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Hypertension Kidney Stones
Hypercholestrolemia
The prevalence of "true" treatmentresistant 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 exercise
Aerobic exercise is more effective than resistance
exercise
Several short bouts of exercise are more effective
than one longer bout
One 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 heparininduced 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 erythropoietinsecreting 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 activity
Decreased antibody titers
Poor circulation
Loss of natural barriers
Diminished cough reflex
Problems 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 vancomycinresistant enterococci (VRE)
before cultures and sensitivities
are known includes which of the
following?AmpicillinClindamyci
nGentamicinA 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 lowdensity 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 LDLC
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-lowdensity 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 statinassociated necrotizing myopathy
is _______ to
immunosuppression.
A) Responsive
B) Not responsive
Answer
• A) Responsive