Christina, a 55-year-old woman, presents to her primary care physician with a blood pressure reading of 150/90 mmHg. She has a history of hypertension but has not been consistently taking her medications. The physician discusses the importance of controlling blood pressure to reduce the risk of heart disease, stroke, and kidney disease. She is started on a diuretic to lower her blood pressure. She is educated about the potential side effects of the medication. She is advised to monitor her blood pressure at home and report any side effects to her doctor. Of the following, which diuretic is most commonly associated with development of gout?

A 54-year-old man presents to the clinic for a pre-employment physical examination. He has no complaints other than ‘occasional coughs and colds’. His only concern is elevated blood pressure for the last 4 weeks. He made some lifestyle changes including exercise, weight loss, smoking cessation and a low-salt diet. His temperature is 99 ⁰ F, heart rate is 72 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 160/90 mm Hg. You prescribe hydrochlorothiazide to treat his hypertension. Of the following, which is the mechanism of action of this medication?

A 54-year-old man presents to the clinic for a pre-employment physical examination. He has no complaints other than ‘occasional coughs and colds’. His only concern is elevated blood pressure for the last 4 weeks. He made some lifestyle changes including exercise, weight loss, smoking cessation and a low-salt diet. His temperature is 99 ⁰ F, heart rate is 72 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 160/90 mm Hg. You prescribe hydrochlorothiazide to treat his hypertension. Which of the following is an adverse effect of this medication?

A 52-year-old man presents to your clinic for pre pre-surgery physical examination. He has no complaints other than occasional backaches. He is due for a surgery for right hip replacement. During the history taking, you discover that he is a smoker and an alcoholic. He works as an electrician. His vital signs are His temperature is 99.8 ⁰ F, heart rate is 82 beats per minute, respiratory rate is 18 breaths per minute, blood pressure is 167/88 mm Hg, and oxygen saturation is 97% of room air. Physical examination is significant for obesity. Patient is disappointed that he cannot undergo his hip replacement surgery without controlling his blood pressure. Routine laboratory tests yielded normal results. In addition to medications, he would like to try some lifestyle changes to treat his hypertension. Which of the following yields best results in reducing blood pressure in this patient?

A 12-year-old girl is brought to your primary care center by her parents for having fever, joint pains and a rash. The pain moves from joint to joint. Her parents are particularly concerned about involuntary, uncoordinated movements of her tongue, face and upper extremities. On review of systems, you discover that he suffered from a sickness 2 to 3 weeks ago, which was assumed to be a viral infection and treated with acetaminophen and fluids. Physical examination is notable for involuntary movements in the face and upper extremities. When you asked the patient to squeeze your hand, she made repetitive irregular squeezes. There are subcutaneous nodules on both upper and lower extremities. You also noticed branching erythematous ring-shaped rash over the extremities. As you discuss the diagnosis with the girl and her parents, the parents asked you about the most feared complication of this disorder. Which of the following disorders is the most serious complication of this disease?

A 12-year-old girl is brought to your primary care center by her parents for having fever, joint pains and a rash. The pain moves from joint to joint. Her parents are particularly concerned about involuntary, uncoordinated movements of her tongue, face and upper extremities. On review of systems, you discover that he suffered from a sickness 2 to 3 weeks ago, which was assumed to be a viral infection and treated with acetaminophen and fluids. Physical examination is notable for involuntary movements in the face and upper extremities. When you asked the patient to squeeze your hand, she made repetitive irregular squeezes. There are subcutaneous nodules on both upper and lower extremities. You also noticed branching erythematous ring-shaped rash over the extremities. Which of the following most likely preceded this patient’s current condition?

A 72-year-old man presents to your clinic with a 4-month history of worsening shortness of breath. His exercise tolerance decreased, he has been having chest pains and lightheadedness. He also changed his shoes because of swelling in both feet. He finds that he becomes short of breath after working a couple of hours in an 8 hour work day. He awakens at night, gasping for breath. He has to prepare himself with pillows in order to sleep. His temperature is 99 ⁰ F, heart rate is 62 beats per minute, respiratory rate is 17 breaths per minute, and blood pressure is 190/75 mm Hg. On physical examination, his apical impulse is displaced to the left and downard. There are rales over both lower lung fields. On cardiac auscultation, there are three distinct murmurs: a high-pitched, early diastolic murmur loudest at the left lower sternal border, a diastolic rumble heard at the apex, and a crescendo–decrescendo systolic murmur heard at the left upper sternal border. Chest x-ray film shows cardiomegaly and pulmonary edema. Of the following, which is the most likely diagnosis in this patient?