NMS Q&A Family Medicine

chap ter 10HypertensionExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Each of the following is one of the actions of hydrochlorthiazideexcept for one. Which among thoselisted does not apply to hydrochlorthiazide (hctz)?(A) Distal loop diuresis(B) Reduction of insulin resistance(C) Kaliuresis (excretion of potassium)(D) Natriuresis (excretion of potassium)(E) Preservation of bone calcium2 A 55-year-old Caucasian man has a history of poorlycontrolled hypertension with blood pressure (BP) running165 /105. He is presently on lisinopril 20 mgbid. A routine chemical battery of blood tests showsa blood urea nitrogen (BUN) test result of 40 mg/dL,serum creatinine 2.1 mg/dL, and serum potassium5.1 mEq/L. Which of the following might be the mosteffective as an antihypertensive adjunctive to the currentregimen?(A) Hydrochlorthiazide(B) Capoten(C) Furosemide(D) Triampterene(E) Amiloride3 The antihypertensive category of “alpha 2 receptor stimulants”includes clonidine , methyldopa, and many others.Each of the following is true about this classificationexcept for which one?(A) Antihypertensive effects of alpha 2 stimulants arewrought through reduction of centralsympathetic outflow(B) At high dosages, alpha 2 stimulants elevate BP(C) Alpha2 stimulants are characterized bypredisposition to a hypertensive discontinuancesyndrome(D) Beta-adrenergic blockade works well inconjunction with alpha 2 stimulants(E) Alpha2 stimulants work well in conjunctionwith antihypertensive diuretics4 You have been following a 35-year-old Caucasianman for 5 years as his primary care physician. Duringthose years, the patient has “spiked” his BP severaltimes to levels such as 150/100 when he first arrivedat the office, most often when he was on a tight schedule.Usually the BP has subsided to 110 to 120/70 to80. However, over the past year, more and more timeelapses after the patient’s arrival at the office beforethe BP subsides to normal range, and over the past2 months, the lowest systolic BP level you have foundhas been 145 and the lowest diastolic BP level hasbeen 98. This has occurred despite the patient’s compliancewith your prescribed no-salt-added diet. Thepatient denies headaches, focal weakness, numbness,and bouts of confusion. The man weighs 165 lb(74.74 kg) at a height of 5 ft 10 in (1.77 m). Which ofthe following medication classes would be the leastlikely to be effective as single-drug therapy?(A) Thiazide diuretic(B) Angiotensin-converting enzyme inhibitor(ACEI)(C) Beta-blocking agent(D) Angiotensin-converting enzyme (ACE) receptorblocking agent(E) Verapamil (calcium channel blocker [CCB])5 A 48-year-old African-American man has manifestedBP levels of 150/100, 145/95, and 170/105 on consecutiveseparate days over a 3-week period. He has afamily history of deaths by stroke and renal failure.Which of the following may be the single most propitiouschoice as the first drug to be prescribed?(A) Hydrochlorthiazide(B) Lisinopril (an ACEI)(C) Propranolol (beta-adrenergic blocker)(D) ACE receptor blocking agent(E) Hydralazine (vasodilator)6 Normal BP is presently defined as 140/90. However,therapeutic targets vary with special circumstances.Regarding the black male patient withhypertension, what should be the targeted therapeuticlevel of BP?67