Nokea
A 56-year-old man presented to his primary care physician complaining of difficulty urinating. Digital rectal exam reveals an enlarged prostate. The patient is started in a trial of Terazosin, after which his symptoms improve dramatically. Which of the following describes terazosin's drug class?
- A. Alpha1-adrenergic antagonist
- B. Alpha2-adrenergic antagonist
- C. Beta2-adrenergic agonist
- D. Beta2-adrenergic antagonist
Correct Answer: A
Rationale: Terazosin, an alpha1-adrenergic antagonist, relaxes prostate smooth muscle.
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Which of the following is NOT a typical sign or symptom of right-sided heart failure?
- A. Jugular venous distention
- B. Persistent cough
- C. Weight gain
- D. Crackles
Correct Answer: B
Rationale: Persistent cough (B) and crackles (D) are more typical of left-sided heart failure due to pulmonary congestion. Right-sided heart failure typically presents with jugular venous distention (A), weight gain (C), and nocturia (E), while orthopnea (F) is more left-sided.
IV sodium nitroprusside is ordered for a patient with acute pulmonary edema. During the first hours of administration, the nurse will need to titrate the nitroprusside rate down if the patient develops
- A. ventricular ectopy
- B. a dry, hacking cough
- C. a systolic BP below 90 mm Hg
- D. a heart rate below 50 beats/min
Correct Answer: C
Rationale: Sodium nitroprusside is a potent vasodilator and the major adverse effect is severe hypotension. Coughing and bradycardia are not adverse effects of this medication. Nitroprusside does not cause increased ventricular ectopy.
Regarding arrhythmias, which is TRUE?
- A. The PR interval is shortened but the QRS normal in length in Lown Ganong Levine syndrome
- B. With respect to the long QT syndrome, the genetic defect can occur in both Ca2+ and K+ channels
- C. In atrial fibrillation, the atria beat at 200-300bpm, with the ventricles varying from 80-160/minute (irregular) depending on variable AV conduction
- D. Ventricular premature beats are never benign
Correct Answer: C
Rationale: In atrial fibrillation, the atria beat rapidly and irregularly, leading to variable ventricular response rates.
A 68-y old male with a longstanding history of cigarette smoking presents with a 3-month history of progressive shortness of breath and dyspnea on exertion. The symptoms have been ongoing and indolent. He reports chronic cough productive of his usual yellow sputum. Physical exam is notable for normal vital signs, prolonged expiratory phase and wheeze bilaterally, elevated jugular venous pressure, and moderate pedal edema. Hematocrit 49%. Which of the following is most likely to prolong his survival?
- A. Phosphodiesterase-4 inhibitor
- B. Oral glucocorticoid
- C. Inhaled anticholinergic
- D. Oxygen
Correct Answer: D
Rationale: This patient likely has COPD with cor pulmonale (elevated JVP, edema). Long-term oxygen therapy is proven to prolong survival in hypoxemic COPD patients by reducing pulmonary hypertension and improving tissue oxygenation, as shown in trials like the NOTT and MRC studies.
If the Purkinje fibers, situated distal to the AV junction, become the pacemaker of the heart, what is the expected heart rate?
- A. 30/min
- B. 50/min
- C. 60/min
- D. 70/min
Correct Answer: A
Rationale: Purkinje fibers as pacemakers produce a rate of 20-40 beats/min, with 30/min being typical.