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2. You are evaluating a 48-year-old man with liver His labora- tory evaluation is as follows:
AST: 298 u/L (H) ALT: 144 u/L (H)
Alk Phos: 140 u/L (H) Bilirubin: 2.3 mg/dL (H) GGT: 220 u/L (H)
What is the most likely cause?
3. You are evaluating a 45-year-old man with liver His labora- tory evaluation reveals the following:
AST: 52 u/L (H) ALT: 56 u/L (H)
Alkaline phosphatase: 132 u/L (H) GGT: 188 u/L (H)
Albumin: 2.9 g/dL (L) Bilirubin: 3.5 mg/dL (H) Prothrombin time: 14.9 sec (H)
Which of the following lab results is more likely to suggest chronic liver disease?
4. You have just diagnosed a 46-year-old woman with The patient also has asthma, arthritis, hypertension, depression, and hypothy- roidism. Of the following, which medication should be avoided in this patient?
5. You are seeing a patient who has end-stage liver disease with cirrho- sis due to hepatitis What will be her most likely cause of death?
6. You are taking care of a 47-year-old woman with She asks you about transplantation as a definitive treatment option. Which of the following is an absolute contraindication to transplantation?
7. You are evaluating a 58-year-old man with coronary artery disease, hypertension and liver disease due to a history of He is pre- senting to you with shortness of breath, and on examination has hepatomegaly. To help determine the cause, you ask the patient to lie down, and while looking at his jugular veins, compress his right upper quadrant for 1 minute. If he has congestive heart failure, which of the fol- lowing signs would you expect to see?
8. You are assessing a 54-year-old woman with suspected heart You are auscultating her heart to listen for an S3 gallop which you know to be a common finding in heart failure. Which of the following will give you the optimal chance of hearing a S3 gallop?
9. You are caring for a patient, who continues to smoke despite having She also has poorly controlled diabetes and hypertension with left ventricular hypertrophy. She presents to your office with shortness of breath. On physical examination, she appears to be in mild respiratory distress, and has 2+ pitting edema bilaterally. She has inspiratory and expiratory wheezes bilaterally, with dullness to percussion at the bases of her lungs. You order a stat b-type natriuretic peptide (BNP) and it comes back elevated at 498 pg/mL (normal is less than 100). Which of the following is the most likely diagnosis?
10. You have diagnosed a 66-year-old woman with heart She has a history of hypertension, but has never had heart failure before. Which of the following tests is not routinely indicated?
11. You are seeing a patient in follow up after being She ini- tially presented to the emergency room with dyspnea and was found to be in congestive heart failure. They admitted her for diuresis and initiation of appropriate first-line therapy. Since being released, she reports that she is comfortable at rest, but that ordinary activity results in mild dyspnea. According to the New York Heart Association Functional Classification, which class of heart failure best describes this patient?
12. A 62-year-old woman comes to your office complaining of She has a history of chronic obstructive pulmonary disease, hypertension, and diabetes. She also smokes and drinks heavily. Her evaluation reveals that she is in heart failure. Which of the following interventions will lead to functional improvement in this patient?
13. You have been treating a 61-year-old man for chronic heart In his baseline state, he is comfortable at rest, but experiences some symp- toms of heart failure with ordinary activity. You are having difficulty achiev- ing optimal volume status using furosemide (Lasix) alone, and want to add another diuretic. Which of the following would be the best diuretic to add?
14. You have diagnosed a 49-year-old man with congestive heart failure due to left ventricular systolic In addition to acute diuresis, which of the following is the best first-line agent to use for treatment, in the absence of contraindications?
15. After starting lisinopril for NYHA Class II heart failure due to left ven- tricular systolic dysfunction, a 69-year-old woman develops Which of the following alternative therapies would be best for this patient?
16. You are treating a patient for heart failure due to systolic dysfunction with daily diuretics and an ACE He is continuing to have symp- toms with activity, but they do not seem to be related to volume overload. Adding which of the following medications has been shown to reduce symptoms and improve mortality?
17. You take care of a 56-year-old woman whose 75-year-old mother just began living with The mother has been diagnosed with Alzheimer’s disease. The daughter is trying to learn all she can about the illness and asks you what causes it. Which of the following is believed to be the criti- cal pathologic problem involved in Alzheimer’s disease?
18. Which of the following is the most consistent neurochemical change associated with Alzheimer’s disease?
19. You are concerned that one of your 65-year-old patients is develop- ing Which of the following, if present, would lead you to suspect dementia rather than delirium or depression?
20. You are caring for a 79-year-old woman with symptoms suggesting Alzheimer’s Which of the following clinical features of Alzheimer’s disease is most likely to remain intact until the late stages of the disease?
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