PX Exam 3

A 32-year-old pregnant woman at 20 weeks gestation has familial hypercholesterolemia and an LDL-C of 280 mg/dL. She cannot tolerate dietary modifications alone.
Which lipid-lowering therapy is appropriate?
A. Atorvastatin
B. Ezetimibe
C. Cholestyramine
D. Evolocumab

C

A 58-year-old man with coronary artery disease takes low-dose aspirin. He complains of frequent indigestion and bloating.
What is the most likely mechanism of his symptoms?
A. Direct bacterial overgrowth
B. Inhibition of COX-2 in neurons
C. Inhibition of gastric mucosal prostaglandins
D. Acid overproduction

C

A 12-year-old boy is found to have an LDL-C of 250 mg/dL. His father had a myocardial infarction at 40.
What is the next best step?
A. Repeat testing at age 18
B. Start dietary changes and follow in a year
C. Begin statin therapy
D. Start PCSK9 inhibitor

C

A 29-year-old woman is found to be 6 weeks pregnant while taking atorvastatin.
What should you advise her?
A. Continue the statin for cardiovascular protection
B. Switch to ezetimibe
C. Stop the statin immediately
D. Continue statin and add folic acid

C

A 63-year-old woman with pancreatic cancer is starting chemotherapy. She is at high risk for VTE.
What is the ASH guideline–recommended prophylactic therapy?
A. Aspirin
B. Rivaroxaban
C. Dalteparin
D. Heparin infusion

B

A 70-year-old man with colon cancer develops a DVT.
What is the preferred initial treatment?
A. Warfarin
B. DOAC
C. Dalteparin
D. Unfractionated heparin

C

A 65-year-old man with stable angina and a resting HR of 55 bpm has persistent chest pain.
Which medication is most appropriate?
A. Diltiazem
B. Verapamil
C. Amlodipine
D. Metoprolol

C

A 48-year-old woman with HeFH is on high-intensity statin and ezetimibe, but LDL remains >160 mg/dL.
What is the next best step?
A. Add PCSK9 inhibitor
B. Increase ezetimibe dose
C. Add niacin
D. Switch to fibrates

A

A 55-year-old man with TGs of 900 mg/dL is started on fenofibrate.
What lipid change might be expected?
A. LDL-C will decrease significantly
B. LDL-C may increase
C. HDL will drop
D. Triglycerides will increase

B

A 60-year-old man with stable angina and EF of 30% needs angina control.
Which medication is contraindicated?
A. Metoprolol
B. Amlodipine
C. Diltiazem
D. Nitrates

C

A patient on cholestyramine complains of poor blood pressure control after starting the med.
What is the likely explanation?
A. Cholestyramine causes hypertension
B. Impaired absorption of antihypertensives
C. Reflex vasoconstriction
D. CYP450 interaction

B

A 45-year-old woman experiences chest pain at rest with transient ST elevations that resolve spontaneously.
Which is the best treatment?
A. Beta-blockers
B. Amlodipine
C. Aspirin
D. ACE inhibitors

B

A pregnant woman develops a PE.
Which anticoagulant is preferred?
A. Rivaroxaban
B. Enoxaparin
C. Warfarin
D. Apixaban

B

A patient with myeloma on lenalidomide is at risk of thrombosis.
What is the best prophylactic agent if their risk is low/moderate?
A. Warfarin
B. Aspirin
C. Enoxaparin
D. Rivaroxaban

B

A patient with LDL-C of 200 and TG of 420 is started on cholestyramine.
What adverse effect is most likely?
A. Hypotension
B. Myopathy
C. Pancreatitis
D. Worsening hypertriglyceridemia

D

A 65-year-old man with a history of MI and stable angina is started on verapamil for chest pain. He returns with dizziness and a HR of 45 bpm.
What is the most likely cause of his symptoms?
A. Reflex tachycardia
B. Bradycardia due to verapamil
C. Angina worsening
D. Heart block from nitrates

B

A 55-year-old woman with breast cancer on chemotherapy is assessed as high risk for VTE. She has no bleeding risks.
Which is an appropriate thromboprophylaxis option?
A. Warfarin
B. Apixaban
C. Aspirin
D. Unfractionated heparin

B

 A 29-year-old pregnant woman with a strong family history of premature MI has LDL-C of 270 mg/dL.
What is the safest lipid-lowering option in pregnancy?
A. Atorvastatin
B. Ezetimibe
C. Colesevelam
D. Evolocumab

C

A patient with FH is on maximum statin and ezetimibe therapy but still has LDL-C >190 mg/dL.
What is the next best step?
A. Add niacin
B. Add fibrate
C. Add PCSK9 inhibitor
D. Increase statin dose

C

A 64-year-old man with angina and hypertension has a HR of 56 bpm.
Which medication is preferred for angina relief?
A. Diltiazem
B. Amlodipine
C. Metoprolol
D. Verapamil

B

A 58-year-old man starts aspirin 81 mg daily. He complains of mild upper abdominal discomfort.
What is the most likely cause?
A. Increased acid secretion
B. Reduced gastric prostaglandin synthesis
C. Bacterial overgrowth
D. Gastric perforation

B

A 48-year-old woman with hypertriglyceridemia (TG 850 mg/dL) is started on fenofibrate.
What change in LDL might you expect?
A. Large decrease
B. No change
C. Modest increase
D. Significant drop

C

A 60-year-old man with NSTEMI has HFrEF (EF 30%) and needs BP control.
Which CCB is contraindicated?
A. Amlodipine
B. Felodipine
C. Diltiazem
D. None of the above

C

A patient with SIHD and high BP is already on beta-blockers. HR is 54 bpm.
Which medication should be avoided?
A. Amlodipine
B. Diltiazem
C. Isosorbide mononitrate
D. Ranolazine

B

A patient on cholestyramine has triglycerides of 420 mg/dL.
What complication is this patient at risk for?
A. Myopathy
B. GI bleed
C. Pancreatitis
D. Hypoglycemia

C

A 50-year-old man has angina and asthma. He cannot tolerate beta-blockers.
Which is the best alternative to reduce myocardial oxygen demand?
A. Amlodipine
B. Isosorbide dinitrate
C. Verapamil
D. Hydralazine

C

A woman with multiple myeloma and low thrombosis risk is started on lenalidomide.
What is an appropriate thromboprophylaxis?
A. Warfarin
B. Aspirin
C. Apixaban
D. LMWH

B

A 40-year-old man with tendon xanthomas and an LDL-C of 350 mg/dL is diagnosed with HeFH.
What is the initial treatment?
A. Fibrate
B. Niacin
C. High-intensity statin
D. Bile acid sequestrant

C

 A pregnant woman is diagnosed with DVT.
Which anticoagulant is appropriate?
A. Rivaroxaban
B. Warfarin
C. Dalteparin
D. Apixaban

C

 A patient taking cholestyramine reports constipation and difficulty absorbing his blood pressure medication.
What’s the likely mechanism?
A. Decreased renal clearance
B. Increased GI motility
C. Binding and reduced absorption in GI tract
D. Hepatic CYP450 induction

C

A 10-year-old boy experiences coughing and wheezing 3 times per week and uses his albuterol inhaler twice weekly. He has nighttime symptoms twice a month.
What is his asthma classification?
A. Mild persistent
B. Moderate persistent
C. Intermittent
D. Severe persistent

C

A 32-year-old woman has daily asthma symptoms and nighttime awakenings 3 times per week. Her FEV1 is 70%.
What is the best treatment step?
A. SABA as needed
B. Low-dose ICS
C. Low-dose ICS + LABA
D. Oral corticosteroids

C

A patient on step 2 therapy still experiences daily symptoms and uses albuterol 3–4 times per day.
What’s the next best step in therapy?
A. Continue current regimen
B. Add montelukast
C. Increase to medium-dose ICS or add LABA
D. Start oral prednisone

C

A 5-year-old child is started on low-dose ICS for mild persistent asthma. Parents are concerned about growth suppression.
What do you tell them?
A. ICS significantly impair adult height
B. ICS are unsafe in children under 6
C. The benefit outweighs the small, potential growth effect
D. Use oral steroids instead

C

A 28-year-old man experiences asthma symptoms triggered by exercise.
Which medication is most appropriate before activity?
A. ICS
B. LABA
C. Albuterol
D. Leukotriene receptor antagonist

C

A patient uses albuterol 5 times per week, wakes up once weekly with symptoms, and has normal spirometry.
What is their asthma severity?
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent

B

A 20-year-old female with severe persistent asthma is on high-dose ICS + LABA + montelukast. She remains symptomatic.
What is the next step?
A. Add SABA
B. Add oral corticosteroids
C. Switch to cromolyn
D. Decrease ICS dose

B

A patient with known asthma presents with acute wheezing, RR 28, SpO2 88%, and minimal air entry.
What is the first-line management?
A. IV steroids only
B. Oral montelukast
C. Inhaled SABA + oxygen + systemic steroids
D. Nebulized LABA

C

Which of the following medications is most likely to cause asthma symptoms in a patient with aspirin-exacerbated respiratory disease?
A. Montelukast
B. Ibuprofen
C. Albuterol
D. Salmeterol

B

A patient on low-dose ICS and as-needed albuterol continues to have night symptoms twice per week.
What is the next step?
A. Add a LABA
B. Increase ICS to high dose
C. Add oral prednisone
D. Stop ICS

A

A patient is started on a combination inhaler with fluticasone and salmeterol.
What is the role of salmeterol?
A. Rapid rescue relief
B. Long-term control of inflammation
C. Bronchodilation over 12+ hours
D. Prevents airway remodeling

C

Which class of asthma medication works by blocking leukotriene receptors?
A. Beta agonists
B. ICS
C. Montelukast
D. Theophylline

C

A patient is experiencing daily wheezing despite ICS and LABA. Spirometry shows an FEV1 of 55%.
What medication could be added next?
A. Theophylline
B. LAMA (e.g., tiotropium)
C. SABA
D. Cromolyn

B

A 30-year-old asthmatic woman has worsening symptoms in spring. Her IgE is elevated.
Which medication is most appropriate for allergic asthma?
A. Omalizumab
B. Roflumilast
C. Tiotropium
D. Cromolyn

A

A child with asthma is prescribed a corticosteroid inhaler.
Which advice is most important to prevent side effects?
A. Take it before meals
B. Use it lying down
C. Rinse mouth after use
D. Take with albuterol every time

C

A 68-year-old man, a former smoker with a 40-pack-year history, presents with chronic cough and dyspnea on exertion. Spirometry reveals a post-bronchodilator FEV₁/FVC ratio of 0.65.
What is the most likely diagnosis?
A. Asthma
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Pulmonary Fibrosis
D. Congestive Heart Failure

B

A 55-year-old woman with COPD has an FEV₁ of 60% predicted.
According to the GOLD classification, what is the severity of her airflow limitation?
A. Mild
B. Moderate
C. Severe
D. Very Severe

B

A patient with COPD reports shortness of breath when hurrying on level ground or walking up a slight hill.
What is their mMRC grade?
A. 0
B. 1
C. 2
D. 3

B

A 72-year-old man with COPD has an mMRC score of 3 and has had two exacerbations in the past year, one requiring hospitalization.
Which GOLD group does he belong to?
A. A
B. B
C. C
D. E

D

A patient with COPD is classified as GOLD Group B.
What is the recommended initial pharmacological treatment?
A. Short-acting bronchodilator as needed
B. Long-acting bronchodilator (LABA or LAMA)
C. ICS/LABA combination
D. Oral corticosteroids

B

A 65-year-old patient with COPD presents with increased dyspnea and purulent sputum production.
What is the most appropriate management for this acute exacerbation?
A. Increase dose of inhaled corticosteroids
B. Initiate oral antibiotics and systemic corticosteroids
C. Start long-term oxygen therapy
D. Perform pulmonary rehabilitation

B

A patient with COPD has an FEV₁ of 45% predicted.
What is the GOLD grade of airflow limitation?
A. 1
B. 2
C. 3
D. 4

C

A 70-year-old woman with COPD and an mMRC score of 2 has had one exacerbation not requiring hospitalization in the past year.
Which GOLD group does she belong to?
A. A
B. B
C. C
D. E

B

A patient with COPD is experiencing persistent symptoms despite using a LAMA.
What is the next step in treatment?
A. Add a LABA
B. Add an ICS
C. Switch to a SABA
D. Initiate oral corticosteroids

A

A 60-year-old man with COPD has an mMRC score of 1 and has had two exacerbations in the past year, neither requiring hospitalization.
Which GOLD group does he belong to?
A. A
B. B
C. C
D. E

C

A patient with COPD is prescribed a combination inhaler containing fluticasone and salmeterol.
What is the role of salmeterol in this combination?
A. Rapid relief of symptoms
B. Long-term control of inflammation
C. Long-acting bronchodilation
D. Mucolytic agent

C

A 58-year-old patient with COPD and a history of frequent exacerbations is being considered for inhaled corticosteroid therapy.
What is a potential risk of adding ICS to their regimen?
A. Increased blood pressure
B. Increased risk of pneumonia
C. Weight gain
D. Hypoglycemia

B

A 70-year-old man with GOLD group E COPD is currently on LAMA/LABA/ICS triple therapy but continues to have exacerbations. Blood eosinophils are >300 cells/μL.
What is the next best option?
A. Add roflumilast
B. Switch to LAMA only
C. Add azithromycin
D. Consider biologic therapy targeting eosinophils

D

A COPD patient has chronic bronchitis and continues to experience exacerbations despite maximal inhaled therapy. He has a history of FEV₁ <50%.
What additional medication may reduce exacerbations?
A. Montelukast
B. Theophylline
C. Roflumilast
D. Cromolyn

C

A 65-year-old former smoker with COPD is evaluated for home oxygen therapy. His SpO₂ is 91% on room air at rest.
Does he qualify for long-term oxygen therapy?
A. Yes, immediately
B. Only if SpO₂ drops with exertion
C. No, must be ≤88% or meet other criteria
D. Yes, based on COPD diagnosis alone

C