Answer and Explanation 21

21.  The correct answer is D.  This is a notorious side effect of ACE inhibitors and should be classified as a class effect.  Switching a patient to a different ACE inhibitor will not fix this.  It is because of the elevated levels of the bradykinnin produced.  Diovan is an angiotensin receptor blocker and would produce  a similar effect but not raise bradykinnin levels.  Metoprolol may induce bronchospasm but should not be ruled out.  It the patient is not wheezing, it would be prudent to start removing the ACE inhibitor.

Question 21

21.  Your are evaluating a a patient in your office that come to you complaining of a dry cough.  You have recently started him on many medicines and suspect that may be the cause.  Which of the following medicines would likely be the culprit?

A.  Diovan

B. Cardizem

C. Metoprolol

D. Lisinopril

Answer and Explanation 20

20.  The correct answer is B.  This rhythm is torsades which is caused by low magnesium.  It is important not only to obtain a magnesium level but to treat it in a timely manner.  Potassium should also be checked.  Remember hypokalemia cannot be  effectively treated if the magnesium level is low.  Abnormal phosphorus and sodium levels will not produce rhythms such as this.

Question 20

20.  You have just successfully treated a patient who was just in this rhythm listed below in this EKG strip.  Which of the following is the most important lab value to check on this patient immediately and correct?

A.  Potassium

B.  Magnesium

C.  Phosphorus

D. Sodium

Answer and Explanation 19

19.  The correct answer is A.  Vancomycin is the drug of choice for patients with infective endocarditis, especially for IV drug users.  The causative organism is usually staph.

Question 19

19.  Once the diagnosis is confirmed in question 18, what is the most appropriate antibiotic to give the patient intravenously?

A.  Vancomycin 1 gram IV
 
B.  Avelox 400 mg IV piggy back

C.  Zosyn 3.375 grams IV

D.  Cipro 400 mg IV piggy back

Answer and Explanation 18

18.  The correct answer is D.  This patient has infective endocarditis.  Blood cultures times 5 can rule out endocarditis but does not confirm the diagnosis.  The patient needs an echo.  A cardiac cath may be dangerous to perform.  A VQ scan would not be helpful because the patient really is not presenting like a pulmonary embolus.