12-13-2009, 09:48 AM
The following vignette applies to the next 3 items.
Patient History
Sex: Male
Age: 53 years
Sociodemographic information: African-American high school teacher, married, no tobacco use, history of heavy alcohol use but not for the past 10 years
Medical history: Hypertension; peptic ulcer disease 15 years ago; pneumonia-related hospitalization 15 years ago; no known drug allergies
Family history: Mother died of renal failure due to diabetes and hypertension at age 69 years; father died of heart failure and hypertension; two sisters have hypertension
Current medications/drug information: One aspirin tablet daily
Today's Visit
Height: 185 cm (6 ft 1 in)
Weight: 87 kg (192 lb)
Vital signs:
Temperature 36.8°C (98.2°F) Respirations 16/min
Pulse 88/min, regular Blood pressure 150/95 mm Hg
Physical examination: Blood pressure is equal in both arms, fundi show arteriolar narrowing; remainder of physical examination is normal
Laboratory studies: Electrocardiogram shows normal sinus rhythm and left ventricular hypertrophy
The patient whose chart is shown comes to the office for the first time because he has been transferred to your managed care organization. He had been taking a blood pressure medication but explains that he ran out of it 8 months ago. He did not make an appointment until now because, he says, "I just never got to it." His wife persuaded him to seek care now. He tells you that he requested his previous records be sent to you but they have not arrived.
Item 1 of 3
7. Which of the following is the most appropriate pharmacotherapy for this patient?
A) Clonidine
B) Enalapril
[C) Hydrochlorothiazide]
D) Nifedipine
E) Terazosin
tem 2 of 3
8. The patient returns to the office in 1 week for a follow-up visit. He says he has a cold with cough, nasal congenstion and a scratchy throat. Blood pressure in now 140/85 mm Hg. On physical examination lungs are clear and there is no peripheral edema. Regarding over-the-counter medications for this patient's cold, he should be cautioned to avoid which of the following?
A) Chlorpheniramine
B) Dextromethorphan
C) Guaifenesin
D) Oxymetazoline
[E) Pseudoephedrine]
Item 3 of 3
9. Regarding his blood pressure, which of the following is the most appropriate management?
[A) Add a second antihypertensive medication to the regimen]
B) Add potassium chloride supplements to the medication
C) Change the antihypertensive medication
D) Continue with the current regimen
E) Increase the dose of the prescribed medication