CHAPTER 1

Internal Medicine
Questions
Questions 1 through 4 A 45-year-old male comes to your office for his first annual checkup in the last 10 years. On first impression, he appears overweight but is otherwise healthy and has no specific complaints. He has a brother with diabetes and a sister with high blood pressure. Both of his parents are deceased and his father died of a stroke at age 73. He is a long-standing heavy smoker and only drinks alcohol on special occasions. On physical examination, his blood pressure is 166/90 in the left arm and 164/88 in the right arm. The rest of the examination is unremarkable. He is concerned about his health and does not want to end up on medication, like his siblings. 1. Regarding your initial recommendations, which of the following would be most appropriate? (A) You should take no action and ask him to return to the clinic in 1 year for a repeat blood pressure check. (B) You should immediately start him on an oral antihypertensive medication and ask him to return to the clinic in 1 week. (C) You should advise him to stop smoking, start a strict diet and exercise routine with the goal of losing weight, and return to the clinic in 6 months. (D) You should consider starting a workup for potential causes of secondary hypertension. (E) You should screen him for diabetes and evaluate him for other cardiovascular risk factors before proceeding any further. 2. In the initial evaluation of a patient such as this, which of the following should be routinely recommended? (A) (B) (C) (D) a urine microalbumin/creatinine ratio an echocardiogram thyroid function tests renal function tests (serum creatinine and blood urea nitrogen [BUN]) (E) an exercise stress test

3. Which of the following describes the patients blood pressure status? (A) (B) (C) (D) (E) normal blood pressure prehypertension stage 1 hypertension stage 2 hypertension stage 3 hypertension

4. Your patient returns to clinic a few weeks later for a follow-up appointment. Despite having lost 3 lbs and increasing his activity to walking 2 mi three times per week, his blood pressure remains elevated at 162/92. His initial evaluation revealed a fasting blood sugar of 156 and a hemoglobin (Hgb) A1C of 7.5. Along with starting hypoglycemic medications to control his diabetes, you recommend that he take an antihypertensive medication. At this point, you decide to start the patient on hypoglycemic medications to control his diabetes. What other intervention is appropriate at this time? (A) allow more time for the patient to practice lifestyle modifications (B) start treatment with an angiotensinconverting enzyme (ACE) inhibitor only (C) start treatment with a thiazide diuretic only (D) start treatment with a beta-blocker only (E) start treatment with a two-drug combination
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