A 57-year-old retired schoolteacher with a history of Prinzmetal angina presents to his primary care physician for follow-up. He has not had an attack in the last 6 months and wishes to stop preventative medications. Which of the following statements is true?

Correct Answer: A

Rationale: Rationale: The correct answer is A) Continuation of his medications would be helpful. In Prinzmetal angina, also known as variant angina, episodes of chest pain occur at rest due to coronary artery vasospasm. By continuing preventative medications, such as calcium channel blockers or nitrates, the vasospasm can be controlled, reducing the frequency and severity of angina attacks. Stopping these medications could lead to an increased risk of anginal episodes and potential complications like myocardial infarction. Option B) Increased blood flow to the heart worsens symptoms is incorrect. In Prinzmetal angina, the symptoms are typically triggered by vasospasm, not increased blood flow to the heart. Vasodilators are actually beneficial in this condition to prevent vasospasm. Option C) Symptoms are related to physical activity is incorrect. Unlike typical angina, Prinzmetal angina occurs at rest and is not necessarily related to physical exertion. Option D) Symptoms are worsened with worsening hypertension is incorrect. While hypertension can contribute to overall cardiovascular risk, it is not specifically linked to the pathophysiology of Prinzmetal angina. Educational Context: Understanding the management of cardiovascular conditions like Prinzmetal angina is crucial for healthcare providers to optimize patient care. Continuation of preventative medications in this case is essential to control vasospasm and prevent angina attacks. Patient education on the importance of adherence to medications and regular follow-ups is key to managing chronic conditions effectively.

Correct Answer: B

Rationale: In this question, the correct answer is B) Hydralazine. Hydralazine is a direct-acting vasodilator that reduces blood pressure by dilating arterioles. One of the common adverse effects of hydralazine is reflex tachycardia, where the body compensates for the sudden drop in blood pressure by increasing the heart rate. This reflex response can lead to symptoms like headache and hypotension. Now, let's discuss why the other options are incorrect: A) Prazosin is an alpha-1 adrenergic blocker. While it can cause orthostatic hypotension, it is not typically associated with reflex tachycardia or headache. C) Clonidine is a centrally acting alpha-2 adrenergic agonist. It can cause hypotension and bradycardia but is not known to cause reflex tachycardia. D) Guanethidine is a postganglionic adrenergic neuron blocker. It can cause orthostatic hypotension but is not commonly associated with reflex tachycardia or headache. Educational context: Understanding the adverse effects of different antihypertensive agents is crucial in clinical practice. By knowing the specific adverse effects of each drug, healthcare providers can make informed decisions when selecting the most appropriate treatment for patients with hypertension. Patients should also be educated about potential side effects to improve adherence and ensure timely medical intervention if needed.

Correct Answer: D

Rationale: The correct answer is D: Decreased levels of acetylcholine. Acetylcholine is essential for memory and motor function. Reduced levels can lead to memory deficits and decreased motor function. Abnormal levels of serotonin (A), decreased levels of dopamine (B), and increased levels of norepinephrine (C) are not directly linked to memory deficits and motor function impairment.

Correct Answer: A

Rationale: The correct answer is A. Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening side effect of antipsychotic medications like Thorazine. The treatment involves discontinuing the causative agent (Thorazine) and administering dantrolene to manage muscle rigidity and hyperthermia. Increasing Thorazine dosage (B) would worsen NMS symptoms. Treating dystonia with trihexyphenidyl (C) or bromocriptine (D) is not appropriate for NMS.

Correct Answer: D

Rationale: The correct answer is D: Heart failure. Patients with heart failure often have fluid and electrolyte imbalances, affecting lithium levels. Monitoring serum lithium concentrations is critical in these patients due to the risk of toxicity. Arthritis (choice A), epilepsy (choice B), and psoriasis (choice C) do not directly impact lithium levels or require close monitoring like heart failure does.