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lisinopril

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

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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
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A 65-year-old male with a history of hypertension and type 2 diabetes presents with stable angina. He is currently on metformin, atorvastatin, and lisinopril. Which of the following medications is most appropriate to add to his regimen to reduce angina symptoms?

A. Diuretic (e.g., hydrochlorothiazide)
B. Beta-blocker (e.g., metoprolol)
C. Angiotensin II receptor blocker (e.g., losartan)
D. Calcium channel blocker (e.g., amlodipine)
E. Nitrate (e.g., isosorbide mononitrate)
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A 72-year-old man with a history of chronic heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation presents to the cardiology clinic for routine follow-up. He reports increased fatigue and occasional palpitations but denies chest pain or syncope. His current medications include lisinopril, carvedilol, furosemide, and digoxin. His blood pressure is 110/70 mmHg, heart rate is 78 bpm, and he has mild peripheral edema. Recent laboratory tests show a serum creatinine of 1.2 mg/dL and potassium of 4.5 mmol/L. An echocardiogram shows an ejection fraction of 35%. Considering his current medication regimen and clinical status, which of the following is the most appropriate next step in his pharmacological management?

A. Increase the dose of carvedilol
B. Initiate ivabradine
C. Start warfarin for anticoagulation
D. Switch lisinopril to sacubitril/valsartan
E. Add spironolactone
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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. Order a D-dimer to rule out acute aortic dissection
B. Referral to vascular surgery for elective repair
C. Initiate beta-blocker therapy to reduce wall stress
D. Repeat imaging in 6-12 months to monitor growth
E. Prescribe a statin to stabilize atherosclerotic plaques
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A 52-year-old woman presents to her general practitioner with fatigue, increased thirst, and frequent urination over the past three months. She has a history of hypertension and hyperlipidemia, for which she takes lisinopril and atorvastatin. Her BMI is 32 kg/m². On examination, her blood pressure is 140/85 mmHg, and her heart rate is 78 bpm. Laboratory tests reveal a fasting plasma glucose of 8.5 mmol/L and an HbA1c of 7.2%. She is diagnosed with type 2 diabetes mellitus. Which of the following is the most appropriate initial management step for this patient according to Australian guidelines?

A. Lifestyle modification including diet and exercise
B. Commencement of insulin therapy
C. Initiation of metformin therapy
D. Referral to an endocrinologist
E. Addition of a sulfonylurea
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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
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A 68-year-old man with a history of hypertension, type 2 diabetes, and stable angina is scheduled for elective hernia repair surgery. He is currently on aspirin, metformin, lisinopril, and atorvastatin. His last angina episode was over a year ago, and he has no history of myocardial infarction. What is the most appropriate preoperative management step to minimize his cardiovascular risk during surgery?

A. Discontinue aspirin therapy one week before surgery
B. Increase the dose of atorvastatin
C. Continue aspirin therapy
D. Order a preoperative stress test
E. Start beta-blocker therapy
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A 72-year-old man presents to the emergency department with confusion and difficulty walking. His family reports that he has been increasingly forgetful over the past few months and has had several falls. He has a history of hypertension and hyperlipidemia, for which he takes lisinopril and atorvastatin. On examination, he is disoriented to time and place, with a blood pressure of 140/85 mmHg, heart rate of 78 bpm, and a wide-based gait. Neurological examination reveals brisk reflexes and a positive Romberg sign. A CT scan of the head shows mild cortical atrophy but no acute lesions. Which of the following is the most likely diagnosis?

A. Vascular dementia
B. Normal pressure hydrocephalus
C. Parkinson's disease
D. Alzheimer's disease
E. Subdural hematoma
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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
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A 52-year-old woman presents to her general practitioner with fatigue, increased thirst, and frequent urination over the past three months. She has a history of hypertension and hyperlipidemia, managed with lisinopril and atorvastatin. Her BMI is 32 kg/m². On examination, her blood pressure is 140/85 mmHg, and her heart rate is 78 bpm. Laboratory tests reveal a fasting plasma glucose of 8.5 mmol/L and an HbA1c of 7.2%. She is concerned about her risk of complications and asks about the best initial management strategy. Considering Australian guidelines, what is the most appropriate next step in managing her condition?

A. Initiate metformin therapy
B. Advise lifestyle modifications only
C. Prescribe a sulfonylurea
D. Refer to an endocrinologist immediately
E. Start insulin therapy
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A 62-year-old man presents to the emergency department with a history of palpitations and dizziness that started suddenly 2 hours ago. He has a history of hypertension and is on lisinopril. He denies chest pain, shortness of breath, or syncope. On examination, his blood pressure is 110/70 mmHg, heart rate is 150 bpm (irregular), respiratory rate is 18 breaths per minute, and temperature is 36.7°C. An ECG is performed, showing an irregularly irregular rhythm with no distinct P waves and a narrow QRS complex. Which of the following is the most appropriate initial management step?

A. Initiation of anticoagulation therapy
B. Rate control with a beta-blocker
C. Immediate electrical cardioversion
D. Administration of adenosine
E. Rate control with digoxin
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to the emergency department complaining of increasing shortness of breath and epigastric discomfort over the past several months. He reports feeling full quickly after eating only small amounts. He denies any chest pain, fever, or recent weight loss. His past medical history includes hypertension and well-controlled type 2 diabetes. He takes lisinopril and metformin daily. On examination, his vital signs are stable: blood pressure 130/80 mmHg, heart rate 82 bpm, respiratory rate 18 breaths/min, and oxygen saturation 96% on room air. Auscultation of the chest reveals decreased breath sounds at the left base. Abdominal examination reveals mild epigastric tenderness to palpation, but no rebound tenderness or guarding. The provided image was obtained. Which of the following is the MOST appropriate next step in management?

A. Initiate a proton pump inhibitor and monitor symptoms
B. Esophageal manometry
C. Endoscopic surveillance every 3 years
D. Surgical repair
E. Barium swallow study
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