A 73-year-old man presents to the primary care clinic with increasing shortness of breath. He has had shortness of breath for many years, but it has been progressively worsening. It is associated with peripheral edema and dry cough. A transthoracic echocardiogram shows pulmonary hypertension. What is the most appropriate treatment for this patient?

Correct Answer: B

Rationale: Bosentan, an endothelin receptor antagonist, is a targeted therapy for pulmonary hypertension, reducing pulmonary vascular resistance and improving symptoms like shortness of breath and edema. Albuterol (a bronchodilator) treats asthma/COPD, not pulmonary hypertension. Guaifenesin (an expectorant) and N-acetylcysteine (a mucolytic) address mucus, not vascular issues. Theophylline (a bronchodilator) is outdated and ineffective for pulmonary hypertension.

Correct Answer: B

Rationale: Losartan (b), an angiotensin II receptor blocker (ARB), affects the renin-angiotensin-aldosterone system (RAAS) and is often substituted for ACE inhibitors when side effects (e.g., cough) are intolerable. Spironolactone is a potassium-sparing diuretic affecting aldosterone, but ARBs are more direct RAAS alternatives to ACE inhibitors. Atenolol is a beta-blocker, and adenosine is an antiarrhythmic—neither targets RAAS. Note: Answer key says (c), but is pharmacologically correct.

Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: B

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Correct Answer: C

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.