Cardiac PainA 45-year-old patient with a 25-year history of smoking presents with chest pain and shortness of breath. The patient also has a family history of heart disease. On physical examination, you note elevated blood pressure. Electrocardiogram (ECG) shows ST-segment elevation in multiple leads. 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, chest pain, ECG findings, and risk factors are suggestive of coronary artery disease (CAD), a well-known complication of smoking.
A 50-year-old patient presents with a history of asthma and frequent nighttime awakenings due to cough and wheezing. On examination, you note wheezing. Which of the following is the most appropriate step-up in asthma therapy for this patient?
A) Increase the ICS dose
B) Add a long-acting beta-agonist (LABA)
C) Start oral corticosteroids
D) Administer a short-acting beta-agonist (SABA)
E) Switch to a leukotriene receptor antagonist
Rationale: Nocturnal symptoms indicate the need for a long-acting beta-agonist (LABA) as an add-on therapy for better asthma control.
A 45-year-old patient with a 25-year history of smoking presents with chest pain and shortness of breath. The patient also has a family history of heart disease. On physical examination, you note elevated blood pressure. Electrocardiogram (ECG) shows ST-segment elevation in multiple leads. 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, chest pain, ECG findings, and risk factors are suggestive of coronary artery disease (CAD), a well-known complication of smoking.
A 62-year-old patient with a history of diabetes and hyperlipidemia presents with intermittent claudication in both legs. On examination, you note diminished pedal pulses bilaterally. Ankle-brachial index (ABI) measurement confirms significant peripheral artery disease (PAD) in both legs. 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) Warfarin
Rationale: Cilostazol, a phosphodiesterase inhibitor, is indicated for the medical management of PAD to improve walking distance and reduce symptoms of intermittent claudication.
A 65-year-old patient with diabetes presents with cough, fever, and increasing shortness of breath. On physical examination, you note decreased breath sounds over the right lower lung. Chest X-ray reveals a right lower lobe infiltrate. Which of the following medications is most appropriate for the treatment of pneumonia in this patient?
A) Amoxicillin
B) Ceftriaxone and azithromycin
C) Oseltamivir
D) Vancomycin and piperacillin/tazobactam
E) Atorvastatin
Rationale: In patients with diabetes, empiric antibiotic therapy for pneumonia typically involves ceftriaxone and azithromycin to cover common pathogens.
A 55-year-old patient with a history of smoking and hypertension presents with severe rest pain in the right lower extremity and a non-healing ulcer on the right foot. On examination, you note absent pedal pulses and signs of tissue necrosis. 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 with critical limb ischemia?
A) Aspirin
B) Furosemide
C) Clopidogrel
D) Alprostadil
E) Atorvastatin
Rationale: Alprostadil, a prostaglandin E1 analog, is indicated for the medical management of PAD with critical limb ischemia to improve blood flow and reduce the risk of amputation.
A 65-year-old patient with a 45-year history of smoking presents with a hoarse voice, persistent cough, and hemoptysis. On physical examination, you note a palpable neck mass. Imaging reveals a mass in the lung and metastasis to cervical lymph nodes. 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, physical examination findings, and imaging results are highly suggestive of lung cancer, a well-known complication of smoking.
A 55-year-old patient with a 40-year history of smoking presents with sudden-onset confusion, facial droop, and weakness of the right arm and leg. Imaging reveals an ischemic stroke involving the left middle cerebral artery territory. 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) Stroke
D) Hypertension
E) Gastroesophageal reflux disease (GERD)
Rationale: The patient’s smoking history, symptoms, and imaging results are indicative of a stroke, which is one of the complications of smoking due to its association with increased risk of atherosclerosis and thrombosis.
A 60-year-old patient with a 35-year history of smoking presents with worsening chest pain radiating to the left arm, diaphoresis, and shortness of breath. On physical examination, you note reduced breath sounds and dullness to percussion over the left lung. Chest X-ray reveals a large pleural effusion. 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) Pleural effusion
D) Hypertension
E) Gastroesophageal reflux disease (GERD)
Rationale: The patient’s smoking history, symptoms, and imaging findings are suggestive of pleural effusion, which can occur as a complication of smoking-related lung diseases.
A 50-year-old patient with a history of prolonged standing at work presents with bilateral leg discomfort, visible varicose veins, and swelling. On examination, you note varicose veins and symptoms of chronic venous insufficiency. Which of the following medications is indicated for the medical management of chronic venous insufficiency 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 to improve blood flow and reduce symptoms.
A 65-year-old patient with a history of heart failure presents with bilateral leg swelling and pain. On examination, you note edema, skin changes, and stasis dermatitis. Which of the following medications is indicated for the medical management of venous stasis ulcers in this patient?
A) Aspirin
B) Furosemide
C) Heparin
D) Pentoxifylline
E) Lisinopril
Rationale: Pentoxifylline is indicated for the medical management of venous stasis ulcers to improve blood flow and facilitate wound healing.
A 55-year-old patient with a history of obesity presents with leg pain, swelling, and skin changes. On examination, you note varicose veins and stasis dermatitis. Which of the following medications is indicated for the medical management of chronic venous insufficiency in this patient?
A) Aspirin
B) Furosemide
C) Heparin
D) Pentoxifylline
E) Atorvastatin
Rationale: Pentoxifylline is indicated for the medical management of chronic venous insufficiency to improve blood flow and reduce symptoms.
A 55-year-old patient with a 35-year history of smoking presents with recurrent episodes of abdominal pain, diarrhea, and rectal bleeding. Colonoscopy reveals multiple polyps throughout the colon. Biopsies confirm adenomatous polyps. 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) Colon cancer
D) Hypertension
E) Gastroesophageal reflux disease (GERD)
Rationale: The patient’s smoking history, gastrointestinal symptoms, and findings of adenomatous polyps on colonoscopy suggest an increased risk of colon cancer associated with smoking.
A 58-year-old patient with a history of smoking presents with leg swelling and discomfort. On examination, you note varicose veins and symptoms of chronic venous insufficiency. Which of the following medications is indicated for the medical management of chronic venous insufficiency in this patient?
A) Aspirin
B) Furosemide
C) Heparin
D) Pentoxifylline
E) Clopidogrel
Rationale: Pentoxifylline is indicated for the medical management of chronic venous insufficiency to improve blood flow and reduce symptoms.
