AAFP Questions
& answers
graded A+ latest
update
AAFP
[Document subtitle]
PC
,AAFP Questions & answers graded A+
latest update
A 70yo M with h/o HTN and DM presents with a 2-mo h/o increasing paroxysmal nocturnal
dyspnea and SOB with minimal exertion. An echocardiogram shows an ejection fraction of 25%.
Which one of the patients current medications should be discontinued?
A. Lisinopril (Zestril)
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL) - correct answer ✔✔Pioglitazone
thiazolidinediones (TZDs) are associated with fluid retention, and their use can be complicated
by the development of heart failure. Caution is necessary when prescribing TZDs in patients
with known heart failure or other heart diseases, those with preexisting edema, and those on
concurrent insulin therapy
What is the most common cause of hypertension in children under 6 years of age? - correct
answer ✔✔Renal Parenchymal Disease
The most common cause of hypertension is renal parenchymal disease, and a urinalysis, urine
culture, and renal ultrasonography should be ordered for all children presenting with
hypertension.
A 72-year-old African-American male with New York Heart Association Class III heart failure sees
you for follow-up. He has shortness of breath with minimal exertion. The patient is adherent to
his medication regimen. His current medications include lisinopril (Prinivil, Zestril), 40 mg twice
daily; carvedilol (Coreg), 25 mg twice daily; and furosemide (Lasix), 80 mg daily. His blood
pressure is 100/60 mm Hg, and his pulse rate is 68 beats/min and regular. Findings include a few
scattered bibasilar rales on examination of the lungs, an S3 gallop on examination of the heart,
,and no edema on examination of the legs. An EKG reveals a left bundle branch block, and
echocardiography reveals an ejection fraction of 25%, but no other abnormalities. What's the
appropriate next step? - correct answer ✔✔Refer for cardiac resynchronization therapy (CRT)
Note: he's already on maximum doses of ACEI, loop diuretic, beta-blocker
Using a pacemaker-like device, CRT aims to get both ventricles contracting simultaneously,
overcoming the delayed contraction of the left ventricle caused by the left bundle-branch block.
These guidelines were refined by an April 2005 AHA Science Advisory, which stated that optimal
candidates for CRT have a dilated cardiomyopathy on an ischemic or nonischemic basis, an LVEF
≤0.35, a QRS complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV
despite maximal medical therapy for heart failure.
What dietary change recommended for the prevention and treatment of cardiovascular disease
has been shown to decrease the rate of sudden death? - correct answer ✔✔increase intake of
omega 3 fatty acids
Omega-3 fats contribute to the production of eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA), which inhibit the inflammatory immune response and platelet aggregation, are mild
vasodilators, and may have antiarrhythmic properties. The American Heart Association
guidelines state that omega-3 supplements may be recommended to patients with preexisting
disease, a high risk of disease, or high triglyceride levels, as well as to patients who do not like
or are allergic to fish. The Italian GISSI study found that the use of 850 mg of EPA and DHA daily
resulted in decreased rates of mortality, nonfatal myocardial infarction, and stroke, with
particular decreases in the rate of sudden death.
A 75-year-old male presents to the emergency department with a several-hour history of back
pain in the interscapular region. His medical history includes a previous myocardial infarction
(MI) several years ago, a history of cigarette smoking until the time of the MI, and hypertension
that is well controlled with hydrochlorothiazide and lisinopril (Prinivil, Zestril). The patient
appears anxious, but all pulses are intact. His blood pressure is 170/110 mm Hg and his pulse
rate is 110 beats/min. An EKG shows evidence of an old inferior wall MI but no acute changes. A
chest radiograph shows a widened mediastinum and a normal aortic arch, and CT of the chest
, shows a dissecting aneurysm of the descending aorta that is distal to the proximal abdominal
aorta but does not involve the renal arteries. Which one of the following would be the most
appropriate next step in the management of this patient? - correct answer ✔✔Dx: aortic
dissection
next step: Intravenous labetalol (Normodyne, Trandate)
Initial management should reduce the systolic blood pressure to 100-120 mm Hg or to the
lowest level tolerated. The use of a β-blocker such as propranolol or labetalol to get the heart
rate below 60 beats/min should be first-line therapy. If the systolic blood pressure remains over
100 mm Hg, intravenous nitroprusside should be added. Without prior beta-blocade,
vasodilation from the nitroprusside will induce reflex activation of the sympathetic nervous
system, causing increased ventricular contraction and increased shear stress on the aorta.
According to the U.S. Preventive Services Task Force, what are the screening recommendations
for an abdominal aortic aneurysm? - correct answer ✔✔The guideline recommends one-time
screening with ultrasonography for AAA in men 65-75 years of age who have ever smoked. No
recommendation was made for or against screening women. Men with a strong family history of
AAA should be counseled about the risks and benefits of screening as they approach 65 years of
age.
A 36-year-old white female presents to the emergency department with palpitations. Her pulse
rate is 180 beats/min. An EKG reveals a regular tachycardia with a narrow complex QRS and no
apparent P waves. The patient fails to respond to carotid massage or to two doses of
intravenous adenosine (Adenocard), 6 mg and 12 mg. The most appropriate next step would be
to administer intravenous - correct answer ✔✔verapamil (Calan)
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can
usually be terminated by the administration of intravenous verapamil or a β-blocker. If that fails,
intravenous propafenone or flecainide may be necessary. It is also important to look for and
treat possible contributing causes such as hypovolemia, hypoxia, or electrolyte disturbances.
Electrical cardioversion may be necessary if these measures fail to terminate the
tachyarrhythmia.
& answers
graded A+ latest
update
AAFP
[Document subtitle]
PC
,AAFP Questions & answers graded A+
latest update
A 70yo M with h/o HTN and DM presents with a 2-mo h/o increasing paroxysmal nocturnal
dyspnea and SOB with minimal exertion. An echocardiogram shows an ejection fraction of 25%.
Which one of the patients current medications should be discontinued?
A. Lisinopril (Zestril)
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL) - correct answer ✔✔Pioglitazone
thiazolidinediones (TZDs) are associated with fluid retention, and their use can be complicated
by the development of heart failure. Caution is necessary when prescribing TZDs in patients
with known heart failure or other heart diseases, those with preexisting edema, and those on
concurrent insulin therapy
What is the most common cause of hypertension in children under 6 years of age? - correct
answer ✔✔Renal Parenchymal Disease
The most common cause of hypertension is renal parenchymal disease, and a urinalysis, urine
culture, and renal ultrasonography should be ordered for all children presenting with
hypertension.
A 72-year-old African-American male with New York Heart Association Class III heart failure sees
you for follow-up. He has shortness of breath with minimal exertion. The patient is adherent to
his medication regimen. His current medications include lisinopril (Prinivil, Zestril), 40 mg twice
daily; carvedilol (Coreg), 25 mg twice daily; and furosemide (Lasix), 80 mg daily. His blood
pressure is 100/60 mm Hg, and his pulse rate is 68 beats/min and regular. Findings include a few
scattered bibasilar rales on examination of the lungs, an S3 gallop on examination of the heart,
,and no edema on examination of the legs. An EKG reveals a left bundle branch block, and
echocardiography reveals an ejection fraction of 25%, but no other abnormalities. What's the
appropriate next step? - correct answer ✔✔Refer for cardiac resynchronization therapy (CRT)
Note: he's already on maximum doses of ACEI, loop diuretic, beta-blocker
Using a pacemaker-like device, CRT aims to get both ventricles contracting simultaneously,
overcoming the delayed contraction of the left ventricle caused by the left bundle-branch block.
These guidelines were refined by an April 2005 AHA Science Advisory, which stated that optimal
candidates for CRT have a dilated cardiomyopathy on an ischemic or nonischemic basis, an LVEF
≤0.35, a QRS complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV
despite maximal medical therapy for heart failure.
What dietary change recommended for the prevention and treatment of cardiovascular disease
has been shown to decrease the rate of sudden death? - correct answer ✔✔increase intake of
omega 3 fatty acids
Omega-3 fats contribute to the production of eicosapentaenoic acid (EPA) and docosahexaenoic
acid (DHA), which inhibit the inflammatory immune response and platelet aggregation, are mild
vasodilators, and may have antiarrhythmic properties. The American Heart Association
guidelines state that omega-3 supplements may be recommended to patients with preexisting
disease, a high risk of disease, or high triglyceride levels, as well as to patients who do not like
or are allergic to fish. The Italian GISSI study found that the use of 850 mg of EPA and DHA daily
resulted in decreased rates of mortality, nonfatal myocardial infarction, and stroke, with
particular decreases in the rate of sudden death.
A 75-year-old male presents to the emergency department with a several-hour history of back
pain in the interscapular region. His medical history includes a previous myocardial infarction
(MI) several years ago, a history of cigarette smoking until the time of the MI, and hypertension
that is well controlled with hydrochlorothiazide and lisinopril (Prinivil, Zestril). The patient
appears anxious, but all pulses are intact. His blood pressure is 170/110 mm Hg and his pulse
rate is 110 beats/min. An EKG shows evidence of an old inferior wall MI but no acute changes. A
chest radiograph shows a widened mediastinum and a normal aortic arch, and CT of the chest
, shows a dissecting aneurysm of the descending aorta that is distal to the proximal abdominal
aorta but does not involve the renal arteries. Which one of the following would be the most
appropriate next step in the management of this patient? - correct answer ✔✔Dx: aortic
dissection
next step: Intravenous labetalol (Normodyne, Trandate)
Initial management should reduce the systolic blood pressure to 100-120 mm Hg or to the
lowest level tolerated. The use of a β-blocker such as propranolol or labetalol to get the heart
rate below 60 beats/min should be first-line therapy. If the systolic blood pressure remains over
100 mm Hg, intravenous nitroprusside should be added. Without prior beta-blocade,
vasodilation from the nitroprusside will induce reflex activation of the sympathetic nervous
system, causing increased ventricular contraction and increased shear stress on the aorta.
According to the U.S. Preventive Services Task Force, what are the screening recommendations
for an abdominal aortic aneurysm? - correct answer ✔✔The guideline recommends one-time
screening with ultrasonography for AAA in men 65-75 years of age who have ever smoked. No
recommendation was made for or against screening women. Men with a strong family history of
AAA should be counseled about the risks and benefits of screening as they approach 65 years of
age.
A 36-year-old white female presents to the emergency department with palpitations. Her pulse
rate is 180 beats/min. An EKG reveals a regular tachycardia with a narrow complex QRS and no
apparent P waves. The patient fails to respond to carotid massage or to two doses of
intravenous adenosine (Adenocard), 6 mg and 12 mg. The most appropriate next step would be
to administer intravenous - correct answer ✔✔verapamil (Calan)
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can
usually be terminated by the administration of intravenous verapamil or a β-blocker. If that fails,
intravenous propafenone or flecainide may be necessary. It is also important to look for and
treat possible contributing causes such as hypovolemia, hypoxia, or electrolyte disturbances.
Electrical cardioversion may be necessary if these measures fail to terminate the
tachyarrhythmia.
