A 65-year-old patient with a history of smoking and carotid artery stenosis presents with recurrent episodes of weakness in the right arm and leg. On examination, you note an auscultatory bruit over the right carotid artery. Imaging confirms significant right carotid artery stenosis. Which of the following medications is indicated for the medical management of carotid artery stenosis in this patient?
A) Aspirin
B) Furosemide
C) Clopidogrel
D) Ramipril
E) Nicardipine
Rationale: Clopidogrel, an antiplatelet medication, is indicated for the medical management of carotid artery stenosis to reduce the risk of stroke and cardiovascular events by preventing platelet aggregation.
A 65-year-old patient with a history of smoking and diabetes presents with cramping leg pain (intermittent claudication) in the right calf while walking. The pain resolves with rest. On examination, you note diminished pedal pulses and cool, pale skin of the right lower extremity. Ankle-brachial index (ABI) measurement confirms significant peripheral artery disease (PAD) in the right leg. Which of the following medications is indicated for the medical management of PAD in this patient?
A) Aspirin
B) Furosemide
C) Clopidogrel
D) Cilostazol
E) Atorvastatin
Rationale: Cilostazol, a phosphodiesterase inhibitor, is indicated for the medical management of PAD to improve walking distance and reduce symptoms of intermittent claudication.
A 55-year-old patient with a history of obesity and a sedentary lifestyle presents with persistent leg pain, swelling, and skin changes in the lower legs. On examination, you note varicose veins and stasis dermatitis. Which of the following medications is indicated for the medical management of chronic venous insufficiency and venous stasis ulcers in this patient?
A) Aspirin
B) Furosemide
C) Heparin
D) Pentoxifylline
E) Warfarin
Rationale: Pentoxifylline is indicated for the medical management of chronic venous insufficiency and venous stasis ulcers to improve blood flow and reduce symptoms.
A 50-year-old patient with a 30-year history of smoking presents with increasing shortness of breath, chronic cough, and sputum production. The patient also reports frequent respiratory infections. On physical examination, you note wheezing and decreased breath sounds. Pulmonary function tests show airflow limitation that is not fully reversible. Which of the following complications of smoking is most likely in this patient?
A) Coronary artery disease (CAD)
B) Chronic obstructive pulmonary disease (COPD)
C) Lung cancer
D) Hypertension
E) Gastroesophageal reflux disease (GERD)
Rationale: The patient’s smoking history, symptoms, and pulmonary function tests are suggestive of COPD, a well-known complication of smoking.
A 68-year-old patient with a history of hyperlipidemia and smoking presents with recurrent episodes of leg pain while walking. On examination, you note diminished pedal pulses and signs of tissue ischemia in the left lower extremity. Ankle-brachial index (ABI) measurement confirms significant peripheral artery disease (PAD) in the left leg. Which of the following medications is indicated for the medical management of PAD in this patient?
A) Aspirin
B) Furosemide
C) Clopidogrel
D) Pentoxifylline
E) Lisinopril
Rationale: Pentoxifylline, a medication that improves blood flow, is indicated for the medical management of PAD to improve symptoms and walking distance.
A 40-year-old patient presents with a history of asthma and recent exacerbations requiring oral corticosteroids. On examination, you note increased work of breathing, wheezing, and diminished breath sounds. Peak expiratory flow rate (PEFR) measurement shows values less than 50% of predicted. Which of the following is the most appropriate management step for this patient?
A) Increase the inhaled corticosteroid (ICS) dose
B) Add a long-acting beta-agonist (LABA)
C) Start oral corticosteroids
D) Administer a short-acting beta-agonist (SABA)
E) Initiate continuous positive airway pressure (CPAP)
Rationale: This patient is experiencing a severe asthma exacerbation with significant airflow obstruction. Treatment includes administering a short-acting beta-agonist (SABA) to relieve bronchospasm and improve PEFR.
A 12-year-old patient with a history of asthma presents with cough, wheezing, and shortness of breath. On examination, you note decreased breath sounds and hyperresonance on percussion. Which of the following is the most appropriate initial management for this patient?
A) Administer a short-acting beta-agonist (SABA)
B) Initiate inhaled corticosteroids (ICS)
C) Perform a chest X-ray
D) Refer to a pediatric pulmonologist
E) Start continuous positive airway pressure (CPAP)
Rationale: This patient is experiencing an acute asthma exacerbation. Initial management involves administering a short-acting beta-agonist (SABA) to relieve bronchospasm.
A 50-year-old patient with a history of alcohol abuse presents with fever, confusion, and cough. On physical examination, you note coarse crackles on lung auscultation. Chest X-ray reveals diffuse infiltrates. Blood cultures grow Streptococcus pneumoniae. Which of the following medications is the most appropriate for this patient’s pneumonia?
A) Amoxicillin
B) Ceftriaxone and azithromycin
C) Oseltamivir
D) Vancomycin and piperacillin/tazobactam
E) Atorvastatin
Rationale: In patients with alcohol abuse, pneumonia may be associated with aspiration and may require broader coverage. Vancomycin and piperacillin/tazobactam provide coverage against potential pathogens.
A 25-year-old patient presents with a history of recurrent episodes of wheezing, cough, and shortness of breath. Symptoms are often triggered by exposure to allergens and cold air. On examination, you note wheezing and prolonged expiration. Spirometry reveals reversible airflow obstruction. Which of the following is the most appropriate medication for long-term control of asthma in this patient?
A) Albuterol
B) Fluticasone
C) Montelukast
D) Epinephrine
E) Ipratropium
Rationale: This patient’s symptoms, physical examination findings, and spirometry results are consistent with asthma. Inhaled corticosteroids like fluticasone are the cornerstone of long-term control in asthma management.
A 30-year-old patient with a history of asthma presents with increasing daytime symptoms, nocturnal awakenings due to cough, and rescue inhaler use more than twice a week. On examination, you note wheezing. Which of the following is the most appropriate step-up in asthma therapy for this patient?
A) Increase the rescue inhaler use
B) Add a long-acting beta-agonist (LABA)
C) Increase the inhaled corticosteroid (ICS) dose
D) Start oral corticosteroids
E) Switch to a leukotriene receptor antagonist
Rationale: This patient’s symptoms indicate poorly controlled asthma. The next step in management is to increase the dose of the inhaled corticosteroid (ICS).
