Multiple Choice Questions (MCQ)

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Category: Medicine--->General Medicine and Prevention
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Question 1# Print Question

A 53-year-old woman presents to the emergency room with a minor injury and is found to have a blood pressure of 150/102, possibly elevated as a result of pain. On follow-up at your office, her BP on two occasions is 142/94 despite good dietary habits and reasonable exercise. Her history and physical are otherwise normal. Urinalysis and serum creatinine and potassium are normal. Based on recent recommendations of the JNC 7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure),

which of the following is accurate information to give her? 

A. At age older than 50, high diastolic BP becomes a more important cardiovascular risk factor than high systolic BP
B. She has prehypertension and does not need drug therapy at this time
C. Thiazide diuretics would be a good initial choice for her
D. Initiating therapy with two anti-hypertensives would be preferred based on her current BP
E. Estrogen-replacement therapy would be helpful in delaying her need for anti-hypertensives

Question 2# Print Question

A 69-year-old woman complains of gradually worsening vision over the last 2 years. She can no longer read the newspaper on her porch in the early evening, and sometimes has difficulty seeing faces and distinguishing colors. She has hypertension and smokes cigarettes, but does not have diabetes. Her only regular medication is lisinopril. Funduscopic examination is shown below.

What is the next best step in the evaluation of this patient? 

A. Determination of fasting blood sugar and hemoglobin A1C
B. Referral to an optometrist for tonometry
C. Recommendation that she stop smoking cigarettes, take antioxidants, and see an ophthalmologist
D. Referral to an ophthalmologist for cataract extraction
E. MRI scan of the brain with particular attention to the pituitary

Question 3# Print Question

A 60-year-old white man has just moved to town and needs to establish care. He had a “heart attack” last year. Preferring a “natural” approach, he has been very conscientious about low-fat, low-cholesterol eating habits and a significant exercise program. He has gradually eliminated a number of prescription medications (he does not recall their names) that he was on at the time of hospital discharge. Past history is negative for hypertension, diabetes, or smoking. The lipid profile you obtain shows the following:

  • Total cholesterol: 194 mg/dL
  • Triglycerides: 140 mg/dL
  • HDL: 42 mg/dL
  • LDL (calculated): 124 mg/dL
  • ECG shows Q waves in leads II, II, and aVF consistent with an old inferior MI

Which of the following recommendations would most optimally treat his lipid status?

A. Continue current dietary efforts and exercise
B. Add an HMG-CoA reductase inhibitor (statin drug) to reduce LDL cholesterol to less than 100 mg/dL with an ideal goal of 70 mg/dL if achievable
C. Add a fibric acid derivative such as gemfibrozil or fenofibrate
D. Review previous medications and resume an angiotensin-converting enzyme inhibitor
E. Have the patient buy over-the-counter fish oil tablets and take 2 g in the morning and 2 g in the evening

Question 4# Print Question

A 60-year-old man had an anterior myocardial infarction 3 months ago. He currently is asymptomatic and has normal vital signs and a normal physical examination. His echocardiogram shows a mildly depressed ejection fraction of 40%. He is on an antiplatelet agent and an ACE inhibitor. What other category of medication would typically be prescribed for secondary prevention of myocardial infarction? 

A. Alpha-blocker
B. Beta-blocker
C. Calcium-channel blocker
D. Nitrates
E. Naproxen sodium

Question 5# Print Question

A patient with type 2 diabetes mellitus is found to have a blood pressure of 152/98. She has never had any ophthalmologic, cardiovascular, or renal complications of diabetes or hypertension.

Which of the following is the currently recommended goal for blood pressure control in this case? 

A. Less than 160/90
B. Less than 145/95
C. Less than 140/90
D. Less than 130/80
E. Less than 120/70

Category: Medicine--->General Medicine and Prevention
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