MISC - Long Quiz (Prelims) Flashcards by Juan Carlos Cornelio

A 58-year-old man with a history of type 2 diabetes presents with BP 160/95 mmHg despite lifestyle modification. Which is the most appropriate initial antihypertensive?

Verapamil
Metoprolol
Lisinopril
Hydrochlorothiazide
Doxazosin
Clonidine

Lisinopril

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A 67-year-old woman with atrial fibrillation develops acute shortness of breath and irregularly irregular pulse. Which drug is most effective for immediate rate control?

Labetalol
Verapamil
Flecainide
Digoxin
Amiodarone
Adenosine

Verapamil

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A 55-year-old smoker presents with exertional chest pain relieved by rest. Which drug provides symptomatic relief by reducing myocardial oxygen demand?

Aspirin
Nitroglycerin
Furosemide
Warfarin
Atorvastatin
Ranolazine

Nitroglycerin

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A 70-year-old man with systolic heart failure (EF 30%) is started on a drug that reduces mortality by blocking maladaptive neurohormonal activation. Which drug class is this?

Nitrate
Calcium channel blocker
Digoxin
ACE inhibitor
Thiazide
Loop diuretic

ACE inhibitor

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A 45-year-old woman develops cough after initiation of an antihypertensive drug. Which alternative medication is most appropriate?

Metoprolol
Valsartan
Amlodipine
Minoxidil
Verapamil
Hydralazine

Valsartan

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A 64-year-old man with angina is started on a drug that decreases heart rate and contractility, reducing myocardial oxygen demand. Which drug is most appropriate?

Amlodipine
Aspirin
Ranolazine
Nitroglycerin
Clopidogrel
Atenolol

Atenolol

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A 72-year-old man with atrial fibrillation is started on warfarin. Which test is required to monitor therapy?

Bleeding time
Platelet count
Factor Xa level
D-dimer
PT/INR
aPTT

PT/INR

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A 59-year-old woman with LDL cholesterol 200 mg/dL is started on first-line therapy. Which adverse effect must be monitored?

Ankle edema
Constipation
Dry cough
Hyperkalemia
Hepatotoxicity
Bradycardia

Hepatotoxicity

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A 62-year-old hypertensive patient with chronic kidney disease (eGFR 35 mL/min) should avoid which antihypertensive?

Loop diuretic
Calcium channel blocker
Thiazide diuretic
ARB
ACE inhibitor
Beta-blocker

Thiazide diuretic

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A 70-year-old man with NSTEMI is started on dual antiplatelet therapy. Which drugs are included?

Aspirin + Digoxin
Rivaroxaban + Aspirin
Heparin + Aspirin
Warfarin + Aspirin
Aspirin + Atorvastatin
Aspirin + Clopidogrel

Aspirin + Clopidogrel

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A 50-year-old woman with systolic heart failure is prescribed spironolactone. What important adverse effect should be monitored?

Cough
Hypokalemia
Hyponatremia
Bradycardia
Neutropenia
Hyperkalemia

Hyperkalemia

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A 62-year-old man with paroxysmal supraventricular tachycardia is given a rapid IV push drug that terminates the arrhythmia within seconds. Which is it?

Adenosine
Digoxin
Verapamil
Lidocaine
Atropine
Amiodarone

Adenosine

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A 45-year-old man presents with fatigue, pallor, and glossitis. Labs show macrocytic anemia with low vitamin B12. What is the most appropriate treatment?

Hydroxocobalamin
Erythropoietin
Folic acid
Vitamin C
Ferrous sulfate
Deferoxamine

Hydroxocobalamin

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A 70-year-old woman with AF and high stroke risk is started on dabigatran. What is its mechanism of action?

Antithrombin activator
GP IIb/IIIa inhibitor
Direct thrombin inhibitor
Factor Xa inhibitor
ADP receptor blocker
Vitamin K antagonist

Direct thrombin inhibitor

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A 56-year-old man on simvastatin complains of muscle pain and dark urine. Which complication is suspected?

Hyperthyroidism
Anemia
Rhabdomyolysis
Nephrotoxicity
Hypokalemia
Hepatotoxicity

Rhabdomyolysis

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A 65-year-old woman with EF 25% is prescribed a beta-blocker shown to
reduce mortality in heart failure. Which drug is appropriate?

Ivabradine
Metoprolol succinate
Verapamil
Propranolol
Atenolol
Diltiazem

Metoprolol succinate

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A 60-year-old hypertensive man with gout should avoid which medication?

Lisinopril
Spironolactone
Amlodipine
Hydrochlorothiazide
Losartan
Metoprolol

Hydrochlorothiazide

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A 50-year-old man with unstable angina is started on heparin. What is the antidote in case of overdose?

Protamine sulfate
Platelet transfusion
Vitamin K
Idarucizumab
FFP
Andexanet alfa

Protamine sulfate

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A 72-year-old woman with anemia has microcytic hypochromic RBCs and low ferritin. Best treatment?

Oral ferrous sulfate
Iron sucrose IV
Hydroxocobalamin
Folic acid
Deferoxamine
Erythropoietin

Oral ferrous sulfate

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A 58-year-old man with exertional angina is prescribed ranolazine. What is its mechanism?

PDE-5 inhibition
Ca2+ channel blockade
Inhibits Na+ current
Vasodilation via NO
Beta-blocker
Platelet inhibition

Inhibits Na+ current

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A 65-year-old man presents with severe hypertension (BP 210/120) and papilledema. Which IV drug is best for rapid control?

Hydralazine
Captopril
Sodium nitroprusside
Minoxidil
Amlodipine
Atenolol

Sodium nitroprusside

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A 48-year-old woman with AF is started on apixaban. What is its mechanism?

GP IIb/IIIa blocker
Factor Xa inhibitor
Platelet inhibitor
Direct thrombin inhibitor
Fibrinolytic
Vitamin K antagonist

Factor Xa inhibitor

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A 70-year-old man with heart failure and renal impairment is prescribed digoxin. What electrolyte abnormality increases toxicity risk?

Hyperkalemia
Hypocalcemia
Hyponatremia
Hypernatremia
Hypokalemia
Hypermagnesemia

Hypokalemia

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A 66-year-old man on warfarin develops GI bleeding. What is the best reversal agent?

Idarucizumab
Fresh frozen plasma
Andexanet alfa
Desmopressin
Protamine sulfate
Vitamin K

Vitamin K

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A 55-year-old woman with angina cannot tolerate beta-blockers. Which drug can be used as an alternative to reduce angina episodes? Warfarin Aspirin Metformin Nitroglycerin Amlodipine Simvastatin

Amlodipine

A 72-year-old man with atrial fibrillation is started on amiodarone. Which adverse effect should be monitored? Tinnitus Cataracts Kidney stones Pulmonary fibrosis Constipation Hypoglycemia

Pulmonary fibrosis

A 68-year-old man with systolic heart failure is given sacubitril/valsartan. What is sacubitril’s mechanism? ACE inhibitor Direct renin inhibitor Beta-blocker Neprilysin inhibitor Aldosterone antagonist PDE-5 inhibitor

Neprilysin inhibitor

A 40-year-old man with anemia from chronic kidney disease is best treated with which agent? Hydroxocobalamin Ferrous sulfate Folic acid Deferoxamine Vitamin C Erythropoietin

Erythropoietin

A 62-year-old hypertensive patient with asthma is started on propranolol and develops wheezing. What is the explanation? Increased renin release Beta-2 blockade Alpha-1 blockade Decreased prostaglandins Beta-1 blockade Increased bradykinin

Beta-2 blockade

A 75-year-old woman on long-term aspirin develops peptic ulcer bleeding. Which drug can be substituted for continued stroke prevention with less GI bleeding risk? Dabigatran Heparin Warfarin Clopidogrel Apixaban Ticagrelor

Clopidogrel

A 55-year-old man with resistant hypertension is prescribed minoxidil. Which adverse effect is most characteristic? Tinnitus Bradycardia Hypoglycemia Pulmonary edema Reflex tachycardia Hyperkalemia

Reflex tachycardia

A 60-year-old woman presents with exertional angina. She is started on isosorbide mononitrate. Which adverse effect is common? Rash Palpitations Constipation Hypokalemia Headache Bradycardia

Headache

A 50-year-old man with hyperlipidemia is given a fibrate. Which adverse effect is increased when combined with statins? Bradycardia Hypoglycemia Constipation Hypertension Tinnitus Rhabdomyolysis

Rhabdomyolysis

A 72-year-old woman with atrial fibrillation is treated with digoxin. Which symptom suggests toxicity? Constipation Headache Dysphagia Tremor Yellow vision Hypotension

Yellow vision

A 63-year-old man with NSTEMI is given abciximab. What is its mechanism? PDE-3 inhibitor Factor Xa inhibitor ADP receptor blocker GP IIb/IIIa receptor antagonist Vitamin K antagonist Direct thrombin inhibitor

GP IIb/IIIa receptor antagonist

A 55-year-old woman with heart failure and diabetes is prescribed dapagliflozin. What is the mechanism for HF benefit? Sodium-glucose cotransporter-2 inhibition Neprilysin inhibition Renin inhibition Beta-blockade Aldosterone antagonism Calcium channel blockade

Sodium-glucose cotransporter-2

A 70-year-old man with unstable angina is started on enoxaparin. What is its mechanism? GP IIb/IIIa blockade Vitamin K antagonist PDE-3 inhibition ADP receptor blockade Direct thrombin inhibitor Factor Xa inhibition via ATIII

Factor Xa inhibition via ATIII

A 65-year-old woman with heart failure is prescribed ivabradine. What is its mechanism? Aldosterone antagonist Ca2+ channel blocker PDE-5 inhibitor Beta-1 blocker Na+/K+ ATPase inhibitor Funny channel (If) inhibitor

Funny channel (If) inhibitor

A 50-year-old man with long QT syndrome develops torsades de pointes. Which drug can treat this arrhythmia? Atropine Lidocaine Digoxin Amiodarone Magnesium sulfate Verapamil

Magnesium sulfate

A 45-year-old man with hypertension and benign prostatic hyperplasia is prescribed doxazosin. What additional benefit does this drug provide? Prevents kidney stones Reduces prostate smooth muscle tone Reduces arrhythmia risk Improves lipid profile Improves renal perfusion Increases insulin secretion

Reduces prostate smooth muscle tone

A 61-year-old man with atrial fibrillation is started on sotalol. What is a major adverse effect? Hyperkalemia Constipation Hyperglycemia Bradycardia and torsades Pulmonary fibrosis Hearing loss

Bradycardia and torsades

A 70-year-old man with systolic heart failure is started on hydralazine + isosorbide dinitrate. This combination is particularly beneficial in which population? Renal transplant patients Women <50 years COPD patients Smokers African descent Diabetics

African descent

A 64-year-old woman with chest pain at rest has normal coronary angiography. Which drug is most useful? Nitrate Ranolazine Beta-blocker Atorvastatin Aspirin Verapamil

Verapamil

A 50-year-old man develops hemolytic anemia while taking an antimalarial drug. Which other drug shares this risk in G6PD deficiency? Warfarin Dabigatran Nitrofurantoin Atorvastatin Aspirin Clopidogrel

Nitrofurantoin

A 58-year-old man with acute DVT is started on rivaroxaban. What lab test is needed for monitoring? PT/INR Bleeding time aPTT CBC only None routinely Anti-Xa activity

None routinely

A 72-year-old woman with heart failure develops gynecomastia while on therapy. Which drug is most likely responsible? Digoxin Amlodipine Spironolactone Eplerenone Furosemide Captopril

Spironolactone

A 62-year-old man with atrial fibrillation is prescribed flecainide. Which patients should avoid this drug? Anemia Diabetes Structural heart disease COPD Hyperthyroidism Hypertension

Structural heart disease

A 65-year-old man on chronic warfarin has INR 9.0 but no bleeding. What is the best management? Continue warfarin Dialysis Protamine sulfate Stop warfarin + vitamin K FFP Idarucizumab

Stop warfarin + vitamin K

A 58-year-old woman with angina is prescribed nicorandil. Its mechanism resembles which drug class? Beta-blockers Nitrates + K+ channel openers Calcium channel blockers Fibrinolytics Statins Antiplatelets

Nitrates + K+ channel openers

A 60-year-old hypertensive man with CKD is best treated with which class? Clonidine ACE inhibitors Thiazides CCBs Beta-blockers Alpha-blockers

ACE inhibitors

A 75-year-old man with new atrial fibrillation develops thyrotoxicosis. Which antiarrhythmic is contraindicated? Sotalol Verapamil Metoprolol Digoxin Amiodarone Adenosine

Amiodarone

A 65-year-old woman with angina takes nitroglycerin daily. Why is a nitrate-free interval recommended? Prevent flushing Prevent hypotension Prevent arrhythmias Prevent bradycardia Prevent GI upset Prevent tolerance

Prevent tolerance

A 40-year-old man with severe hypertension is treated with fenoldopam. What is its mechanism? Ca2+ blocker Beta-1 blocker Alpha-1 blocker Renin inhibitor PDE-5 inhibitor Dopamine D1 agonist

Dopamine D1 agonist

A 72-year-old woman with atrial fibrillation is started on edoxaban. What is its mechanism? GP IIb/IIIa blocker Platelet inhibitor ADP receptor blocker Vitamin K antagonist Factor Xa inhibitor Direct thrombin inhibitor

Factor Xa inhibitor

A 58-year-old man with dilated cardiomyopathy is prescribed carvedilol. What additional receptor action does it have compared to metoprolol? H1 blockade Beta-2 only Dopamine D1 blockade Alpha-1 blockade Beta-1 only Muscarinic blockade

Alpha-1 blockade

A 50-year-old woman with microcytic anemia from heavy menses is intolerant of oral iron. Which therapy is best? Folic acid Oral ferrous sulfate Erythropoietin IV iron sucrose Hydroxocobalamin Vitamin C

IV iron sucrose

A 65-year-old man with atrial fibrillation has an ejection fraction of 20%. Which antiarrhythmic is safest? Diltiazem Sotalol Amiodarone Propafenone Verapamil Flecainide

Amiodarone

A 59-year-old woman with ischemic heart disease is on aspirin. She develops stroke while compliant. Which agent should be added? Diltiazem Atorvastatin Ticagrelor Heparin Dabigatran Warfarin

Ticagrelor

A 70-year-old man with severe heart failure is given dobutamine IV. What is its primary effect? PDE-5 inhibition K+ channel opening Beta-1 agonism → increased contractility Beta-2 agonism → bronchodilation Alpha-1 agonism → vasoconstriction Muscarinic blockade

Beta-1 agonism → increased contractility

A 55-year-old man with hypertension is started on amlodipine. Which common adverse effect may occur? Hyperkalemia Bradycardia Tinnitus Ankle edema Cough Constipation

Ankle edema

A 63-year-old woman with mechanical heart valve is on warfarin. She is pregnant. What should be used instead? Rivaroxaban Dabigatran Ticagrelor Aspirin Low molecular weight heparin Clopidogrel

Low molecular weight heparin

A 68-year-old man with AF is prescribed dronedarone. Which condition is a contraindication? Heart failure Stable angina Diabetes COPD Hypertension Hypothyroidism

Heart failure

A 59-year-old man with prior MI and LV dysfunction is started on eplerenone. What is its advantage over spironolactone? Stronger antihypertensive Less risk of gynecomastia Increased potassium sparing Faster onset Improves lipid profile More potent diuretic

Less risk of gynecomastia

A 72-year-old woman with unstable angina is treated with aspirin. What is its mechanism? ADP receptor blockade Factor Xa inhibition GP IIb/IIIa inhibition Cyclooxygenase-1 inhibition Direct thrombin inhibition Phosphodiesterase inhibition

Cyclooxygenase-1 inhibition

A 45-year-old man with chest pain at rest is diagnosed with Prinzmetal angina. Which drug should be avoided? Nitroglycerin Propranolol Isosorbide mononitrate Amlodipine Verapamil Diltiazem

Propranolol

A 70-year-old woman with DVT is treated with dabigatran. What is the antidote for overdose? Vitamin K FFP Protamine sulfate Andexanet alfa Idarucizumab Desmopressin

Idarucizumab

A 64-year-old man with HFpEF is treated with spironolactone. What is the main rationale? Reduces hospitalizations Increases BP Improves ejection fraction Improves exercise tolerance Reduces preload Increases contractility

Reduces hospitalizations

A 55-year-old woman develops cough and angioedema after starting lisinopril. Which agent is the best substitute? Atenolol Amlodipine Minoxidil Clonidine Hydrochlorothiazide Valsartan

Valsartan

A 70-year-old man with atrial fibrillation is given verapamil. What is the contraindication? COPD Stable angina CKD Systolic heart failure Hypertension Diabetes

Systolic heart failure

A 62-year-old man with hyperlipidemia is started on ezetimibe. What is its mechanism? Activates PPAR-alpha Inhibits HMG-CoA reductase Inhibits cholesterol absorption in intestine Inhibits bile acid reabsorption Increases LDL receptor expression Stimulates LPL activity

Inhibits cholesterol absorption in intestine

A 50-year-old woman with atrial fibrillation and BP 90/60 mmHg needs acute rate control. Which drug is most appropriate? Diltiazem Metoprolol Adenosine Verapamil Amiodarone Digoxin

Digoxin

A 68-year-old man with stable angina is started on beta-blocker therapy. Which is contraindicated in asthma? Nebivolol Esmolol Metoprolol Propranolol Atenolol Bisoprolol

Propranolol

A 75-year-old woman with AF is started on rivaroxaban. What is the advantage over warfarin? Fewer drug interactions Routine INR monitoring Teratogenic Longer half-life Food interactions Narrow therapeutic index

Fewer drug interactions

A 60-year-old hypertensive man has bilateral renal artery stenosis. Which antihypertensive is contraindicated? Calcium channel blocker Beta-blocker ACE inhibitor Alpha-blocker Thiazide diuretic Loop diuretic

ACE inhibitor

A 55-year-old woman with heart failure is prescribed digoxin. What is its primary mechanism? Stimulates adenylate cyclase Blocks angiotensin II receptor Blocks beta-1 receptors Blocks calcium channels Inhibits renin release Inhibits Na+/K+ ATPase

Inhibits Na+/K+ ATPase

A 72-year-old man with AF is given amiodarone. Which thyroid abnormality may occur? Diabetes Hypothyroidism Hyperthyroidism Both hypothyroidism and hyperthyroidism SIADH None

Both hypothyroidism and hyperthyroidism

A 65-year-old man with MI is prescribed beta-blocker therapy. What is the survival benefit? Prevents heart block Improves renal function Improves ejection fraction Reduces arrhythmias Reduces angina tolerance Increases CO

Reduces arrhythmias

A 50-year-old woman with iron deficiency anemia responds poorly to oral iron. What dietary factor may impair absorption? Dairy products Spicy food Tea/coffee High protein diet Fruits Vitamin C

Tea/coffee

A 70-year-old man with angina is given ranolazine. Which adverse effect is important? Rash Hyperkalemia QT prolongation Constipation Bradycardia Gynecomastia

QT prolongation

A 68-year-old man with dilated cardiomyopathy is on digoxin. Which drug increases digoxin toxicity? Clopidogrel Atorvastatin Spironolactone Amlodipine Aspirin Furosemide

Furosemide

A 55-year-old woman with unstable angina is started on clopidogrel. What is its mechanism? Inhibits thrombin Inhibits GP IIb/IIIa Inhibits ADP receptor Inhibits P2Y14 Inhibits factor Xa Inhibits thromboxane A2

Inhibits ADP receptor

A 70-year-old man with hypertension and heart failure is treated with bisoprolol. What is its primary mechanism? Ca2+ blockade PDE inhibition Alpha-1 blockade Beta-2 blockade K+ channel opening Beta-1 blockade

Beta-1 blockade

A 60-year-old woman with DVT is treated with fondaparinux. What is its mechanism? ADP receptor blocker Vitamin K antagonist Direct thrombin inhibitor COX-1 inhibitor Factor Xa inhibitor GP IIb/IIIa inhibitor

Factor Xa inhibitor

A 72-year-old man with AF is started on digoxin. Which feature supports rate control rather than rhythm control? First AF episode Preserved EF Narrow QRS Advanced age Paroxysmal episodes Young age

Advanced age

A 68-year-old man with chronic heart failure is treated with sacubitril/valsartan. Which adverse effect is important? Cough Angioedema Hyperthyroidism Myopathy Anemia Gynecomastia

Angioedema

A 50-year-old man with dyslipidemia is given niacin. What is its most limiting side effect? Hypotension Myopathy Constipation Flushing Hepatotoxicity Rash

Flushing

A 65-year-old man with angina is prescribed beta-blocker + nitrate therapy. What is the benefit of this combination? Prevents headache Prevents hyperkalemia Prevents arrhythmias Prevents cough Balanced HR and BP effects Reduced tolerance

Balanced HR and BP effects

A 62-year-old man with hypertension and type 2 diabetes is started on first-line therapy. Which drug best protects renal function? Metoprolol Lisinopril Amlodipine Hydrochlorothiazide Clonidine Hydralazine

Lisinopril

A 70-year-old woman with atrial fibrillation presents for rate control. Which drug is most appropriate in the absence of heart failure? Verapamil Amiodarone Metoprolol Digoxin Flecainide Adenosine

Metoprolol

A 55-year-old man with resistant hypertension is prescribed spironolactone. What is the main adverse effect to monitor? Hyperkalemia Bradycardia Gynecomastia Constipation Hyponatremia Hypoglycemia

Hyperkalemia

A 48-year-old woman with paroxysmal supraventricular tachycardia (PSVT) is given a rapid IV push drug that terminates the arrhythmia within seconds. Which is it? Lidocaine Atropine Amiodarone Digoxin Adenosine Verapamil

Adenosine

A 66-year-old man with heart failure and hypertension is started on carvedilol. What is the main benefit of this drug class in heart failure? Increases contractility Promotes diuresis Decreases preload Improves survival Reduces cough Immediate symptom relief

Improves survival

A 59-year-old woman with hypertension develops ankle edema after starting medication. Which drug is the likely cause? Lisinopril Amlodipine Hydralazine Metoprolol Hydrochlorothiazide Clonidine

Amlodipine

A 74-year-old man with atrial fibrillation and heart failure needs rhythm control. Which antiarrhythmic is most appropriate? Amiodarone Propafenone Quinidine Sotalol Verapamil Flecainide

Amiodarone

A 50-year-old man with hypertension is started on hydrochlorothiazide. Which metabolic effect is a concern? Hypernatremia Hypocalcemia Hyperuricemia Hyperkalemia Hypokalemia Hypermagnesemia

Hypokalemia

A 68-year-old woman with recurrent AF is prescribed warfarin. Which test is used to monitor anticoagulation? aPTT Anti-Xa assay Bleeding time D-dimer PT/INR Platelet count

PT/INR

A 63-year-old man with hypertension and chronic kidney disease (eGFR 30 mL/min) should avoid which drug? Lisinopril Losartan Amlodipine Metoprolol Hydrochlorothiazide Furosemide

Hydrochlorothiazide

A 58-year-old woman develops lupus-like syndrome after prolonged use of an antihypertensive. Which drug is the culprit? Spironolactone Hydralazine Enalapril Clonidine Metoprolol Amlodipine

Hydralazine

A 72-year-old man with AF and structural heart disease requires antiarrhythmic therapy. Which class is contraindicated? Class III Class II Class IV Class I C Digoxin Class I A

Class I C

A 60-year-old woman presents with resistant hypertension despite three drugs. Which secondary cause should be suspected? Hypothyroidism Hypocalcemia COPD Peptic ulcer disease Renal artery stenosis Gout

Renal artery stenosis

MISC - Long Quiz (Prelims) Flashcards

(100 cards)