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A 42-Year-Old Asian Male Presents For Follow-Up Of Elevated Blood Pressure. He Has No
Additional Chronic Medical Problems And Is Otherwise Asymptomatic. An Examination Is
Significant For A Blood Pressure Of 162/95 Mm Hg But Is Otherwise Unremarkable.
Laboratory Findings Unremarkable
Urine Microalbumin Negative
According To The American College Of Cardiology/American Heart Association 2017 Guidelines,
Which One Of The Following Would Be The Most Appropriate Medication To Initiate At This
Time?
A) Clonidine (Catapres), 0.1 Mg Twice Daily
B) Hydralazine, 25 Mg Three Times Daily
C) Lisinopril/Hydrochlorothiazide (Zestoretic), 10/12.5 Mg Daily
D) Metoprolol Tartrate (Lopressor), 25 Mg Twice Daily
E) Triamterene (Dyrenium), 50 Mg Daily
CORRECT ANS: C
This Patient Has Hypertension And According To Both JNC 8 And American College Of
Cardiology/American Heart Association 2017 Guidelines, Antihypertensive Treatment Should Be
Initiated. For The General Non-African-American Population, Monotherapy With An ACE
Inhibitor, An Angiotensin Receptor Blocker, A Calcium Channel Blocker, Or A Thiazide Diuretic
Would Be Appropriate For Initial Management. It Is Also Appropriate To Initiate Combination
Antihypertensive Therapy As An Initial Management Strategy, Although Patients Should Not
Take An ACE Inhibitor And An Angiotensin Receptor Blocker Simultaneously. Studies Have
Shown That Blood Pressure Control Is Achieved Faster With The Initiation Of Combination
Therapy Compared To Monotherapy, Without An Increase In Morbidity.
Lisinopril/Hydrochlorothiazide Would Be An Appropriate Choice In This Patient. -Blockers,
Vasodilators, -Blockers, And Potassium-Sparing Diuretics Are Not Recommended As Initial
Choices For The Treatment Of Hypertension.
, During Rounds At The Nursing Home, You Are Informed That There Are Two Residents On The
Unit With Laboratory-Confirmed Influenza. According To CDC Guidelines, Who Should Receive
Chemoprophylaxis For Influenza?
A) Only Symptomatic Residents On The Same Unit
B) Only Symptomatic Residents In The Entire Facility
C) All Asymptomatic Residents On The Same Unit
D) All Residents Of The Facility Regardless Of Symptoms
E) All Staff Regardless Of Symptoms
CORRECT ANS: C
In Long-Term Care Facilities, An Influenza Outbreak Is Defined As Two Laboratory-Confirmed
Cases Of Influenza
Within 72 Hours In Patients On The Same Unit. The CDC Recommends Chemoprophylaxis For All
Asymptomatic Residents Of The Affected Unit. Any Resident Exhibiting Symptoms Of Influenza
Should Be Treated For Influenza And Not Given Chemoprophylaxis Dosing. Chemoprophylaxis Is
Not Recommended For Residents Of Other Units Unless There Are Two Laboratory-Confirmed
Cases In Those Units. Facility Staff Of The Affected Unit Can Be Considered For
Chemoprophylaxis If They Have Not Been Vaccinated Or If They Had A Recent Vaccination, But
Chemoprophylaxis Is Not Recommended For All Staff In The Entire Facility.
A 24-Year-Old Female Presents With A 2-Day History Of Mild To Moderate Pelvic Pain. She Has
Had Two Male Sex Partners In The Last 6 Months And Uses Oral Contraceptives And Sometimes
Condoms.
A Physical Examination Reveals A Temperature Of 36.4°C (97.5°F) And Moderate Cervical Motion
And Uterine Tenderness. Urine Hcg And A Urinalysis Are Negative. Vaginal Microscopy Shows
Only Wbcs.
The Initiation Of Antibiotics For Treatment Of Pelvic Inflammatory Disease In This Patient
A) Is Appropriate At This Time
B) Requires An Elevated Temperature, WBC Count, Or C-Reactive Protein Level