8/14/2019 00020___ffd679309e368d5044a0cda151c7ff8c
1/1
1
CHAPTER 1
Internal Medicine
Questions
Questions 1 through 4
A 45-year-old male comes to your office for his firstannual
checkup in the last 10 years. On first impres-sion, he appears
overweight but is otherwise
healthy and has no specific complaints. He has abrother with
diabetes and a sister with high bloodpressure. Both of his parents
are deceased and hisfather died of a stroke at age 73. He is a
long-standingheavy smoker and only drinks alcohol on
specialoccasions. On physical examination, his blood pres-sure is
166/90 in the left arm and 164/88 in the rightarm. The rest of the
examination is unremarkable.He is concerned about his health and
does not wantto end up on medication, like his siblings.
1. Regarding your initial recommendations, whichof the following
would be most appropriate?
(A) You should take no action and ask himto return to the clinic
in 1 year for arepeat blood pressure check.
(B) You should immediately start him on anoral antihypertensive
medication andask him to return to the clinic in 1 week.
(C) You should advise him to stop smoking,start a strict diet
and exercise routinewith the goal of losing weight, andreturn to
the clinic in 6 months.
(D) You should consider starting a workupfor potential causes of
secondaryhypertension.
(E) You should screen him for diabetes andevaluate him for other
cardiovascular riskfactors before proceeding any further.
2. In the initial evaluation of a patient such asthis, which of
the following should be routinely
recommended?
(A) a urine microalbumin/creatinine ratio
(B) an echocardiogram
(C) thyroid function tests
(D) renal function tests (serum creatinine
and blood urea nitrogen [BUN])(E) an exercise stress test
3. Which of the following describes the patientsblood pressure
status?
(A) normal blood pressure
(B) prehypertension
(C) stage 1 hypertension
(D) stage 2 hypertension
(E) stage 3 hypertension
4. Your patient returns to clinic a few weeks laterfor a
follow-up appointment. Despite havinglost 3 lbs and increasing his
activity to walking2 mi three times per week, his blood
pressureremains elevated at 162/92. His initial evalua-tion
revealed a fasting blood sugar of 156 anda hemoglobin (Hgb) A1C of
7.5. Along withstarting hypoglycemic medications to controlhis
diabetes, you recommend that he take anantihypertensive medication.
At this point, you
decide to start the patient on hypoglycemicmedications to
control his diabetes. What otherintervention is appropriate at this
time?
(A) allow more time for the patient topractice lifestyle
modifications
(B) start treatment with an angiotensin-converting enzyme (ACE)
inhibitor only
(C) start treatment with a thiazide diuretic only
(D) start treatment with a beta-blocker only
(E) start treatment with a two-drug
combination
Copyright 2008by The McGraw-Hill Companies, Inc. Click here for
terms of use.
