Answer 45

45.   Choice C is the correct answer.  Surgery is rarely needed.  It usually affects the aortic arch and great vessels.  Usually affects young women

Question 45

45.  Which of the following is not true of Takayasu's Arteritis?

A.  Usually affects the aortic arch and the great vessels
B.  Treated with corticosteroids
C.  Surgery is almost always necessary
D.  Usually affects young women

Answer 44

44.  Choice C is the correct answer.  The anterior leads V3 and V4, and the lateral leads I, avL, V5, and V6 exhibit   ST elevation.  ST elevation is also seen in one of the septal leads lead V2.  There is no ST depression in these leads so there is no ischemia, just infarction.

Question 44

44.  Your patient is a 46 year old with chest pain.  Below is his EKG.  Which of the following is the correct diagnosis?

A.  Posterior Wall MI
B.  Anteriolateral ischemia
C.  Anteriolateral MI
D. Posterior wall ischemia

Answer 43

43.  Choice A is the correct answer.  NSTEMI's are also none as non Q wave MI have a higher mortality rate.  They usually do not have occlusion of the related coronary artery.  The infarction does not go all the way through the wall.  These are medically treated with beta blockers, nitrates, morphine, oxygen, and ASA.  ACE inhibitors are helpful for those with decreased ejection fraction.

Question 43

43.  Which of the following is not true of a non ST elevation MI (NSTEMI)?

A.  They have a lower mortality rate than STEMI's
B.  They have a higher mortality rate than STEMI's
C.  They have elevated Troponin without any ST elevation on the EKG
D.  Medical management includes beta blockers, nitrates, morphine, oxygen, and ASA

Answer 42

42.  Choice C is the correct answer.  Hydralazine is safe in pregnancy and works great in this situation. The patients HR is too low to increase the dose of labetolol which would be ideal.  Delivery is recommended in severe preclampsia but not pregnancy induced hypertension.  In addition, the patient is only 22 weeks and is not viable.  ACE inhibitors should be avoided late in pregnancy due to increasing prostaglandin levels.

Question 42

42.  Your patient is a 23 year old female with pregnancy induced hypertension that is 22 weeks pregnant.  She is on labetolol 200 mg BID.  She is in your office for a routine visit and she feels fine.  Her urine is negative for protein and otherwise normal.  Her CBC and CMP are normal.  Her vitals are as follows:  BP 168/102, HR-49, Temp-98.6, RR-16.  She has no edema.  Which of the following is the best management option.

A.  Increase dose of labetolol
B.  Recommend delivery
C.  Start Hydralazine
D.  Start lisinopril

Answer 41

41.  Choice B is the correct answer.  The dry cough is coming from the elevated bradykinnin associated with ACE inhibitors.  Lowering the dose usually does not take this side effect away and may not give you adequate blood pressure control.  Switching the patient to diovan, the angiotensin receptor blocker, uses a very similar mechanism but does not elevated bradykinnin levels and will likely give you the same blood pressure control.  The patients HR is too low to start metoprolol.  Usually beta blockers are not start on patients with HR less than 60.  Albuterol is not indicated because the patients clinical picture is not consistent with bronchospasm.

Question 41

41.  Your patient is a 45 year old female who is in your office for a check up for her blood pressure.  She has been taking lisinopril for two months 20 mg daily.  Her vitals are as follows BP 110/68, HR 52, RR-16 Temp-97.6.  She states she feels great but reports a nagging dry cough.  Her lungs are clear and she reports no recent illness or fever.  She is not short of breath and she is a non smoker.  Which of the following is the best management options?

A.  Lower the dose of lisinopril to 10 mg daily
B.  Start diovan at the equivalent dose and stop lisinopril
C.  Start the patient on metoprolol
D.  Continue the lisinopril and start the patient on albuterol MDI.  This is from bronchospasm.