Master the board step 3

Cardiology
When is the goal of therapy an LDL < 70?
a. CHF
b. Diabetes
c. Coronary disease and carotid disease
d. Coronary disease and diabetes
e. Diabetes and hypertension
Step 3 will only ask clear
questions on lipids.
Answer: D. The goal of LDL can be < 70 for patients at the very highest risk of infarction.
This includes those with acute coronary syndromes or the combination of coronary
disease and a very severe risk factor, such as diabetes.
The most common adverse effect of statin medications is liver toxicity.
As many as 1 percent of patients will stop a statin because of its effect on
raising transaminases. Liver function tests should be routinely checked.
Rhabdomyolysis is not the most common adverse effect. There is no routine
indication to check CPK levels.
Sex and the Heart
A man develops erectile dysfunction after an infarction. What is the most common
cause?
a. Metoprolol
b. Nitrates
c. ACE inhibitors
d. Aspirin
e. Anxiety
Answer: E. Anxiety is the most common cause of erectile dysfunction postinfarction.
Although beta blockers may be the most common medication associated with erectile
dysfunction, anxiety is still a more common cause of erectile dysfunction than beta
blockers.
A man develops erectile dysfunction postinfarction. You are planning to start
sildenafil. Which of the following medications must you stop?
a. Metoprolol
b. Nitrates
c. ACE inhibitors
d. Aspirin
Answer: B. Nitrates are contraindicated when medications such as sildenafil are to be
used. When used at the same time, they can cause a dangerous level of hypotension.
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