15. A 57 year-old woman presents to your clinic for physical examination.

She has no significant past

medical history and is asymptomatic. Her vital signs are significant for a blood pressure of 145/95
mmHg. What are the next steps in her evaluation for hypertension ?
A. Start patient on thiazide diuretic at the initial clinic visit
B. She should return in 1 year for her yearly physical examination
C. Begin evaluation for secondary causes of hypertension
D. She should have a repeat blood pressure measurement at a later time point during her visit and
return in a few weeks to obtain repeat testing if that measurement is elevated

16. A 46 year old business executive presents to A&E with a 2 hour history of central crushing chest
pain and breathlessness. He is a non-smoker, previously very fit and well and attends a gym four times
a week. There is no family history os ischemic heart disease. His cholesterol measured at an insurance
medical was 3,3 mmol/L. His observation on admission are as follows; pulse 105 bpm,blood pressure
80/50 mmHg; O2 saturations 90% on room air. He is apyrexial. An ECG is performed and shown sinus
tachycardia of 105 bpm. Right-axis deviation and non-spesific T-wave inversion in leads III, aVF,V2-
V4. This patient returned to his country from a business trip in Australia 2 weeks previously. On clinical
examination, you can find at of the following. Except?
A. The troponin I within normal limits (<1 ug/L)
B. There is a soft third heart sound over the right sternal border
C. Cyanosed and cool peripherally
D. Jugular venous pressure is elevated
E. The D-dimer is elevated to the 5 times the normal range

17. A 71-year old man comes to your office for evaluation before transurethral resection of the prostate
gland. He has a history of hypertension, feels well, leads an active life, and has no symptoms. On
physical examination, blood pressure is 140/70 mmHg, and heart rate is 70/min and regular. Jugular
venous pressure and carotid upstroke are normal, and an S4 is heard. The patient has no S3, no murmurs,
and no peripheral edema. A preoperative chest radiograph shows cardiomegaly. Echocardiogram
performed to evaluate cardiomegaly shows left ventricular hypertrophy, with global left ventricular
dysfunction and an ejection fraction of 33%. No valvular abnormalities are noted. Ace inhibitor therapy
is initiated. Which of the following medications should also be given to this patient?
A. Diuretic
B. B-Blocker
C. Spironolactone
D. Angiotensin receptor blocker
E. Digoxin