Coc Exam Questions And Answers Already Graded A

A 62 -ye ar -old wo man wi th a histor y of hyp ertens ion and hyp erlipidemia present s to the A) Hashimoto thyroiditis (B) Pyelonephritis (C) Polymyositis (D) Medication effec hospital with diffuse muscle pain, weakness, and dark urine. She has no history of autoimmune or renal disease. Over the past month, she has had symptoms of cold intolerance, weight gain, and constipation. Her medications include hydrochlorothiazide, simvastatin, and gemfibrozil. Urine dipstick reveals 3+ blood; however, there are no red blood cells on microscopic analysis. Some of the other laboratory values are shown below. Creatinine 2.3 mg/dL Creatine kinase 34,000 U/L TSH 8.0 μU/mL Which of the following is the most likely cause of her presentation? t Note: Hashimotos Thyroiditis symptoms are constipation, hair loss, excessive sleep. 2. A 28-year-old woman frantically presents to the Emergency Department in the middle of the night with chest discomfort that awoke her from sleep. She has experienced similar episodes a few times before, always at night, but never as bad as this. She reports a history of migraines but denies any other medical history, including heart disease. Her medications include NSAIDs as needed and OCPs. She smokes a half pack of cigarettes a day but denies any alcohol or drug use. She admits that she gets “stressed out” a lot but believes that overall she lives a healthy lifestyle. Laboratory values show normal CK and troponin. An ECG shows ST elevations and she is taken for coronary angiography that does not show any significant coronary occlusions. What is the most appropriate treatment for this patient? (A) Alprazolam (B) Diltiazem (C) Alteplase (D) NSAIDs (E) Reassurance 3. A 53-year-old man is hospitalized with pneumonia and is placed on a cardiac monitor. While in the room, you notice that he is in normal sinus rhythm but has occasional wide complexes without any pattern or relationship to the cardiac cycle. They occur several times per minute. The patient states that every once in awhile he feels like his heart skips a beat. He has no history of heart disease or sudden death in the family, and his vitals are normal. Which of the following is the most appropriate next step in management? (A) Catheter ablation of the ectopic focus (B) Administer metoprolol (C) Administer propafenone (D) Avoidance of caffeine and other stimulants Note: heart skipped means suddenly skipped a beat /heart palpation /beating too hard and drug used for heart skips a beat is metoprolol, propranolol and atenolol but propafenone is used to treat patients who have irregular heartbeats. 4. A 56-year-old man was recently hospitalized for an acute myocardial infarction. He was treated appropriately and had no complications during his hospitalization. After discharge, he follows up regularly in your clinic. Several months after his hospitalization, he comes to clinic for a regular visit with no complaints, stating that he is tolerating his new medications well. As he begins to leave, he mentions problems during intercourse with his wife and asks if he could have a prescription for sildenafil. A further history is obtained, and he reports that he no longer has morning erections. Which of the following is most likely responsible for this complaint? (A) Lisinopril (B) Metoprolol (C) Amlodipine (D) Atorvastatin Calcium channel blocker such as Amlodipine, Diltiazem and verapamil cause erectile dysfunction, 5. A 52-year-old woman presents to the hospital with a severe headache and nausea. She has no history of headaches and is concerned that she is having a stroke. Her medical history is significant for longstanding hypertension, diabetes, and GERD. She admits that she is not always compliant with her medications, and recently ran out of them. Her blood pressure is 193/124 mmHg, and fundoscopic examination reveals papilledema. The rest of her physical examination, including a neurologic examination, is normal. What is the correct diagnosis and treatment? (A) Hypertensive urgency; gradual lowering of blood pressure with oral agents (B) Hypertensive urgency; rapid lowering of blood pressure with IV agents (C) Hypertensive emergency; gradual lowering of blood pressure with oral agents (D) Hypertensive emergency; rapid lowering of blood pressure with IV agents 6. A 68-year-old woman presents with progressive dyspnea. She has a history of longstanding hypertension, previous myocardial infarction, and several episodes of ventricular tachycardia that required cardioversion. She is now maintained on prophylactic medication with good cardiac function and no further arrhythmias. On examination, she is afebrile with a respiratory rate of 28 breaths per minute and oxygen saturation of 92% on room air. Cardiac examination is normal, but she has dry rales throughout her lung fields. A CT scan of the chest shows diffuse ground-glass opacities. Which medication is most likely responsible for the patient’s symptoms? (A) Digoxin (B) Lisinopril (C) Amiodarone (D) Bleomycin 7. A 69-year-old woman with a history of hypertension, diabetes, and myocardial infarction comes to the hospital with worsening shortness of breath and leg swelling. She has an S3 on examination with crackles at both lung bases and 2+ pitting edema in her lower extremities. The level of brain natriuretic peptide is elevated and a chest x-ray shows vascular congestion with bilateral fluffy opacities. Which of the following would be unlikely to contribute to the patient’s current presentation? (A) Excessive sodium in the diet (B) Forgetting to take medications (C) Digoxin (D) Renal failure 8. A 58-year-old man presents to the hospital with persistent fatigue and some exertional dyspnea. He has a history of hypertension, diabetes, and atrial fibrillation. Cardioversion was attempted previously but without success. He was lost to follow-up, but reports that he takes lisinopril and metformin regularly. On examination, he is normotensive with a heart rate of 76 beats per minute with an irregularly irregular rhythm. There are no murmurs or extra heart sounds, and his lungs are clear to auscultation bilaterally. What is the most appropriate next step in management? Metformin associated Atrial Fibrillation (A) Repeat cardioversion (B) Aspirin (C) Warfarin (D) Amiodarone 9. 55-year-old man presents to the hospital with progressive dyspnea over the course of the last few weeks. He denies fever, cough, or chest pain. He has no significant medical or family history, but endorses drinking two 750-mL bottles of wine daily. He is afebrile with a blood pressure of 139/82 mmHg, heart rate of 98 beats per minute, and respiratory rate of 24 breaths per minute. The point of maximal impulse is displaced laterally, a 2/6 holo systolic murmur is heard at the apex, and an S3 is auscultated. There are crackles at the lung bases with pitting edema around the ankles. Which of the following is the most important intervention for this patient? (A) Low sodium diet (B) Cardiac glycoside (C) β-blocker (D) Alcohol cessation