Answer 10

10.  Choice B is the correct answer.  Elevated bradykinnin levels are responsible for the dry cough in patients that take ACE inhibitors.  It should be thought of as a class effect. Switching the patient to an Angiotensin Receptor Blocker would help this.  There is no elevated bradykinnin levels with that class.  Prostaglandin levels are increased with ACE inhibitors and ARB’s but do not cause the dry cough.  Elevated cyclooxygenase levels and catecholamine levels have nothing to do with the dry cough or ACE inhibitors.  

  

Question 10

10.  Your patient is a 53 year old male that presents with a dry cough and  has been recently started on lisinopril for hypertension.  Which of the following is the best explanation for the patients symptoms?

A.  Elevated Prostaglandin levels
B.  Elevated Bradykinnin levels
C.  Elevated cyclooxygenase levels
D.  Elevated catecholamines

Answer 9

9.  Choice B is the correct answer.  Alcohol ingestion is not identified as a modifiable risk factor.  In fact mild alcohol intake may be beneficial in helping heart disease.  Diabetes, smoking, hypertension are modifiable risk factors.

Question 9

9.  Which of the following is not recognized as a modifiable risk factor in the prevention of coronary disease?

A.  Diabetes
B.  Alcohol intake
C.  Smoking
D.  Hypertension

Answer 8

8.  Choice C is the correct answer.  Prinzmetal’s angina or Variant angina is caused by spasm of the coronary arteries.  It tends to occur at rest.  Verapamil best targets it because it helps dilate arteries. Nitroglycerin has little activity on arteries.  Metoprolol is useful in regular angina because it helps decrease myocardial demand by blocking the effect of catecholamines.  Lisinopril helps with after load reduction.  

Question 8

8.  Which of the following is the medication of choice for treating Prinzmetal’s Angina?

A.  Metoprolol

B.  Lisinopril

C.  Verapamil

D.  Nitroglycerin

Answer 7

7.  Choice C is the correct answer.  This patient with his presenting symptoms and impaired renal function needs a TEE.  CT with IV contrast is contraindicated when the creatinine is greater than 2.0.  The above two are the only two options for screening for a dissection.  A normal ECHO is not going to be able give you any information rather the patient is dissecting or not.  Taking the patient to surgery without a definitive diagnosis is dangerous and should not be done.