Hypertension Kidney Stones Hypercholestrolemia. The prevalence of "true" treatment- resistant...
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Transcript of Hypertension Kidney Stones Hypercholestrolemia. The prevalence of "true" treatment- resistant...
Hypertension Kidney Stones Hypercholestrolemia
The prevalence of "true" treatment-resistant hypertension (HTN) is:
A) Unknown B) Approximately 20% in patients
with HTN C) 10% to 15% in patients without diabetes mellitus (DM) or chronic
kidney disease (CKD) D) Up to 33% in patients with DM
and/or CKD
Answer
• A) Unknown
Which of the following is a cause of pseudoresistance to HTN
treatment? A) Poor adherence with prescribed medications
B) Inaccurate measurement of blood pressure (BP)
C) "White-coat" HTN D) All the above
Answer
• D) All the above
All the following are associated with resistant HTN, except:
A) Older age B) Obesity
C) White ethnicity D) Residence in southeastern
United States
ANswer
• C) White ethnicity
Which of the following has not been shown to interfere
with control of BP? A) Amphetamines B) Coenzyme Q10
C) Alcohol D) Oral contraceptives
Answer
• B) Coenzyme Q10
Studies suggest that cyclooxygenase (COX)-2 selective inhibitors induce
_______ hypertensive responses than COX-2 nonselective
inhibitors. A) Fewer B) Milder
C) Stronger D) A and B
Answer
• D) A and B
Measurements of urinary metanephrine and normetanephrine
are the recommended screening tests for which of the following causes of
secondary HTN? A) Cushing disease
B) Glucocorticoid remediable aldosteronism
C) Renal artery stenosis D) Pheochromocytoma
Answer
• D) Pheochromocytoma
Which of the following is not recommended as a pharmacologic treatment of resistant
HTN? A) Combining agents with different
mechanisms of action B) Using a long-acting thiazide
C) Adding an aldosterone receptor antagonist as a "last resort"
D) Using a loop diuretic in patients with stage 4 CKD
Answer
• C) Adding an aldosterone receptor antagonist as a "last resort“
• Add it earlier
A weight loss of ≈10 kg plus regular exercise can reduce a
patient's BP by: A) 5 to 10 mm Hg B) 5 to 20 mm Hg C) 8 to 15 mm Hg
D) 20 to 30 mm Hg
Answer
• D) 20 to 30 mm Hg
Sedentary patients who initiate exercise therapy for HTN should
begin with: A) 10-min walks twice per week B) 15 min of moderate intensity
activity 5 to 7 days/wk C) 30 min of brisk walking 5
days/wk D) 30 to 45 min of moderate
activity 3 days/wk
Answer
• A) 10-min walks twice per week
Choose the correct statements about the effects of exercise on reduction of BP.Resistance exercise is
more effective than aerobic exerciseAerobic exercise is more effective than resistance
exerciseSeveral short bouts of exercise are more effective
than one longer boutOne longer bout of exercise is more effective than
several short bouts
A) 1,3 B) 2,3 C) 1,4 D) 2,4
Answer
• Aerobic exercise is more effective than resistance exercise
• Several short bouts of exercise are more effective than one longer bout
• B) 2,3
Which of the following can be associated with comorbid
insomnia? A) Depression
B) Gastroesophageal reflux disease
C) Menopausal symptoms D) All the above
Answer
• D) All the above
Periodic limb movement disorder A) Diagnosed by polysomnography; treated
with dopaminergic agents B) Diagnosed by clinical history and physical
examination; begins or worsens with rest C) Occurs during REM sleep; muscle atonia;
more common in older women D) Tends to occur in neurodegenerative
disorders and in older men; no muscle atonia
Answer
• A) Diagnosed by polysomnography; treated with dopaminergic agents
Restless legs syndrome A) Diagnosed by polysomnography; treated with
dopaminergic agents B) Diagnosed by clinical history and physical
examination; begins or worsens with rest C) Occurs during REM sleep; muscle atonia; more
common in older women D) Tends to occur in neurodegenerative disorders
and in older men; no muscle atonia
Answer
• B) Diagnosed by clinical history and physical examination; begins or worsens with rest
Rapid eye movement (REM) sleep behavior disorder
A) Diagnosed by polysomnography; treated with dopaminergic agents
B) Diagnosed by clinical history and physical examination; begins or worsens with rest
C) Occurs during REM sleep; muscle atonia; more common in older women
D) Tends to occur in neurodegenerative disorders and in older men; no muscle atonia
Answer
• D) Tends to occur in neurodegenerative disorders and in older men; no muscle atonia
Choose the correct statement about cognitive behavioral therapy for
insomnia. A) Rarely as effective as medications
B) Often preferred over medications by patients
C) Duration of effects much shorter than that of medications
D) Not recommended for patients with depression
Answer
• B) Often preferred over medications by patients
Which of the following is least associated with heparin-
induced thrombocytopenia? A) Unfractionated heparin B) Low molecular weight
heparin C) Fondaparinux
D) Combination of any of above
Answer
• C) Fondaparinux
Which of the following types of kidney stones is more common in
women than in men? A) Calcium oxalate
B) Struvite C) Uric acid D) Cystine
Answer
• B) Struvite
Which of the following is most sensitive for identifying kidney
stones? A) Plain film radiography
B) Computed tomography (CT) C) Intravenous (IV) pyelography
D) Ultrasonography
Answer
• B) Computed tomography (CT)
Uric acid stones are visible on plain film radiography but not on
CT. A) True B) False
Answer
• B) False
Which of the following was shown to be least effective in the treatment of pain associated with
kidney stones? A) IV fentanyl B) IV ketorolac
C) Intramuscular ketorolac D) Hydromorphone
Answer
• C) Intramuscular ketorolac
Which of the following is recommended for facilitating passage of proximal stones?
A) Tamulosin B) Nifedipine C) Deflazacort D) Diclofenac
Answer
• A) Tamulosin
All the following beverages are associated with reduced stone
formation, except: A) Coffee
B) Tea C) Alcohol
D) Grapefruit juice
Answer
• D) Grapefruit juice
Which of the following was recommended as the treatment of choice for the management of hypertension in patients with end-stage renal disease
(ESRD)? A) Direct renin inhibitors
B) Angiotensin-converting enzyme inhibitors and angiotensin receptor
blockers C) β-blockers
D) Calcium channel blockers
Answer
• B) Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
High hemoglobin levels in patients with ESRD are related to
higher incidence of stroke, myocardial infarction, access
thrombosis, and erythropoietin-secreting tumor.
A) True B) False
Answer
• A) True
Choose the correct statement about phosphate binders in hyperparathyroidism.
A) Calcium acetate associated with severe reflux disease
B) Sevelamer most effective and has lowest pill burden
C) Calcimimetics highly effective and approved for parathyroid hormone suppression
D) Lanthanum carbonate associated with excess cardiovascular death and hyperlipidemia
Answer
• C) Calcimimetics highly effective and approved for parathyroid hormone suppression
Primary care of patients with ESRD should involve:
A) Effective communication between nephrologist and primary care physician B) Understanding of drug dosing, cancer
screening, and pain management C) Coordination of end-of-life care
D) All the above
Answer
• D) All the above
Which of the following is the most common source of infection
in the elderly? A) Skin and soft tissue B) Gastrointestinal tract C) Genitourinary tract
D) Lower respiratory tract
Answer
• C) Genitourinary tract
Which of the following contribute to immunocompromise in the elderly?Decreased T cell
and B cell activityDecreased antibody titers
Poor circulationLoss of natural barriers
Diminished cough reflexProblems in living and home environment
A) 1,3,5 B) 2,4,6
C) 1,2,3,4,5 D) 1,2,3,4,5,6
Answer
• D) 1,2,3,4,5,6
The following statements about fever in the elderly are true,except:
A) The elderly have diminished thermoregulatory capacity
B) Less likely than young individuals to develop hypothermia in response to serious
infections C) Absence of fever should not rule out
consideration of serious infection D) Fever in the elderly should be redefined to
start at lower oral and rectal temperatures
Answer
• B) Less likely than young individuals to develop hypothermia in response to serious infections
Infection should be considered in the elderly in the presence of
delirium and tachypnea. A) True B) False
Answer
• A) True
Which of the following is a risk factor in the development of venous thromboembolism? A) Long-distance air travel
B) Compound heterozygosity for factor V Leiden and prothrombin
mutation C) Elevated factor VIII
D) All the above
Answer
• D) All the above
Which of the following signs can be reliably used to diagnose urinary tract infection in the
elderly? A) Fever
B) Foul-smelling urine C) White blood cell count
D) None of the above
Answer
• D) None of the above
Which of the following is the most common causative
organism for pneumonia in the elderly?
A) Haemophilus influenzae B) Staphylococcus aureus
C) Streptococcus pneumoniae D) Mycoplasma pneumoniae
Answer
• C) Streptococcus pneumoniae
Initial therapy for vancomycin-resistant enterococci (VRE)
before cultures and sensitivities are known includes which of the
following?AmpicillinClindamycinGentamic
inA fluoroquinolone A) 1,3 B) 2,4
C) 1,2,3 D) 4
Answer
• Ampicillin Gentamicin
• A) 1,3
Long-term dialysis within 30 days is a risk factor for which of
the following cases? A) VRE
B) Health care-associated pneumonia
C) Clostridium difficile colitis D) Hospital-acquired pneumonia
Answer
• B) Health care-associated pneumonia
In C difficile colitis, the more severe the presentation, the more
likely diarrhea is present. A) True B) False
Answer
• B) False
Which of the following tests is the gold standard for the
diagnosis of C difficile colitis? A) Enzyme-linked immunoassay
B) Computed tomography C) Cytotoxicity assay
D) Stool culture
Answer
• C) Cytotoxicity assay
Dual antiplatelet therapy with aspirin and clopidogrel is
strongly recommended for stroke prevention in older patients with
atrial fibrillation (AF). A) True B) False
Answer
• B) False
Cholinesterase inhibitors increase the risk for all the following,except:
A) Syncope B) Bradycardia
C) Falls D) Stroke
Answer
• D) Stroke
The Rate Control Efficacy in Permanent Atrial Fibrillation
(RACE II) study found that strict rate control produced slightly better outcomes than lenient control in patients with AF,
including those >80 yr of age. A) True B) False
Answer
• B) False
In the treatment of mixed dyslipidemia, there is currently
no target value for: A) Triglycerides (TGs) or low-density lipoprotein cholesterol
(LDL-C) B) TGs or high-density
lipoprotein cholesterol (HDL-C) C) LDL-C or HDL-C
Answer
• B) TGs or high-density lipoprotein cholesterol (HDL-C)
Compared with patients taking metformin or placebo, patients with impaired fasting
glucose and impaired glucose tolerance who achieved an initial loss of body weight of 7%
to 10% (via diet plus 150 min of moderate exercise 3 days/wk) had _______ of
progression to diabetes mellitus, according to a study by the Diabetes Prevention Program.
A) The same rate B) A slightly faster rate C) A much slower rate
Answer
• C) A much slower rate
Choose the incorrect statement about hypertriglyceridemia and the risk for coronary heart
disease (CHD). A) Increases in TG levels do not correlate closely
with increased risk for CHD B) Increased TG levels correlate with increased risk for CHD, except in cases of very low LDL-C levels
C) Increased TG levels tend to correlate with an increased risk for CHD only at extreme levels of
LDL-C D) Increased TG levels correlate with increased risk
for CHD at all levels of LDL-C
Answer
• D) Increased TG levels correlate with increased risk for CHD at all levels of LDL-C
In patients with hypertriglyceridemia, lipid and lipoprotein metabolism is characterized
by all the following, except: A) Increased secretion of TG
B) Increased conversion of very-low-density lipoprotein (VLDL) to LDL
C) Impaired function of lipoprotein lipase D) Production of small dense LDL and HDL
particles
Answer
• B) Increased conversion of very-low-density lipoprotein (VLDL) to LDL
Studies consistently show that _______ is superior to _______ for assessment of cardiovascular
(CV) risk and as the goal for therapy.
A) Non-HDL-C; LDL-C B) LDL-C; non-HDL-C
Answer
• A) Non-HDL-C; LDL-C
When used with a statin, which of the following agents increases the risk for associated myopathy?
A) Niacin B) High-dose prescription fish
oil C) Fenofibrate D) Gemfibrozil
Answer
• D) Gemfibrozil
It is estimated that approximately _______ million people in the United States currently take a
statin. A) 15.8 B) 29.7 C) 43.6 D) 68.3
Answer
• C) 43.6
Choose the incorrect statement about the clinical aspects of statin myopathy.
A) Toxicity associated with statin use is rare
B) Nonspecific muscle pain and weakness are more common than is frank
rhabdomyolysis C) Myalgias account for ≈25%
D) Muscle symptoms and high serum creatine kinase always resolve quickly
with statin withdrawal
Answer
• D) Muscle symptoms and high serum creatine kinase always resolve quickly with statin withdrawal
Perifascicular atrophy is pathognomonic for which of the
following conditions: A) Toxic myopathy B) Dermatomyositis
C) Becker muscular dystrophy D) Necrotizing myopathy
Answer
• B) Dermatomyositis
Evidence indicates that statin-associated necrotizing myopathy
is _______ to immunosuppression.
A) Responsive B) Not responsive
Answer
• A) Responsive