← Back to Topics

hypertension

Practice targeted AMC-style multiple-choice questions on hypertension.

Related Topics

A 70-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of hypertension and is currently on antihypertensive medication. On examination, he is drowsy and has a blood pressure of 180/110 mmHg. A CT scan of the brain shows a hyperdense area in the right basal ganglia. What is the most likely diagnosis?

A. Intracerebral hemorrhage
B. Ischemic stroke
C. Migraine with aura
D. Transient ischemic attack
E. Subarachnoid hemorrhage
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 55-year-old man, non-smoker, presents for a health check. BP 135/85 mmHg, total cholesterol 5.5 mmol/L, HDL 1.2 mmol/L. No personal history of CVD or diabetes. Family history of premature CVD in father. BMI 28. Based on Australian guidelines, what is the most appropriate initial management step?

A. Order a fasting glucose and HbA1c.
B. Start perindopril 5mg daily.
C. Start atorvastatin 20mg daily.
D. Calculate absolute cardiovascular risk and discuss lifestyle modification.
E. Advise weight loss and recheck BP in 6 months.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 65-year-old man with hypertension is started on a medication that blocks the angiotensin-converting enzyme (ACE). What is the most common side effect of this class of drugs?

A. Hyperkalemia
B. Acute kidney injury
C. Angioedema
D. Hypotension
E. Dry cough
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old man with a history of smoking, hypertension, and dyslipidaemia presents for investigation of intermittent flank pain. Physical examination is unremarkable. Routine blood tests are normal. A CT scan of the abdomen is performed. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Surveillance with abdominal ultrasound in 12 months
B. Urgent referral for surgical assessment and repair planning
C. Referral for immediate endovascular aneurysm repair
D. No specific follow-up imaging required, focus on risk factor modification
E. Repeat CT scan of the abdomen in 3 months
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 62-year-old man with a history of hypertension and type 2 diabetes mellitus presents to the emergency department complaining of palpitations and lightheadedness. He reports that the symptoms started suddenly about an hour ago. He denies any chest pain, shortness of breath, or syncope. His medications include metformin and lisinopril. On examination, he is alert and oriented. His blood pressure is 110/70 mmHg, heart rate is irregularly irregular at 140 bpm, respiratory rate is 18 breaths per minute, and oxygen saturation is 97% on room air. An ECG is performed, which shows an absence of P waves, irregularly irregular R-R intervals, and narrow QRS complexes. Which of the following is the most appropriate next step in the management of this patient?

A. Synchronized cardioversion
B. Vagal maneuvers
C. Administration of intravenous magnesium sulfate
D. Intravenous amiodarone
E. Rate control with intravenous diltiazem
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 67-year-old man with a history of type 2 diabetes mellitus and hypertension presents to the emergency department with sudden onset of right-sided weakness and slurred speech that began 2 hours ago. He has no history of atrial fibrillation or previous strokes. On examination, his blood pressure is 180/95 mmHg, heart rate is 88 bpm, and he is afebrile. Neurological examination reveals right-sided hemiparesis and expressive aphasia. A non-contrast CT scan of the head shows no evidence of hemorrhage. Which of the following is the most appropriate next step in the management of this patient?

A. Perform a CT angiogram of the head and neck
B. Administer intravenous labetalol to lower blood pressure
C. Intravenous thrombolysis with alteplase
D. Refer for urgent carotid endarterectomy
E. Start aspirin therapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 67-year-old man with a history of hypertension and type 2 diabetes is scheduled for elective cholecystectomy due to symptomatic gallstones. During the preoperative assessment, he mentions experiencing mild chest discomfort during exertion over the past few weeks. What is the most appropriate next step in his preoperative management?

A. Start the patient on aspirin and beta-blockers immediately
B. Order a preoperative chest X-ray
C. Refer for a cardiology evaluation and possible stress testing
D. Proceed with surgery as planned with close intraoperative monitoring
E. Schedule an urgent coronary angiogram
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 72-year-old man with a history of chronic kidney disease stage 4, hypertension, and type 2 diabetes presents to the emergency department with confusion and lethargy. His family reports that he has been increasingly drowsy over the past two days. On examination, he is disoriented to time and place, with a blood pressure of 150/90 mmHg, heart rate of 88 bpm, respiratory rate of 20 breaths per minute, and temperature of 36.5°C. Laboratory tests reveal: sodium 130 mmol/L, potassium 5.8 mmol/L, bicarbonate 18 mmol/L, urea 25 mmol/L, creatinine 450 µmol/L, and glucose 8 mmol/L. An ECG shows peaked T waves. What is the most appropriate immediate management step?

A. Administer oral sodium polystyrene sulfonate
B. Administer intravenous calcium gluconate
C. Initiate hemodialysis
D. Start intravenous insulin and glucose
E. Administer intravenous sodium bicarbonate
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 68-year-old woman with a history of hypertension and heart failure is being treated with an ACE inhibitor. Her recent blood tests show a potassium level of 5.8 mmol/L. Which of the following is the most appropriate initial step in managing her hyperkalemia?

A. Prescribe a loop diuretic such as furosemide
B. Administer intravenous calcium gluconate
C. Immediately commence haemodialysis
D. Review and potentially reduce or discontinue the ACE inhibitor
E. Administer intravenous insulin and glucose
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male with a history of hypertension and hyperlipidemia presents for a routine follow-up. He is asymptomatic. A contrast-enhanced CT scan of the abdomen was performed as part of a screening protocol. An axial view is shown. What is the MOST appropriate next step?

A. Start aspirin therapy
B. Measure ankle-brachial index
C. Initiate statin therapy
D. Surgical repair
E. Repeat imaging in 6-12 months
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents to the emergency department complaining of new onset left flank pain radiating to his groin. He reports a history of hypertension and hyperlipidemia, both managed with medications. He denies any recent trauma. His vital signs are stable: blood pressure 130/80 mmHg, heart rate 88 bpm, respiratory rate 16 breaths/min, and oxygen saturation 98% on room air. Physical examination reveals mild tenderness to palpation in the left flank, but no guarding or rebound tenderness. Peripheral pulses are normal and symmetric. A contrast-enhanced CT scan of the abdomen and pelvis is performed, the axial view is shown. Given the clinical context and the findings on the image, which of the following is the MOST appropriate next step in management?

A. Referral to vascular surgery for elective repair
B. Order a renal ultrasound to evaluate for hydronephrosis
C. Prescribe analgesics and schedule a repeat CT scan in 6 months
D. Start oral antibiotics for suspected pyelonephritis
E. Initiate intravenous heparin and consult vascular surgery for urgent repair
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old man presents to the emergency department with sudden onset of severe abdominal pain radiating to the back. He is a smoker and has a history of hypertension. On examination, he is diaphoretic, with a heart rate of 120 bpm and blood pressure of 90/60 mmHg. Abdominal examination reveals a pulsatile mass in the midline. What is the most likely diagnosis?

A. Acute pancreatitis
B. Ruptured abdominal aortic aneurysm
C. Acute mesenteric ischemia
D. Perforated peptic ulcer
E. Renal colic
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 58-year-old man with a history of hypertension and left ventricular systolic dysfunction (LVSD) is being treated with an ACE inhibitor. His blood pressure is well-controlled, but he develops a persistent, dry cough that is affecting his sleep and quality of life. What is the most appropriate next step in management?

A. Add a cough suppressant
B. Switch to an angiotensin II receptor blocker (ARB)
C. Add a diuretic
D. Discontinue the ACE inhibitor and start a beta-blocker
E. Reduce the dose of the ACE inhibitor
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents for routine follow-up. He is asymptomatic. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medication. Review the provided image. What is the most appropriate next step in management?

A. Prescribe a statin
B. Repeat CT scan in 3 months
C. Referral for immediate surgical repair
D. Annual ultrasound surveillance
E. Initiate beta-blocker therapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 65-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus, hypertension, and dyslipidaemia presents with a 6-month history of burning pain in his feet, worse at night, often waking him from sleep. He also reports feeling lightheaded when standing up quickly and has noticed difficulty initiating urination and a weak stream. On examination, his blood pressure is 135/85 mmHg supine and 115/70 mmHg after standing for 3 minutes. Neurological examination reveals decreased sensation to pinprick and light touch in a stocking distribution up to the mid-calf bilaterally. Vibration sense is reduced at the ankles. Ankle reflexes are absent. The remainder of the examination is unremarkable. His most recent HbA1c is 8.9%. Which of the following is the most likely underlying cause of his constellation of symptoms?

A. Diabetic sensorimotor polyneuropathy with autonomic involvement
B. Charcot joint arthropathy
C. Peripheral arterial disease
D. Vitamin B12 deficiency
E. Lumbar spinal stenosis
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 62-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of poorly controlled hypertension and is currently on no medications. On examination, he is drowsy but arousable, with a blood pressure of 210/120 mmHg and a heart rate of 90 bpm. Neurological examination reveals right-sided hemiparesis and a left gaze preference. A CT scan of the head shows a large hyperdense area in the left basal ganglia with surrounding edema. What is the most appropriate initial management for this patient?

A. Immediate surgical evacuation of the hematoma
B. Intravenous labetalol to lower blood pressure
C. Oral antihypertensive therapy to gradually lower blood pressure
D. Intravenous mannitol to reduce intracranial pressure
E. Intravenous thrombolysis to dissolve the clot
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 62-year-old man presents to his GP reporting a swelling in his right groin that has been present for approximately 18 months. He describes it as intermittent, appearing when he stands or strains, and disappearing when he lies down. He occasionally experiences a mild, dull ache in the area, but denies any severe pain, nausea, vomiting, or change in bowel habits. His past medical history includes hypertension controlled with medication. On examination, vital signs are stable, and the finding shown in the image is noted. It is easily reducible. Considering the patient's history, the absence of acute symptoms, and the physical examination finding depicted, what is the most appropriate next step in the management of this patient?

A. Order an urgent ultrasound scan of the groin to confirm the diagnosis.
B. Immediate referral to the emergency department for urgent surgical exploration.
C. Recommend the use of a supportive truss.
D. Prescribe simple analgesia and advise watchful waiting with regular review.
E. Referral for elective surgical repair.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 62-year-old Aboriginal and Torres Strait Islander man presents for a routine check-up. He has a history of smoking, obesity, and type 2 diabetes, managed with metformin. His blood pressure is 150/90 mmHg. Which of the following is the MOST significant modifiable risk factor for cardiovascular disease in this patient?

A. Type 2 diabetes
B. Smoking
C. Obesity
D. Indigenous status
E. Hypertension
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A. Hydrocephalus
B. Post-operative delirium
C. Re-rupture of the aneurysm
D. Vasospasm
E. Cerebral salt wasting
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A patient is on metformin 1g BD, with a blood pressure of 135/85 mmHg, HbA1c of 8.5%, no history of cardiovascular disease, fasting blood sugar of 9 mmol/L, and an albumin/creatinine ratio of 500. Which drug should be added to their treatment regimen?

A. Pioglitazone
B. Ramipril
C. Sitagliptin
D. Gliclazide
E. Insulin
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Neuroblastoma, CT of the abdomen
Image by RadsWiki CC BY-SA 3.0 · Source

A 4-year-old with abdominal pain and hypertension has this CT. What is the MOST appropriate next step in management?

A. Surgical resection
B. Observation with serial imaging
C. Alpha-blockade
D. Radiation therapy
E. Chemotherapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 40-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress, with a blood pressure of 180/110 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the most appropriate next step in the management of this patient?

A. Lumbar puncture
B. Administer analgesics and observe
C. Start antihypertensive therapy
D. MRI of the brain
E. Repeat CT scan with contrast
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 68-year-old man with hypertension presents with sudden onset right-sided weakness and slurred speech. GCS is 13. BP 190/110 mmHg. What is the most critical initial investigation to guide management?

A. CT angiography
B. Lumbar puncture
C. Non-contrast CT head
D. ECG
E. MRI brain
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. He has a history of hypertension and is a smoker. On examination, his blood pressure is 180/110 mmHg in the right arm and 160/100 mmHg in the left arm. His heart rate is 110 bpm, and he has diminished pulses in the left radial artery. A chest X-ray shows a widened mediastinum. Which of the following is the most appropriate next step in management?

A. Immediate surgical consultation
B. CT angiography of the chest
C. Nitroglycerin infusion
D. Intravenous beta-blockers
E. Echocardiography
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He describes the headache as the worst he has ever experienced. He has a history of hypertension but is otherwise healthy. On examination, he is alert but in distress due to the headache. His blood pressure is 180/110 mmHg, heart rate is 90 bpm, and he has no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. What is the next best step in management?

A. Administer analgesics and observe
B. Repeat CT scan with contrast
C. MRI of the brain
D. Lumbar puncture
E. Start antihypertensive therapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Inguinal hernia right view. Adult male with an inguinal hernia, showing bulging in the groin area.
Image by IkeTheSloth CC0 1.0 · Source

A 58-year-old male presents to the emergency department complaining of right groin pain that started approximately 6 hours ago. He reports noticing a bulge in his groin for several months, which he could usually push back in. However, today he is unable to reduce it, and the pain has become progressively severe. He denies any fever, nausea, or vomiting. His past medical history includes hypertension and hyperlipidemia, both well-controlled with medications. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 80 bpm, respiratory rate 16 bpm, and temperature 37.0°C. Abdominal examination is benign. Examination of the groin reveals the finding shown in the image. The area is tender to palpation. Which of the following is the MOST appropriate next step in the management of this patient?

A. Surgical consultation for emergent repair
B. Ultrasound of the groin to rule out testicular torsion
C. Prescription for a truss and referral to a general surgeon for elective repair
D. CT scan of the abdomen and pelvis with intravenous contrast
E. Trial of manual reduction with sedation and analgesia
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old male with a history of hypertension and hyperlipidemia presents for a routine follow-up. He is asymptomatic. A contrast-enhanced CT abdomen, axial view shown, was performed as part of a screening protocol. What is the MOST appropriate next step?

A. Initiate beta-blocker therapy
B. Prescribe a statin for lipid management
C. Start aspirin for antiplatelet therapy
D. Repeat imaging in 6-12 months
E. Refer for immediate surgical repair
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 72-year-old man with a history of hypertension and hyperlipidemia presents for a routine health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed, axial view shown. Besides optimizing medical management, what is the MOST appropriate next step?

A. Referral for immediate surgical repair
B. Prescribe a statin
C. Initiate aspirin therapy
D. Repeat imaging in 6-12 months
E. Order a D-dimer
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Gynaecomastia
Image by ProloSozz CC BY-SA 4.0 · Source

A 62-year-old man presents with a 4-month history of bilateral breast enlargement and tenderness. He denies weight loss, fever, or changes in bowel habit. His medical history includes hypertension managed with amlodipine. On examination, vital signs are stable. The physical findings are demonstrated in the image. There is no palpable testicular mass. Given the clinical presentation and the findings shown, which of the following investigations is the most appropriate initial step to determine the underlying cause?

A. Mammography of both breasts
B. Fine needle aspiration of the breast tissue
C. Serum testosterone, oestradiol, LH, FSH, prolactin, and hCG
D. Trial of tamoxifen
E. Liver function tests and renal function tests
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
X-ray of hiatal hernia
Image by Ahmed Farhat, Daryn Towle CC BY 4.0 · Source

A 72-year-old male presents to the ED with increasing shortness of breath and epigastric pain, especially when lying down. He has a history of GORD, hypertension and COPD. His vitals are stable. An X-ray is performed. What is the MOST appropriate next step in management?

A. Administer intravenous antibiotics for possible aspiration pneumonia
B. Prescribe a short course of oral corticosteroids for COPD exacerbation
C. Order a barium swallow study to assess esophageal motility
D. Initiate a proton pump inhibitor and schedule an upper endoscopy
E. Perform a diagnostic thoracentesis to rule out pleural effusion
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old man presents to the clinic with a 3-month history of fatigue, weight loss, and abdominal pain. He has a history of type 2 diabetes and hypertension. On examination, he has a palpable mass in the left upper quadrant of the abdomen. Laboratory tests reveal anemia and elevated serum lactate dehydrogenase (LDH). A CT scan of the abdomen shows splenomegaly and multiple hypodense lesions in the spleen. What is the most likely diagnosis?

A. Splenic lymphoma
B. Renal cell carcinoma with splenic metastasis
C. Chronic pancreatitis
D. Infectious mononucleosis
E. Portal hypertension
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

A 68-year-old male presents for a routine check-up. He has a history of smoking and hypertension, managed with lisinopril. He denies any abdominal pain, back pain, or lower extremity claudication. Physical exam is unremarkable. A contrast-enhanced CT scan of the abdomen is performed, the axial view is shown. What is the MOST appropriate next step in management?

A. Repeat imaging in 6-12 months
B. Start aspirin for secondary prevention
C. Refer to vascular surgery for elective repair
D. Prescribe a statin for lipid management
E. Initiate beta-blocker therapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 65-year-old man with a history of type 2 diabetes mellitus and hypertension presents with exertional dyspnea and fatigue. His physical examination reveals a blood pressure of 150/90 mmHg, a heart rate of 88 bpm, and a soft S4 gallop. There is no peripheral edema. An electrocardiogram shows left ventricular hypertrophy with repolarization abnormalities. Which of the following diagnostic tests would be most appropriate to evaluate for underlying coronary artery disease in this patient?

A. Coronary angiography
B. Cardiac MRI
C. 24-hour Holter monitoring
D. Transthoracic echocardiography without stress
E. Exercise stress echocardiography
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old man with a history of hypertension presents to the emergency department with palpitations and lightheadedness. His ECG shows a regular narrow-complex tachycardia at a rate of 180 bpm. There are no visible P waves, and the QRS duration is 0.08 seconds. He is hemodynamically stable. Which of the following is the most appropriate initial management?

A. Synchronized cardioversion
B. Observation without intervention
C. Intravenous adenosine
D. Vagal maneuvers
E. Intravenous metoprolol
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 62-year-old woman presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. She describes the headache as the worst she has ever experienced. Her medical history includes hypertension and hyperlipidemia, for which she is on regular medication. On examination, she is alert but in distress, with a blood pressure of 180/100 mmHg, heart rate of 90 bpm, and respiratory rate of 18 breaths per minute. Neurological examination reveals neck stiffness but no focal neurological deficits. A CT scan of the head shows no acute intracranial hemorrhage. Which of the following is the most appropriate next step in management?

A. Start intravenous antihypertensive therapy
B. Administer antiemetics and observe
C. MRI of the brain
D. Repeat CT scan with contrast
E. Lumbar puncture
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 72-year-old man with a history of hypertension and atrial fibrillation presents to the emergency department with worsening shortness of breath and fatigue over the past two weeks. He reports occasional palpitations but denies chest pain or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 130 bpm (irregularly irregular), respiratory rate is 22 breaths per minute, and oxygen saturation is 94% on room air. Jugular venous pressure is elevated, and there are bilateral lung crackles. An ECG shows atrial fibrillation with a rapid ventricular response. An echocardiogram reveals moderate mitral regurgitation and left atrial enlargement. Which of the following is the most appropriate initial management step?

A. Initiation of antiarrhythmic therapy with amiodarone
B. Rate control with intravenous diltiazem
C. Immediate electrical cardioversion
D. Initiation of oral anticoagulation
E. Referral for mitral valve surgery
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 55-year-old man with a history of hypertension and smoking presents for a routine check-up. He is concerned about his risk of cardiovascular disease and asks for advice on lifestyle modifications. Which of the following lifestyle changes would most significantly reduce his risk of cardiovascular events?

A. Adopting a Mediterranean diet
B. Smoking cessation
C. Increasing physical activity
D. Limiting alcohol consumption
E. Reducing dietary salt intake
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 72-year-old man with a history of hypertension and type 2 diabetes mellitus is being managed with lisinopril. He presents to the emergency department complaining of lip swelling and difficulty breathing. On examination, his tongue appears swollen. What is the most appropriate immediate management?

A. Administer intramuscular epinephrine
B. Administer intravenous corticosteroids
C. Administer nebulized bronchodilators
D. Administer intravenous antihistamines
E. Observe and monitor vital signs
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 55-year-old man with a history of hypertension and stable angina is prescribed a new medication. He reports experiencing a persistent dry cough since starting the medication. Which drug is most likely responsible for this side effect?

A. Amlodipine
B. Losartan
C. Enalapril
D. Hydrochlorothiazide
E. Atenolol
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 72-year-old man with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus presents to the emergency department complaining of exertional chest pain that has been increasing in frequency and severity over the past month. He describes the pain as a pressure-like sensation in the center of his chest, radiating to his left arm, and associated with shortness of breath. The pain typically occurs after walking two blocks and resolves with rest. He denies any recent changes in his medications or lifestyle. On examination, his blood pressure is 150/90 mmHg, heart rate is 78 bpm, and oxygen saturation is 96% on room air. An ECG shows normal sinus rhythm with no acute ST-segment changes. Troponin levels are within normal limits. Which of the following is the MOST appropriate next step in the management of this patient?

A. Stress echocardiography
B. Discharge home with instructions to follow up with his general practitioner
C. Initiate a trial of increased anti-anginal medications and lifestyle modifications
D. Coronary angiography
E. CT angiography of the chest
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old male presents to the emergency department with severe chest pain radiating to his left arm, shortness of breath, and diaphoresis. He has a history of hypertension and hyperlipidemia. On examination, he is diaphoretic, and his blood pressure is 90/60 mmHg. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management for this patient?

A. Administer intravenous fluids to address hypotension
B. Administer beta-blockers to reduce myocardial oxygen demand
C. Administer morphine for pain management
D. Administer aspirin and initiate reperfusion therapy
E. Administer nitroglycerin for chest pain relief
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal subarachnoid hemorrhage is confirmed. The aneurysm was coiled. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A. Rebleeding
B. Hyponatremia
C. Meningitis
D. Hydrocephalus
E. Vasospasm
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
A contrast enhanced CT scan demonstrating an abdominal aortic aneurysm of 4.8 * 3.8 cm
Image by James Heilman, MD CC BY-SA 3.0 · Source

An 68-year-old man attends his GP for a routine check-up. He has a history of well-controlled type 2 diabetes, hypertension, and smoked for 30 years, quitting 5 years ago. He denies any abdominal pain, back pain, or pulsatile sensation. Physical examination is unremarkable. As part of a cardiovascular risk assessment, an abdominal ultrasound is initially performed, which is inconclusive due to bowel gas. A follow-up contrast-enhanced CT scan is arranged. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. No further action required, reassure the patient
B. Immediate admission for urgent surgical assessment
C. Referral for elective surgical repair
D. Repeat CT scan in 3 months
E. Six-monthly abdominal ultrasound surveillance
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 70-year-old man with a history of hypertension and heart failure is being managed with an ACE inhibitor. He presents to the emergency department complaining of dizziness, especially when standing up. His blood pressure is 90/60 mmHg, and his other vital signs are stable. Which of the following is the most appropriate initial step in managing this patient?

A. Order an ECG to rule out cardiac arrhythmia
B. Prescribe compression stockings
C. Review and potentially reduce the dose of the ACE inhibitor
D. Administer an intravenous bolus of normal saline
E. Start fludrocortisone
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 72-year-old woman with a history of well-controlled hypertension and type 2 diabetes presents to the emergency department with sudden onset of visual disturbance and mild weakness. She describes the visual issue as a loss of vision in the left half of her visual field, which began approximately 3 hours ago. She also notes some difficulty moving her right arm and leg, which started around the same time. On examination, her vital signs are stable: BP 135/85 mmHg, HR 78 bpm, RR 16/min, Temp 36.8°C, SpO2 98% on room air. Neurological examination confirms a left homonymous hemianopia and mild right hemiparesis (MRC grade 4/5) affecting both upper and lower limbs. Sensation is intact. Reflexes are symmetrical, and plantar responses are flexor. A non-contrast CT head was unremarkable for acute haemorrhage or established infarction. Subsequent CT angiography identified a cerebral aneurysm in a location consistent with her symptoms, and she was taken for endovascular coiling. The procedure was completed approximately 6 hours after symptom onset. The image provided is a digital subtraction angiogram obtained immediately following the coiling procedure. Despite the intervention, her left homonymous hemianopia and right hemiparesis persist without significant improvement. Considering the findings demonstrated in the post-procedure imaging in the context of her ongoing neurological deficits, which of the following is the MOST appropriate immediate management step?

A. Perform a repeat cerebral angiogram or high-resolution cross-sectional imaging to assess the residual sac and flow dynamics.
B. Assume the persistent symptoms are unrelated to the treated lesion and investigate for alternative causes such as carotid artery stenosis.
C. Administer intravenous alteplase given the persistent symptoms and recent onset.
D. Initiate aggressive inpatient stroke rehabilitation therapy immediately.
E. Discharge the patient home with urgent outpatient follow-up with neurology.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 55-year-old man with a history of hypertension presents for a routine check-up. His blood pressure is consistently measured at 160/95 mmHg despite lifestyle modifications. He is currently on perindopril 5 mg daily. According to Australian guidelines, what is the most appropriate next step in managing his hypertension?

A. Switch to losartan
B. Refer for renal artery imaging
C. Add hydrochlorothiazide
D. Add amlodipine
E. Increase perindopril to 10 mg daily
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 45-year-old man presents to the emergency department with sudden onset of severe chest pain radiating to his back. He describes the pain as tearing in nature. He has a history of hypertension and is a smoker. On examination, his blood pressure is 180/110 mmHg in the right arm and 160/100 mmHg in the left arm. His heart rate is 110 bpm, and he has a new diastolic murmur. An ECG shows left ventricular hypertrophy but no ischemic changes. What is the most appropriate next step in management?

A. Immediate thrombolysis
B. Chest X-ray
C. Echocardiography
D. Coronary angiography
E. CT angiography of the chest
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Gynaecomastia
Image by ProloSozz CC BY-SA 4.0 · Source

A 55-year-old man presents with the condition shown. He reports taking spironolactone for hypertension. What is the MOST appropriate next step?

A. Refer to endocrinology for hormonal evaluation
B. Initiate treatment with tamoxifen
C. Order a mammogram to rule out malignancy
D. Review and potentially adjust his antihypertensive medication
E. Reassure the patient that this is a normal age-related change
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Gynaecomastia
Image by ProloSozz CC BY-SA 4.0 · Source

A 58-year-old man presents with concerns about breast enlargement over the past year. He denies pain or tenderness. He takes medication for hypertension. Examination reveals the findings in the image. Which of the following is the MOST appropriate initial investigation?

A. Mammogram and ultrasound
B. Medication review and hormonal blood tests (testosterone, estradiol, LH, FSH)
C. Reassurance and observation
D. Referral to a breast surgeon
E. Fine needle aspiration
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 70-year-old woman with a history of hypertension and chronic kidney disease (CKD) stage 3 is prescribed an ACE inhibitor for blood pressure control. Which of the following parameters requires the closest monitoring after initiating the ACE inhibitor?

A. Liver function tests
B. Thyroid stimulating hormone (TSH)
C. Serum creatinine and potassium
D. Serum calcium
E. Complete blood count
Mark this as a high-quality question
Mark this as a poor-quality or problematic question