Hypertension Kidney Stones Hypercholestrolemia

The prevalence of "true" treatment-resistant hypertension (HTN) is:

 A) Unknown B) Approximately 20% in patients

with HTN C) 10% to 15% in patients without diabetes mellitus (DM) or chronic

kidney disease (CKD) D) Up to 33% in patients with DM

and/or CKD

Answer

•  A) Unknown

Which of the following is a cause of pseudoresistance to HTN

treatment? A) Poor adherence with prescribed medications

 B) Inaccurate measurement of blood pressure (BP)

 C) "White-coat" HTN D) All the above

Answer

•  D) All the above

All the following are associated with resistant HTN, except:

 A) Older age B) Obesity

 C) White ethnicity D) Residence in southeastern

United States

ANswer

• C) White ethnicity

Which of the following has not been shown to interfere

with control of BP? A) Amphetamines B) Coenzyme Q10

 C) Alcohol D) Oral contraceptives

Answer

•  B) Coenzyme Q10

Studies suggest that cyclooxygenase (COX)-2 selective inhibitors induce

_______ hypertensive responses than COX-2 nonselective

inhibitors. A) Fewer B) Milder

 C) Stronger D) A and B

Answer

•  D) A and B

Measurements of urinary metanephrine and normetanephrine

are the recommended screening tests for which of the following causes of

secondary HTN? A) Cushing disease

 B) Glucocorticoid remediable aldosteronism

 C) Renal artery stenosis D) Pheochromocytoma

Answer

•  D) Pheochromocytoma

Which of the following is not recommended as a pharmacologic treatment of resistant

HTN? A) Combining agents with different

mechanisms of action B) Using a long-acting thiazide

 C) Adding an aldosterone receptor antagonist as a "last resort"

 D) Using a loop diuretic in patients with stage 4 CKD

Answer

• C) Adding an aldosterone receptor antagonist as a "last resort“

• Add it earlier

A weight loss of ≈10 kg plus regular exercise can reduce a

patient's BP by: A) 5 to 10 mm Hg B) 5 to 20 mm Hg C) 8 to 15 mm Hg

 D) 20 to 30 mm Hg

Answer

•  D) 20 to 30 mm Hg

Sedentary patients who initiate exercise therapy for HTN should

begin with: A) 10-min walks twice per week B) 15 min of moderate intensity

activity 5 to 7 days/wk C) 30 min of brisk walking 5

days/wk D) 30 to 45 min of moderate

activity 3 days/wk

Answer

•  A) 10-min walks twice per week

Choose the correct statements about the effects of exercise on reduction of BP.Resistance exercise is

more effective than aerobic exerciseAerobic exercise is more effective than resistance

exerciseSeveral short bouts of exercise are more effective

than one longer boutOne longer bout of exercise is more effective than

several short bouts

 A) 1,3 B) 2,3 C) 1,4 D) 2,4

Answer

• Aerobic exercise is more effective than resistance exercise

• Several short bouts of exercise are more effective than one longer bout

•  B) 2,3

 Which of the following can be associated with comorbid

insomnia? A) Depression

 B) Gastroesophageal reflux disease

 C) Menopausal symptoms D) All the above

Answer

•  D) All the above

Periodic limb movement disorder A) Diagnosed by polysomnography; treated

with dopaminergic agents B) Diagnosed by clinical history and physical

examination; begins or worsens with rest C) Occurs during REM sleep; muscle atonia;

more common in older women D) Tends to occur in neurodegenerative

disorders and in older men; no muscle atonia

Answer

• A) Diagnosed by polysomnography; treated with dopaminergic agents

Restless legs syndrome A) Diagnosed by polysomnography; treated with

dopaminergic agents B) Diagnosed by clinical history and physical

examination; begins or worsens with rest  C) Occurs during REM sleep; muscle atonia; more

common in older women D) Tends to occur in neurodegenerative disorders

and in older men; no muscle atonia

Answer

• B) Diagnosed by clinical history and physical examination; begins or worsens with rest 

Rapid eye movement (REM) sleep behavior disorder

 A) Diagnosed by polysomnography; treated with dopaminergic agents

 B) Diagnosed by clinical history and physical examination; begins or worsens with rest

 C) Occurs during REM sleep; muscle atonia; more common in older women

 D) Tends to occur in neurodegenerative disorders and in older men; no muscle atonia

Answer

• D) Tends to occur in neurodegenerative disorders and in older men; no muscle atonia

Choose the correct statement about cognitive behavioral therapy for

insomnia. A) Rarely as effective as medications

 B) Often preferred over medications by patients

 C) Duration of effects much shorter than that of medications

 D) Not recommended for patients with depression

Answer

• B) Often preferred over medications by patients

 Which of the following is least associated with heparin-

induced thrombocytopenia? A) Unfractionated heparin B) Low molecular weight

heparin C) Fondaparinux

 D) Combination of any of above

Answer

•  C) Fondaparinux

Which of the following types of kidney stones is more common in

women than in men? A) Calcium oxalate

 B) Struvite C) Uric acid D) Cystine

Answer

•  B) Struvite

Which of the following is most sensitive for identifying kidney

stones? A) Plain film radiography

 B) Computed tomography (CT) C) Intravenous (IV) pyelography

 D) Ultrasonography

Answer

•  B) Computed tomography (CT)

Uric acid stones are visible on plain film radiography but not on

CT. A) True B) False

Answer

•  B) False

Which of the following was shown to be least effective in the treatment of pain associated with

kidney stones? A) IV fentanyl B) IV ketorolac

 C) Intramuscular ketorolac D) Hydromorphone

Answer

•  C) Intramuscular ketorolac

Which of the following is recommended for facilitating passage of proximal stones?

 A) Tamulosin B) Nifedipine C) Deflazacort D) Diclofenac

Answer

• A) Tamulosin

 All the following beverages are associated with reduced stone

formation, except: A) Coffee

 B) Tea C) Alcohol

 D) Grapefruit juice

Answer

• D) Grapefruit juice

Which of the following was recommended as the treatment of choice for the management of hypertension in patients with end-stage renal disease

(ESRD)? A) Direct renin inhibitors

 B) Angiotensin-converting enzyme inhibitors and angiotensin receptor

blockers C) β-blockers

 D) Calcium channel blockers

Answer

• B) Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers

High hemoglobin levels in patients with ESRD are related to

higher incidence of stroke, myocardial infarction, access

thrombosis, and erythropoietin-secreting tumor.

 A) True B) False

Answer

•  A) True

Choose the correct statement about phosphate binders in hyperparathyroidism.

 A) Calcium acetate associated with severe reflux disease

 B) Sevelamer most effective and has lowest pill burden

 C) Calcimimetics highly effective and approved for parathyroid hormone suppression

 D) Lanthanum carbonate associated with excess cardiovascular death and hyperlipidemia

Answer

• C) Calcimimetics highly effective and approved for parathyroid hormone suppression

Primary care of patients with ESRD should involve:

 A) Effective communication between nephrologist and primary care physician B) Understanding of drug dosing, cancer

screening, and pain management C) Coordination of end-of-life care

 D) All the above 

Answer

•  D) All the above 

Which of the following is the most common source of infection

in the elderly? A) Skin and soft tissue B) Gastrointestinal tract C) Genitourinary tract

 D) Lower respiratory tract

Answer

• C) Genitourinary tract

Which of the following contribute to immunocompromise in the elderly?Decreased T cell

and B cell activityDecreased antibody titers

Poor circulationLoss of natural barriers

Diminished cough reflexProblems in living and home environment

 A) 1,3,5 B) 2,4,6

 C) 1,2,3,4,5 D) 1,2,3,4,5,6

Answer

•  D) 1,2,3,4,5,6

The following statements about fever in the elderly are true,except:

 A) The elderly have diminished thermoregulatory capacity

 B) Less likely than young individuals to develop hypothermia in response to serious

infections C) Absence of fever should not rule out

consideration of serious infection D) Fever in the elderly should be redefined to

start at lower oral and rectal temperatures

Answer

• B) Less likely than young individuals to develop hypothermia in response to serious infections

Infection should be considered in the elderly in the presence of

delirium and tachypnea. A) True B) False

Answer

• A) True

Which of the following is a risk factor in the development of venous thromboembolism? A) Long-distance air travel

 B) Compound heterozygosity for factor V Leiden and prothrombin

mutation C) Elevated factor VIII

 D) All the above

Answer

•  D) All the above

Which of the following signs can be reliably used to diagnose urinary tract infection in the

elderly? A) Fever

 B) Foul-smelling urine C) White blood cell count

 D) None of the above

Answer

•  D) None of the above

Which of the following is the most common causative

organism for pneumonia in the elderly?

 A) Haemophilus influenzae  B) Staphylococcus aureus 

 C) Streptococcus pneumoniae D) Mycoplasma pneumoniae

Answer

• C) Streptococcus pneumoniae

Initial therapy for vancomycin-resistant enterococci (VRE)

before cultures and sensitivities are known includes which of the

following?AmpicillinClindamycinGentamic

inA fluoroquinolone A) 1,3 B) 2,4

 C) 1,2,3 D) 4

Answer

• Ampicillin Gentamicin

•  A) 1,3

Long-term dialysis within 30 days is a risk factor for which of

the following cases? A) VRE

 B) Health care-associated pneumonia

 C) Clostridium difficile colitis D) Hospital-acquired pneumonia

Answer

• B) Health care-associated pneumonia

In C difficile colitis, the more severe the presentation, the more

likely diarrhea is present. A) True B) False

Answer

• B) False

Which of the following tests is the gold standard for the

diagnosis of C difficile colitis? A) Enzyme-linked immunoassay

 B) Computed tomography C) Cytotoxicity assay

 D) Stool culture

Answer

• C) Cytotoxicity assay

Dual antiplatelet therapy with aspirin and clopidogrel is

strongly recommended for stroke prevention in older patients with

atrial fibrillation (AF). A) True B) False

Answer

•  B) False

Cholinesterase inhibitors increase the risk for all the following,except:

 A) Syncope B) Bradycardia

 C) Falls D) Stroke

Answer

•  D) Stroke

The Rate Control Efficacy in Permanent Atrial Fibrillation

(RACE II) study found that strict rate control produced slightly better outcomes than lenient control in patients with AF,

including those >80 yr of age. A) True B) False

Answer

• B) False

In the treatment of mixed dyslipidemia, there is currently

 no target value for: A) Triglycerides (TGs) or low-density lipoprotein cholesterol

(LDL-C) B) TGs or high-density

lipoprotein cholesterol (HDL-C) C) LDL-C or HDL-C

Answer

• B) TGs or high-density lipoprotein cholesterol (HDL-C)

Compared with patients taking metformin or placebo, patients with impaired fasting

glucose and impaired glucose tolerance who achieved an initial loss of body weight of 7%

to 10% (via diet plus 150 min of moderate exercise 3 days/wk) had _______ of

progression to diabetes mellitus, according to a study by the Diabetes Prevention Program.

 A) The same rate B) A slightly faster rate C) A much slower rate

Answer

• C) A much slower rate

 Choose the incorrect statement about hypertriglyceridemia and the risk for coronary heart

disease (CHD). A) Increases in TG levels do not correlate closely

with increased risk for CHD B) Increased TG levels correlate with increased risk for CHD, except in cases of very low LDL-C levels

 C) Increased TG levels tend to correlate with an increased risk for CHD only at extreme levels of

LDL-C D) Increased TG levels correlate with increased risk

for CHD at all levels of LDL-C

Answer

•  D) Increased TG levels correlate with increased risk for CHD at all levels of LDL-C

In patients with hypertriglyceridemia, lipid and lipoprotein metabolism is characterized

by all the following, except: A) Increased secretion of TG

 B) Increased conversion of very-low-density lipoprotein (VLDL) to LDL

 C) Impaired function of lipoprotein lipase D) Production of small dense LDL and HDL

particles

Answer

• B) Increased conversion of very-low-density lipoprotein (VLDL) to LDL

Studies consistently show that _______ is superior to _______ for assessment of cardiovascular

(CV) risk and as the goal for therapy.

 A) Non-HDL-C; LDL-C B) LDL-C; non-HDL-C

Answer

•  A) Non-HDL-C; LDL-C

When used with a statin, which of the following agents increases the risk for associated myopathy?

 A) Niacin B) High-dose prescription fish

oil C) Fenofibrate D) Gemfibrozil

Answer

•  D) Gemfibrozil

It is estimated that approximately _______ million people in the United States currently take a

statin. A) 15.8 B) 29.7 C) 43.6 D) 68.3

Answer

• C) 43.6

Choose the incorrect statement about the clinical aspects of statin myopathy.

 A) Toxicity associated with statin use is rare

 B) Nonspecific muscle pain and weakness are more common than is frank

rhabdomyolysis C) Myalgias account for ≈25%

 D) Muscle symptoms and high serum creatine kinase always resolve quickly

with statin withdrawal

Answer

•  D) Muscle symptoms and high serum creatine kinase always resolve quickly with statin withdrawal

Perifascicular atrophy is pathognomonic for which of the

following conditions: A) Toxic myopathy B) Dermatomyositis

 C) Becker muscular dystrophy D) Necrotizing myopathy

Answer

• B) Dermatomyositis

Evidence indicates that statin-associated necrotizing myopathy

is _______ to immunosuppression.

 A) Responsive B) Not responsive

Answer

•  A) Responsive