Tess is a 55yo African American female with a PMH of HTN, DM and hyperlipidemia.  She weighs 175 lbs and is 5’4″. She sometimes eats processed foods and admits to having trouble with portion control. She does not exercise regularly and she does not smoke.  Her mother had a MI at the age of 70.  Her fasting lipid profile shows TC 200 [

Mr. Damone, a 59 year old man, presents to the emergency department with crushing chest discomfort. An ECG indicates a small transmural left ventricular free wall infarction. The patient is given several drugs, for both immediate management of ischemia and for long term prevention of a subsequent MI. Which of the following drugs would provide immediate relief of the symptoms of myocardial ischemia, but has no long term effects on mortality (i.e. reducing the risk of sudden cardiac death or ventricular dysfunction)?

John is a 57yo Caucasian male who presents for a routine visit for his hyperlipidemia.  His PMH includes hyperlipidemia and hypertension.  He has no family history of heart disease.  He is a current smoker (1 PPD x 45 years).  He currently takes quinapril (Accupril*) 20mg daily.  Vitals include BP 165/90 x 2, HR 84, EKG shows normal sinus rhythm.  Weight 210 lbs, ht 5’10”.  Fasting labs include K 5.1 , Cr 1.1 [

Which of the following is the recommended daily calcium and vitamin D intake for a 76 yo woman?

Lynette is a 68 yo female who presents to your clinic for a follow up appointment after her recent heart failure diagnosis.  She complains of weakness, loss of appetite, and she is seeing a blue/green halo.  Her daughter comments that she has appeared confused over the past day or so.  Which medication may be causing these side effects?

A 45-year-old female presents to the clinic with complaints of persistent headaches for the past two weeks. She describes the pain as sudden and severe, unlike any headache she has experienced before. She denies any visual disturbances but reports feeling nauseous during the headaches. She has no significant past medical history. Which of the following red flags suggests a potentially serious underlying cause of her headaches?

Tyson is a 50 yo black male with a past medical history significant for hypertension and a heart attack (resulting in reduced LVEF) one year ago.  He is currently taking lisinopril (Zestril*) and a higher dose of amlodipine (Norvasc*).  He says he is having ankle edema over the past couple months since amlodipine (Norvasc*) was started.  His kidney function is normal, and he has no other signs/symptoms of fluid accumulation (e.g. pulmonary congestion, weight gain).  His BP is 138/70, and HR 72. His laboratory values are normal. Considering not only hypertension, but his past medical history ( prior MI / stable HFrEF) and most recent complaint (ankle edema), which of the following recommendations is most appropriate for Tyson to correct the edema and optimize heart failure therapy?

Andrea, a 27 y/o F with a history of asthma, has followed your prescribed asthma treatment plan and is doing much better (she is well controlled). Concerned about using the lowest effective dose of medications and still maintaining control of the asthma, you decide to step down therapy. The current guidelines suggest this is possible because Andrea has been well controlled for at least how long?

Peter is a 48 year old man with hypertension, COPD, erectile dysfunction and stable but moderately intense angina with physical exertion.  He typically fails to keep appointments and declines invasive diagnostic and therapeutic interventions.  His hypertension has been poorly controlled until recently.  His current medications include metoprolol (Toprol*), ramipril (Altace*), amlodipine (Norvasc*), atorvastatin (Lipitor*) and a nitroglycerin patch (Nitro-Dur*) worn from 10AM to 10PM.  He recently received tadalafil tablets (Cialis*) for erectile dysfunction from a questionable internet pharmacy and wants to know how to use them safely.  Which statement is true about the use of tadalafil (Cialis*) in Peter?  (Note: tadalafil inhibits phosphodiesterase for 36-48 hours)

Edward is a 65 yo male with chronic kidney disease (CKD) and hypertension. Based on the 2017 ACC/AHA guidelines, which of the following is Edward’s BP goal?