2011(3)  A 55-year-old female presents to an urgent-care facility with a complaint of weakness of several weeks’ duration. She has no other symptoms. She has been healthy except for a history of
hypertension that has been difficult to control despite the use of hydrochlorothiazide, 25 mg
daily; lisinopril (Prinivil, Zestril), 40 mg daily; amlodipine (Norvasc), 10 mg daily; and
doxazosin (Cardura), 8 mg daily.

On examination her blood pressure is 164/102 mm Hg, with the optic fundi showing grade 2
changes. She has normal pulses, a normal cardiac examination, and no abdominal bruits. A CBC
is normal and a blood chemistry panel is also normal except for a serum potassium level of 3.1
mmol/L (N 3.5–5.5).

Which one of the following would be best for confirming the most likely diagnosis in this patient?
            A) Magnetic resonance angiography of the renal arteries

            B) A renal biopsy
            C) 24-hour urine for metanephrines
            D) Early morning fasting cortisol
            E) A plasma aldosterone/renin ratio
 2011 (67)  Which one of the following is the greatest risk factor for abdominal aortic aneurysm (AAA)?
          A) Cigarette smoking

          B) Diabetes mellitus
          C) Hypertension
          D) African-American race
          E) Female gender

2011 (75)  A 60-year-old male is referred to you by his employer for management of his hypertension.  He has been without primary care for several years due to a lapse in insurance coverage. During
a recent employee health evaluation, he was noted to have a blood pressure of 170/95 mm Hg.
He has a 20-year history of hypertension and suffered a small lacunar stroke 10 years ago. He
has no other health problems and does not smoke or drink alcohol.  A review of systems is
negative except for minor residual weakness in his right upper extremity resulting from his
remote stroke. His blood pressure is 168/98 mm Hg when initially measured by your nurse, and
you obtain a similar reading during your examination.
In addition to counseling him regarding lifestyle modifications, which one of the following is the
most appropriate treatment for his hypertension?
        A) An angiotensin receptor blocker

        B) A $-blocker
        C) A calcium channel blocker
        D) A thiazide diuretic/ACE inhibitor combination
        E) No medication

2011 (102) A 55-year-old female who has hypertension, hyperlipidemia, and osteoarthritis of the knees
develops acute gout and is found to have hyperuricemia.  Discontinuation of which one of the
following medications may improve her hyperuricemia?

       A) Hydrochlorothiazide
       B) Losartan (Cozaar)
       C) Metoprolol (Lopressor)
       D) Simvastatin (Zocor)
       E) Acetaminophen


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