finding in this infant?

A 52-year-old woman presents to the emergency room complaining of chest pain. She reports a 4-hour history of dull substernal pain radiating to her jaw. Her history is notable for hypertension, diabetes mellitus, and alcohol abuse. She has a 30 pack-year smoking history and takes lisinopril and metformin but has an allergy to aspirin. Her temperature is 99.1°F (37.3°C), blood pressure is 150/90 mmHg, pulse is 120/min, and respirations are 22/min. Physical examination reveals a diaphoretic and distressed woman. An electrocardiogram reveals ST elevations in leads I, aVL, and V5-6. She is admitted with plans for immediate transport to the catheterization lab for stent placement. What is the mechanism of the next medication that should be given to this patient?

A 55-year-old man comes to the physician because of difficulties achieving an erection for the past year. A medication is prescribed that inhibits cyclic GMP phosphodiesterase type 5. Which of the following is the most likely site of action of the prescribed drug?

A 30-year-old man presents to his psychiatrist for a follow-up visit. He was diagnosed with schizophrenia 6 months ago and has been taking fluphenazine. He says that his symptoms are well controlled by the medication, and he no longer has auditory hallucinations. The psychiatrist also notes that his delusions and other psychotic symptoms have improved significantly. However, the psychiatrist notices something while talking to the patient that prompts him to say, “I know the drug has effectively controlled your symptoms but I think you should discontinue it now otherwise this side effect is likely to be irreversible.” Which of the following did the psychiatrist most likely notice in this patient?