[MCQs] The Quizzes about Chronic Conditions – Part 6 (20 test)

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Chronic Conditions-6

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Question 1

You are thinking about starting a type 2 diabetic on insulin therapy to improve her glucose Which of the following insulin prepara- tions has the longest duration of action?

A	Aspart (Novolog)
B	Regular
C	Lente
D	Ultralente
E	Glargine (Lantus)

Question 1 Explanation: 

It is important to thoroughly understand the action of the different types of insulin preparations in order to make therapeutic decisions about diabetic patients and their control. Aspart’s duration of action is between 3–5 hours. Regular insulin lasts between 4–12 hours. Lente’s duration is between 10–20 hours, and Lantus’ duration is around 24 hours. The longest duration is with Ultralente,

Question 2

After a period of noncompliance, one of your type 1 diabetics has been hospitalized for diabetic He has required approximately 100 units of insulin in a 24-hour period in the hospital using a sliding scale. You decide to begin split-dose therapy with neutral protamine Hage- dorn (NPH) and regular insulin. How much NPH insulin should be given to this patient in the morning?

A	25 units
B	33 units
C	50 units
D	66 units
E	75 units

Question 2 Explanation: 

There are many methods for determining the appropriate amount of insulin that will be required in type 1 diabetics. One way is to determine the total amount of insulin used while hospitalized, and divide that dose during the day. Two-thirds of the total insulin should be given in the morning, with the remaining one-third in the evening. Each time the patient receives insulin, 75% of the dose should be NPH, and 25% should be regular. In this question, the patient needed 100 units of insulin. Of this, 67 units should be given in the morning, and 33 units should be given in the evening. Of the morning dose, 75% should be NPH. Seventy-five percent of 67 units equals to 50. Therefore, the patient should get 50 units of NPH in the morning and 17 units of regular.

Question 3

You are caring for a type 1 diabetic who has been hospitalized with diabetic ketoacidosis, and determining an appropriate insulin regimen for her. She has required 60 units of insulin per day to maintain adequate con- trol in the hospital. You decide to use insulin glargine (Lantus) and aspart (Lispro) in combination. What should her Lantus dose be?

A	10 units
B	20 units
C	30 units
D	40 units
E	50 units

Question 3 Explanation: 

When using Lantus and Lispro, approximately 40–50% of the total daily insulin requirements should be given as Lantus, with the remaining 50–60% of insulin given as Lispro before each meal, based on a preprandial glucose reading.

Question 4

You have maximized oral therapy for a type 2 diabetic in your She works hard at diet and exercise, and is on maximal doses of oral hypo- glycemics, but her glycosolated hemoglobin is 8.6%. You decide to add insulin to her regimen. She is currently 67 in tall and weighs 100 kg. How much neutral protamine Hagedorn (NPH) should you give her at night as an addition to her current regimen?

A	5 units
B	10 units
C	15 units
D	20 units
E	25 units

Question 4 Explanation: 

Patients with type 2 diabetes may require insulin therapy if diet, exercise and oral hypoglycemic agent do not provide appropriate control. A low dose of NPH is commonly used, estimating 0.1 unit/kg of body weight, as an addition to the current regimen.

Question 5

A 62-year-old woman sees you for preoperative clearance for a right hip Her past medical history is significant for hypertension, chronic kidney disease, osteoarthritis and type 2 diabetes. During your examination, you detect a painless mass in her lower right abdomen. You schecule a CT scan with angiographic contrast. Which one of this patients’ medications should be held prior to her receiving radiocontrast dye?

A	Metoprolol XL 100 mg
B	Metformin ER 1000 mg
C	Lisinopril 20 mg
D	Aspirin 325 mg
E	Pentoxifylline 400 mg

Question 5 Explanation: 

Metformin should be withheld before a procedure with radiocontrast dye, as contrast-induced nephropathy may predispose to developing lactic acidosis if a patient is taking concurrent metformin. It should also be withheld for surgery. It can be restarted immediately after surgery if the person’s renal function is normal and his or her condition is stable.

Question 6

You are caring for a 28-year-old man with dyslipidemia. Specifically, he has hypoalphalipoproteinemia (low high-density lipoprotein). Which of the following interventions is more likely to raise his HDL levels?

A	Cigarette smoking
B	Alcohol in moderation
C	Weight loss
D	Low dietary intake of cholesterol
E	Stress reduction

Question 6 Explanation: 

Alcohol, in moderation, raises HDL cholesterol. Alternatively, cigarette smoking decreases HDL. Being overweight or obese decreases HDL, but weight loss may not raise HDL. Low dietary intake of cholesterol has no impact on HDL. Stress can markedly increase LDL cholesterol, but will not impact HDL.

Question 7

You have performed a screening lipid profile on an otherwise healthy man. His results indicate elevated triglycerides, a low high-density lipopro- tein, a high low-density lipoprotein, an elevated total cholesterol, and an elevated very low-density You’d like to rescreen him in the fasting state. Which of the following laboratory values is likely to decrease in the fasting state?

A	Serum triglycerides
B	High-density lipoprotein
C	Low-density lipoprotein
D	Total cholesterol
E	Very low-density lipoprotein

Question 7 Explanation: 

Blood lipids change acutely in response to food intake. The triglyceride level is lowest in the fasting state, and rises by an average of 50 mg/dL portprandially. As the TG level rises, the total and LDL cholesterol each fall. Thus total and LDL cholesterol tend to be higher when fasting. HDL varies little whether fasting or not.

Question 8

You did screening cholesterol tests on a 33-year-old man and found his results to be: Total cholesterol: 220 mg/dL (H) Low-density lipoprotein: 125 mg/dL (H) High-density lipoprotein: 34 mg/dL (L) Triglycerides: 307 mg/dL (H) C-reactive protein: 2.4 mg/dL (H) Which of his lab results is the best predictor of an adverse outcome in this patient?

A	Total cholesterol
B	Low-density lipoprotein
C	High-density lipoprotein
D	Triglycerides
E	C-reactive protein

Question 8 Explanation: 

Of all the lipid values, HDL is the single best predictor of an adverse outcome. However, high HDL does not guarantee immunity from coronary artery disease. C-reactive protein levels predict risk for myocardial infarction and stroke even better than LDL levels do, but are not as beneficial as HDL.

Question 9

In an effort to become more healthy overall, a 28-year-old woman with dyslipidemia decides to quit What effect would you expect this to have on her lipid profile?

A	Decrease total cholesterol
B	Decrease low-density lipoprotein
C	Decrease fasting triglycerides
D	Increase high-density lipoprotein
E	Decrease very low-density lipoprotein

Question 9 Explanation: 

Smoking cessation increases HDL by 5–10 mg/dL, but does not affect LDL, VLDL, or triglycerides.

Question 10

You are prescribing niacin for a patient with elevated LDL and triglycerides. He complains of flushing with the What is the best way for this patient to avoid flushing with this medication?

A	Take niacin at night
B	Take aspirin before taking niacin
C	Take niacin with food
D	Take niacin on an empty stomach
E	Take niacin with milk

Question 10 Explanation: 

Aspirin blocks much of the flushing that is associated with sustained release niacin preparations. Taking niacin at night, with food, on an empty stomach or with milk will not impact the side effects.

Question 11

You are beginning an HMG-CoA reductase inhibitor on a patient with elevated total cholesterol and a low high-density lipoprotein You are concerned about drug interactions with this class of medications. Which of the following medications is less likely to cause drug interactions?

A	Atorvastatin
B	Simvastatin
C	Lovastatin
D	Lovastatin-niacin
E	Pravastatin

Question 11 Explanation: 

Pravastatin (Pravachol), fluvastatin (Lescol), and rosuvastatin (Crestor) are not metabolized by the cytochrome P-450 3A4 enzyme system and therefore have less potential for drug interactions. Atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor) either alone or in combination are more likely to cause interactions

Question 12

In an attempt to lower cholesterol through diet, you recommend that a 40-year-old male take fish What is the lipid lowering mechanism of action of fish oil?

A	Sequesters bile acids
B	Changes hepatic metabolism of lipoprotein
C	Inhibits HMG-CoA reductase
D	Interferes with cholesterol absorption in the gut
E	Decreases secretions of triglycerides by the liver

Question 12 Explanation: 

Fish oil is high in omega-3 fatty acids and have been shown to be beneficial in lowering cholesterol. Fish oils work by decreasing secretion of triglycerides by the liver.

Question 13

You are seeing a 28-year-old man with significantly elevated triglyc- You are considering gemfibrozil (Lopid) therapy. What is the mech- anism of action of gemfibrozil?

A	Sequesters bile acids
B	Changes hepatic metabolism of lipoprotein
C	Inhibits HMG-CoA reductase
D	Interferes with cholesterol absorption in the gut
E	Decreases secretions of triglycerides by the liver

Question 13 Explanation: 

Gemfibrozil changes the hepatic metabolism of lipoproteins and is a logical choice for the patient with low HDL and elevated triglycerides.

Question 14

You are working with a 44-year-old man with difficult to manage He is taking atorvastatin (Lipitor) at maximum dosages, and you are considering adding ezetemibe (Zetia) to improve the lipid profile. How does ezetemibe work to help lower cholesterol?

A	Sequestration of bile acids
B	Changing hepatic metabolism of lipoproteins
C	Inhibits HMG-CoA reductase
D	Interferes with cholesterol absorption in the gut
E	Decreases secretion of triglycerides by the liver

Question 14 Explanation: 

Ezetemibe (Zetia) lowers cholesterol by interfering with the absorption of cholesterol in the gut. Used alone, it lowers LDL and triglycerides only modestly. When added to a low-dose statin, the combination lowers LDL as much as the maximum statin dose, but its combined use with a low dose statin may produce fewer adverse effects.

Question 15

You are seeing a 26-year-old sexually active man who presents to obtain HIV You perform appropriate pretest counseling and deter- mine his risks to be low. He is heterosexual, has never had sex with pros- titutes or a known HIV positive woman, his last sexual activity was more than 6 months ago, and he has never used IV drugs or had a transfusion. His test is negative. Which of the following is the best way to deliver the results?

A	Copy the results and send them to his home
B	Call him on his home telephone
C	Call him on his personal cell phone
D	Discuss the results in person during an office visit
E	Agree on the method at his pretest visit, and comply with the patient’s wishes

Question 15 Explanation: 

HIV results should always be given during a face-to-face interview. Even in a low risk patient, if the results are positive, it represents a life-changing event. It is important to reassure the patient regarding possibly inappropriate assumptions about HIV infection. Sending the results via mail, or discussing the results on theChronic Conditions Answers 269 telephone would not be appropriate. Even with negative results, it is important to discuss risk reduction with the patient and develop a plan to prevent future exposure.

Question 16

You are taking care of a 22-year-old woman with fever, aches and Her history reveals intravenous drug abuse, and you suspect acute HIV infection. Which of the following tests is best to rule out acute HIV?

A	Enzyme-linked immunosorbent assay (ELISA)
B	Western blot
C	Immunofluroescent antibody test
D	Quantitative plasma HIV RNA (viral load)
E	P24 antigen assay

Question 16 Explanation: 

Testing to establish the diagnosis of HIV infection usually requires an ELISA followed by a confirmatory Western blot of immunofluroescent antibody test. However, there is a “window period” of several weeks to 3 months between the infection and seroconversion when these tests may be negative. During this time, patients may be viremic and infectious, but not have sufficient levels of antibodies to result in positive tests. If there is strong clinical suspicion, plasma HIV RNA should be ordered. P24 antigen assay can be checked, but has a higher false-positive rate.

Question 17

You are caring for a patient newly diagnosed with HIV Ini- tial laboratory work revealed a positive Hepatitis B surface antibody, and a positive Hepatitis A antibody. His immunization history is unknown. Which of the following vaccines should be administered to this patient?

A	Hepatitis A
B	Hepatitis B
C	Pneumococcal vaccine
D	MMR vaccine
E	Oral polio vaccine

Question 17 Explanation: 

Vaccinations appropriate for HIV infected individuals include Hepatitis A and B, if there is no evidence of prior exposure and immunity. In the case described the patient has prior exposure and immunity, since his antibody tests are positive. Yearly influenza and a one-time pneumococcal vaccination should be administered. Live vaccines should not be administered, so MMR and oral polio should not be given. Polio vaccination for HIV infected persons should be with the inactivated (intramuscular) preparation.

Question 18

You are caring for a 38-year-old woman with a long history of intra- venous drug She was diagnosed with HIV 2 years ago, and has been doing well on therapy without disease progression. You order a purified protein derivative skin test for TB. What amount of induration indicates a positive test?

A	Any induration indicates a positive test
B	3 mm
C	5 mm
D	10 mm
E	15 mm

Question 18 Explanation: 

Usually, induration of 15 mm (10 mm in high risk patients) indicates a positive test. In HIV infected individuals, 5 mm is considered a positive test. PPD tests should be placed annually in HIV infected patients, as there is an increased risk of progression from latent to active TB in infected individuals.

Question 19

One of your patients has failed therapy for HIV, and his CD4 lym- phocyte counts are falling. During his last two visits, his CD4 count has been less than 50 lymphocytes/mm³. Prophylaxis for which of the follow- ing should be instituted at this time?

A	Mycobacterium avium complex
B	Fungal infections
C	Herpes simplex
D	Herpes zoster
E	Cytomegalovirus

Question 19 Explanation: 

Prophylaxis against Mycobacterium avium complex (MAC) should be instituted once the patient’s CD4 count drops below 50. Prophylaxis against Pneumocystis carinii pneumonia should be considered once the CD4 count drops below 200. Primary prophylaxis is not indicated for fungal infections, herpes simplex, herpes zoster, or cytomegalovirus.

Question 20

You are seeing a patient with a long-standing HIV The patient has been unable to afford his medication regimen and has been off medication for several months. He presents with shortness of breath. Blood gasses obtained emergently reveal a PaO₂ of 65 mm Hg. His chest x-ray is shown below:

(Reproduced, with permission, from Knoop K, Stack L, Storrow A. Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002: 666.)

Assuming the patient is not allergic, which of the following is the best first- line treatment?

A	Azithromycin
B	Trimethoprim-sulfamethoxazole
C	Trimethoprim-sulfamethoxazole and corticosteroids
D	Triple drug treatment against tuberculosis
E	Quadruple drug treatment against tuberculosis

Question 20 Explanation: 

The x-ray shown is suspicious for Pneumocystis carinii pneumonia, and treatment should be started immediately. The treatment of choice is trimethoprim-sulfamethoxazole270 Family Medicine (TMP-SMX) for 3 weeks. However, if the PaO2 falls below 70 mm Hg, the patient should receive concurrent steroids.

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II. Preview all questions below

1.You are thinking about starting a type 2 diabetic on insulin therapy to improve her glucose Which of the following insulin prepara- tions has the longest duration of action?

1. Aspart (Novolog)
2. Regular
3. Lente
4. Ultralente
5. Glargine (Lantus)

2. After a period of noncompliance, one of your type 1 diabetics has been hospitalized for diabetic He has required approximately 100 units of insulin in a 24-hour period in the hospital using a sliding scale. You decide to begin split-dose therapy with neutral protamine Hage- dorn (NPH) and regular insulin. How much NPH insulin should be given to this patient in the morning?

1. 25 units
2. 33 units
3. 50 units
4. 66 units
5. 75 units

3. You are caring for a type 1 diabetic who has been hospitalized with diabetic ketoacidosis, and determining an appropriate insulin regimen for her. She has required 60 units of insulin per day to maintain adequate con- trol in the hospital. You decide to use insulin glargine (Lantus) and aspart (Lispro) in combination. What should her Lantus dose be?

1. 10 units
2. 20 units
3. 30 units
4. 40 units
5. 50 units

4, You have maximized oral therapy for a type 2 diabetic in your She works hard at diet and exercise, and is on maximal doses of oral hypo- glycemics, but her glycosolated hemoglobin is 8.6%. You decide to add insulin to her regimen. She is currently 67 in tall and weighs 100 kg. How much neutral protamine Hagedorn (NPH) should you give her at night as an addition to her current regimen?

1. 5 units
2. 10 units
3. 15 units
4. 20 units
5. 25 units

5. A 62-year-old woman sees you for preoperative clearance for a right hip Her past medical history is significant for hypertension, chronic kidney disease, osteoarthritis and type 2 diabetes. During your examination, you detect a painless mass in her lower right abdomen. You schecule a CT scan with angiographic contrast. Which one of this patients’ medications should be held prior to her receiving radiocontrast dye?

1. Metoprolol XL 100 mg
2. Metformin ER 1000 mg
3. Lisinopril 20 mg
4. Aspirin 325 mg
5. Pentoxifylline 400 mg

6. You are caring for a 28-year-old man with Specifically, he has hypoalphalipoproteinemia (low high-density lipoprotein). Which of the following interventions is more likely to raise his HDL levels?

1. Cigarette smoking
2. Alcohol in moderation
3. Weight loss
4. Low dietary intake of cholesterol
5. Stress reduction

7. You have performed a screening lipid profile on an otherwise healthy man. His results indicate elevated triglycerides, a low high-density lipopro- tein, a high low-density lipoprotein, an elevated total cholesterol, and an elevated very low-density You’d like to rescreen him in the fasting state. Which of the following laboratory values is likely to decrease in the fasting state?

1. Serum triglycerides
2. High-density lipoprotein
3. Low-density lipoprotein
4. Total cholesterol
5. Very low-density lipoprotein

8. You did screening cholesterol tests on a 33-year-old man and found his results to be:

Total cholesterol: 220 mg/dL (H)

Low-density lipoprotein: 125 mg/dL (H) High-density lipoprotein: 34 mg/dL (L) Triglycerides: 307 mg/dL (H)

C-reactive protein: 2.4 mg/dL (H)

Which of his lab results is the best predictor of an adverse outcome in this patient?

1. Total cholesterol
2. Low-density lipoprotein
3. High-density lipoprotein
4. Triglycerides
5. C-reactive protein

9. In an effort to become more healthy overall, a 28-year-old woman with dyslipidemia decides to quit What effect would you expect this to have on her lipid profile?

1. Decrease total cholesterol
2. Decrease low-density lipoprotein
3. Decrease fasting triglycerides
4. Increase high-density lipoprotein
5. Decrease very low-density lipoprotein

10. You are prescribing niacin for a patient with elevated LDL and triglycerides. He complains of flushing with the What is the best way for this patient to avoid flushing with this medication?

1. Take niacin at night
2. Take aspirin before taking niacin
3. Take niacin with food
4. Take niacin on an empty stomach
5. Take niacin with milk

11. You are beginning an HMG-CoA reductase inhibitor on a patient with elevated total cholesterol and a low high-density lipoprotein You are concerned about drug interactions with this class of medications. Which of the following medications is less likely to cause drug interactions?

1. Atorvastatin
2. Simvastatin
3. Lovastatin
4. Lovastatin-niacin
5. Pravastatin

12. In an attempt to lower cholesterol through diet, you recommend that a 40-year-old male take fish What is the lipid lowering mechanism of action of fish oil?

1. Sequesters bile acids
2. Changes hepatic metabolism of lipoprotein
3. Inhibits HMG-CoA reductase
4. Interferes with cholesterol absorption in the gut
5. Decreases secretions of triglycerides by the liver

13. You are seeing a 28-year-old man with significantly elevated triglyc- You are considering gemfibrozil (Lopid) therapy. What is the mech- anism of action of gemfibrozil?

1. Sequesters bile acids
2. Changes hepatic metabolism of lipoprotein
3. Inhibits HMG-CoA reductase
4. Interferes with cholesterol absorption in the gut
5. Decreases secretions of triglycerides by the liver

14. You are working with a 44-year-old man with difficult to manage He is taking atorvastatin (Lipitor) at maximum dosages, and you are considering adding ezetemibe (Zetia) to improve the lipid profile. How does ezetemibe work to help lower cholesterol?

1. Sequestration of bile acids
2. Changing hepatic metabolism of lipoproteins
3. Inhibits HMG-CoA reductase
4. Interferes with cholesterol absorption in the gut
5. Decreases secretion of triglycerides by the liver

15. You are seeing a 26-year-old sexually active man who presents to obtain HIV You perform appropriate pretest counseling and deter- mine his risks to be low. He is heterosexual, has never had sex with pros- titutes or a known HIV positive woman, his last sexual activity was more than 6 months ago, and he has never used IV drugs or had a transfusion. His test is negative. Which of the following is the best way to deliver the results?

1. Copy the results and send them to his home
2. Call him on his home telephone
3. Call him on his personal cell phone
4. Discuss the results in person during an office visit
5. Agree on the method at his pretest visit, and comply with the patient’s wishes

16. You are taking care of a 22-year-old woman with fever, aches and Her history reveals intravenous drug abuse, and you suspect acute HIV infection. Which of the following tests is best to rule out acute HIV?

1. Enzyme-linked immunosorbent assay (ELISA)
2. Western blot
3. Immunofluroescent antibody test
4. Quantitative plasma HIV RNA (viral load)
5. P24 antigen assay

17. You are caring for a patient newly diagnosed with HIV Ini- tial laboratory work revealed a positive Hepatitis B surface antibody, and a positive Hepatitis A antibody. His immunization history is unknown. Which of the following vaccines should be administered to this patient?

1. Hepatitis A
2. Hepatitis B
3. Pneumococcal vaccine
4. MMR vaccine
5. Oral polio vaccine

18. You are caring for a 38-year-old woman with a long history of intra- venous drug She was diagnosed with HIV 2 years ago, and has been doing well on therapy without disease progression. You order a purified protein derivative skin test for TB. What amount of induration indicates a positive test?

1. Any induration indicates a positive test
2. 3 mm
3. 5 mm
4. 10 mm
5. 15 mm

19. One of your patients has failed therapy for HIV, and his CD4 lym- phocyte counts are During his last two visits, his CD4 count has been less than 50 lymphocytes/mm³. Prophylaxis for which of the follow- ing should be instituted at this time?

1. Mycobacterium avium complex
2. Fungal infections
3. Herpes simplex
4. Herpes zoster
5. Cytomegalovirus

20. You are seeing a patient with a long-standing HIV The patient has been unable to afford his medication regimen and has been off medication for several months. He presents with shortness of breath. Blood gasses obtained emergently reveal a PaO₂ of 65 mm Hg. His chest x-ray is shown below:

(Reproduced, with permission, from Knoop K, Stack L, Storrow A. Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002: 666.)

Assuming the patient is not allergic, which of the following is the best first- line treatment?

1. Azithromycin
2. Trimethoprim-sulfamethoxazole
3. Trimethoprim-sulfamethoxazole and corticosteroids
4. Triple drug treatment against tuberculosis
5. Quadruple drug treatment against tuberculosis