decompansated heart failure

eman mousTAFA
Quiz by eman mousTAFA, updated more than 1 year ago
eman mousTAFA
Created by eman mousTAFA over 4 years ago
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american board quiz

Resource summary

Question 1

Question
D.W. is a 50-year-old African American man being discharged from the hospital after an acute MI. His medical history is significant for hypertension. He was taking hydrochlorothiazide 25 mg/day before hospitalization. An echocardiogram before discharge shows an LVEF of more than 60%. His vital signs include BP 150/94 mm Hg and HR 80 beats/minute. Which one of the following is the best approach for managing his hypertension?
Answer
  • A. Discontinue hydrochlorothiazide and add diltiazem.
  • B. Continue hydrochlorothiazide and add metoprolol.
  • C. Discontinue hydrochlorothiazide and add losartan.
  • D. Continue hydrochlorothiazide and add losartan.

Question 2

Question
L.S. is a 48-year-old woman with alcohol-induced cardiomyopathy. Her most recent LVEF is 20%; her daily activities are limited by dyspnea and fatigue (NYHA class III). Her medications include lisinopril 20 mg/ day, furosemide 40 mg 2 times/day, carvedilol 12.5 mg 2 times/day, spironolactone 25 mg/day, and digoxin 0.125 mg/day. She has been on these doses of medications for the past month. Her most recent laboratory results include the following: sodium (Na) 140 mEq/L, potassium (K) 4.0 mEq/L, chloride 105 mEq/L, bicarbonate 26 mEq/L, blood urea nitrogen (BUN) 12 mg/dL, serum creatinine (SCr) 0.8 mg/dL, glucose 98 mg/dL, calcium 9.0 mg/dL, phosphorus 2.8 mg/dL, magnesium (Mg) 2.0 mEq/L, and digoxin 0.7 ng/mL. Her vital signs today include BP 112/70 mm Hg and HR 68 beats/minute. Which one of the following is the best approach for maximizing the management of her HF?
Answer
  • A. Increase carvedilol to 25 mg 2 times/day.
  • B. Increase lisinopril to 40 mg/day.
  • C. Increase spironolactone to 50 mg/day.
  • D. Increase digoxin to 0.25 mg/day.

Question 3

Question
M.L. is a 32-year-old white woman with a history of type 1 diabetes mellitus and hypertension. She takes lisinopril 10 mg/ day and uses insulin. During her clinic visit, a pregnancy test is performed to follow up on a positive home pregnancy test the patient performed. The results confirm a pregnancy. Her vital signs today include BP 162/105 mm Hg and HR 88 beats/ minute. Which one of the following is the best therapy for her BP at this time?
Answer
  • A. Increase lisinopril to 20 mg/day and add hydrochlorothiazide.
  • B. Continue the lisinopril 20 mg/day and add hydralazine.
  • C. Discontinue lisinopril and begin methyldopa.
  • D. Discontinue lisinopril and add losartan.

Question 4

Question
R.S., a 58-year-old woman with a history of hypertension, coronary artery disease(CAD) (myocardial infarction [MI] 4 months ago), and dyslipidemia, presents to the clinic for follow-up. She is without complaints and specifically has no symptoms of dyspnea or edema. An echocardiogram reveals a left ventricular ejection fraction (LVEF) of 35%, New York Heart Association (NYHA) classification I. Her drugs include aspirin 325 mg/day, metoprolol succinate 200 mg/day, and simvastatin 20 mg every night. Her vital signs include heart rate (HR) 58 beats/ minute and blood pressure (BP) 138/80 mm Hg. Her lungs are clear, and her laboratory results are within the normal reference range. Which one of the following is the best management of R.S.'s drug therapy?
Answer
  • A. Continue current therapy.
  • B. Initiate digoxin 0.125 mg/day.
  • C. Initiate spironolactone 25 mg/day.
  • D. Initiate lisinopril 5 mg/day.

Question 5

Question
B.C. is a 50-year-old man admitted for ADHF (acute decompensated heart failure). At baseline, he has NYHA (New York Heart Association) class II heart failure (HF). During the past few days, he has been short of breath at rest. He is initiated on furosemide 100 mg intravenous bolus but has a history of diuretic resistance. B.C.'s baseline vital signs include a blood pressure (BP) of 89/72 mm Hg and heart rate (HR) of 85 beats/minute. Which one of the following is the next best option for treating B.C.'s decompensated HF?
Answer
  • A. Changing to a furosemide infusion.
  • B. Initiating intravenous vasodilatory medications.
  • C. Initiating intravenous inotropic medications.
  • D. Switching to a different loop diuretic.

Question 6

Question
A.S. is a 56-year-old African American man with a long history of poorly controlled HTN secondary to medication nonadherence and subsequent dilated cardiomyopathy (LVEF 35%). He is assessed in a community health clinic today and reports not having taken his medications for the past week. A.S. is asymptomatic, and his examination is unremarkable except for BP 180/120 mm Hg and HR 92 beats/minute. All laboratory values are within normal limits except for a serum creatinine (SCr) of 1.4 mg/dL and urinalysis with 2+ proteinuria. Which one of the following therapeutic options would be best to manage A.S.'s condition in the clinic?
Answer
  • A. Nifedipine 10 mg sublingually.
  • B. Clonidine 0.2 mg orally.
  • C. Captopril 12.5 mg orally.
  • D. Labetalol 200 mg orall

Question 7

Question
EBM of HF with β-blockers is associated with clinically significant improvement in morbidity and mortality. Which one of the following is the best β-blocker to initiate in a patient with HF?
Answer
  • A. Atenolol 12.5 mg once daily.
  • B. Propranolol 10 mg 3 times/day.
  • C. Carvedilol 3.125 mg 2 times/day.
  • D. Metoprolol XL 100 mg/day.

Question 8

Question
48-year-old man who has diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (HL) is seen in the pharmacotherapy clinic. Vital signs today include blood pressure (BP) 148/84 mm Hg, heart rate (HR) 64 beats/minute, and respiratory rate (RR) 16 breaths/minute. His current therapies include aspirin 81 mg orally daily, lisinopril 20/hydrochlorothiazide (HCTZ) 12.5-mg tablets 2 tablets orally daily, and pravastatin 40 mg orally daily. What is the best therapy for this patient?
Answer
  • • A. Doxazoin240 mg orally daily
  • • B. Carvedilol 6.25 mg orally twice daily
  • • C. Aliskiren 150 mg orally daily
  • • D. Amlodipine 5 mg orally daily

Question 9

Question
a 58-year-old woman with a history of hypertension, coronary artery disease (CAD), (myocardial infarction [MI] 4 months ago), and dyslipidemia, presents to the clinic for follow-up. She is without complaints and has no signs or symptoms of dyspnea or edema. An echocardiogram reveals a left ventricular ejection fraction (LVEF) of 35%. She is New York Heart Association (NYHA) class III. Her medications include aspirin 81 mg/day, metoprolol succinate 150 mg/day, and simvastatin 20 mg every night. Her vital signs include heart rate (HR) 58 beats/minute and blood pressure (BP) 138/80 mm Hg. Her lungs are clear, and laboratory results are within normal limits. Given her history and physical examination, which is the most appropriate modification to R.S.’s current drug therapy?
Answer
  • A. Continue current therapy.
  • B. Initiate digoxin 0.125 mg/day.
  • C. Initiate spironolactone 25 mg/day.
  • D. Initiate lisinopril 5 mg/day

Question 10

Question
. A 65-year-old woman with long-standing hypertension has dyspnea associated with the classic symptoms and physical findings of CHF. Her chest x-ray shows signs of pulmonary edema. Her echocardiogram,however, shows slightly thickened myocardium and a normal left ventricular ejection fraction. Adiagnosis of diastolic dysfunction is made Which of the following would improve this patient's symptoms?•
Answer
  • ❏ A. Digoxin•
  • ❏ B. Furosemide•
  • ❏ C. Enalapril•
  • ❏ D. Metoprolol•
  • ❏ E. None of the above
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