CANS EXAM / CANS COMPREHENSIVE EXAM ACTUAL 2026/2027 EXAM
PREP QUESTIONS AND STUDY GUIDE ACCURATE EXAM REAL
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH DETAILED
RATIONALES (A NEW UPDATED VERSION 2026 EDITION)
|GUARANTEED SUCCESS A+ |JUST RELEASED
1. A 45-year-old patient presents with acute chest pain radiating to the left arm,
diaphoresis, and nausea. An ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the MOST appropriate immediate intervention?
A) Administer sublingual nitroglycerin and admit for observation
B) Perform a chest X-ray to rule out aortic dissection
C) CORRECT ANSWER: Initiate percutaneous coronary intervention (PCI)
protocol
D) Administer intravenous heparin and schedule a stress test
Rationale: ST-elevation in V1-V4 indicates an anterior myocardial infarction. PCI
is the gold standard for reperfusion and must be initiated emergently. Nitroglycerin
is adjunctive but not definitive. Delaying for X-ray or stress testing is
contraindicated in acute STEMI.
2. A 67-year-old male with a history of hypertension and type 2 diabetes presents
with sudden onset of severe, tearing back pain. Blood pressure is 180/110 mmHg
in the right arm and 100/70 mmHg in the left arm. What is the MOST likely
diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) CORRECT ANSWER: Aortic dissection
D) Musculoskeletal back strain
,Rationale: Aortic dissection presents with sudden, severe tearing pain and pulse or
blood pressure differentials between limbs. Hypertension is a major risk factor. MI
and PE typically do not cause extremity BP discrepancies.
3. A 28-year-old woman with a history of asthma presents with acute shortness of
breath, wheezing, and use of accessory muscles. She is unable to speak in full
sentences. Her peak expiratory flow is 35% of predicted. Which medication should
be administered FIRST?
A) Oral prednisone 60 mg
B) Inhaled fluticasone
C) CORRECT ANSWER: Nebulized albuterol with ipratropium
D) Intravenous magnesium sulfate
Rationale: Severe acute asthma exacerbation requires rapid-acting bronchodilators.
Nebulized albuterol combined with ipratropium is first-line. Steroids are given
concurrently but take hours to work. Magnesium is adjunctive if no response.
4. A patient with cirrhosis presents with confusion, asterixis, and a serum ammonia
level of 120 µmol/L. Which dietary intervention is MOST appropriate?
A) High-protein diet to promote healing
B) Low-sodium diet to reduce ascites
C) CORRECT ANSWER: Low-protein diet with lactulose therapy
D) High-carbohydrate, low-fat diet
Rationale: Hepatic encephalopathy is managed by reducing ammonia production.
A low-protein diet and lactulose (to acidify the gut and trap ammonia) are
standard. High protein worsens encephalopathy.
,5. A 55-year-old smoker presents with a non-healing ulcer on the heel, cool lower
extremities, and absent dorsalis pedis pulses. What is the BEST initial diagnostic
test?
A) Venous Doppler ultrasound
B) CORRECT ANSWER: Ankle-brachial index (ABI)
C) Arteriography
D) Transcutaneous oximetry
Rationale: ABI is the first-line, non-invasive test for peripheral artery disease
(PAD). An ABI <0.90 confirms PAD. Venous Doppler is for DVT, not arterial
ulcers.
6. A 32-year-old pregnant woman at 28 weeks gestation develops gestational
diabetes. Her fasting glucose is 110 mg/dL. What is the FIRST-LINE
pharmacological treatment?
A) Metformin
B) Glyburide
C) CORRECT ANSWER: Insulin therapy
D) Sitagliptin
Rationale: Insulin is the preferred and FDA-approved first-line agent for
gestational diabetes when diet and exercise fail, as it does not cross the placenta
significantly. Metformin and glyburide are sometimes used but are not first-line in
all guidelines.
7. A child presents with a petechial rash, fever, and nuchal rigidity. A lumbar
puncture shows gram-negative diplococci. What is the empiric antibiotic of
choice?
A) Vancomycin
, B) Ceftriaxone
C) CORRECT ANSWER: Ceftriaxone plus vancomycin
D) Ampicillin
Rationale: For suspected bacterial meningitis in a child, empiric coverage includes
ceftriaxone (for Neisseria meningitidis and S. pneumoniae) plus vancomycin (for
resistant S. pneumoniae) until cultures confirm susceptibility.
8. A 70-year-old patient is on warfarin for atrial fibrillation. His INR is 9.0 with no
bleeding. What is the appropriate management?
A) Administer vitamin K 10 mg subcutaneously
B) Hold warfarin and restart at a lower dose
C) CORRECT ANSWER: Hold warfarin and administer oral vitamin K 1-2.5 mg
D) Transfuse fresh frozen plasma
Rationale: For an INR >5 but <9 with no bleeding, holding warfarin and giving
low-dose oral vitamin K (1-2.5 mg) is recommended. IV vitamin K and FFP are
reserved for active bleeding or INR >9.
9. A 48-year-old man with chronic kidney disease stage 4 has a hemoglobin of 8.5
g/dL. He is asymptomatic. What is the MOST appropriate therapy?
A) Blood transfusion
B) CORRECT ANSWER: Erythropoiesis-stimulating agent (ESA) with iron
supplementation
C) Oral folic acid
D) High-dose corticosteroids
PREP QUESTIONS AND STUDY GUIDE ACCURATE EXAM REAL
QUESTIONS AND CORRECT VERIFIED ANSWERS WITH DETAILED
RATIONALES (A NEW UPDATED VERSION 2026 EDITION)
|GUARANTEED SUCCESS A+ |JUST RELEASED
1. A 45-year-old patient presents with acute chest pain radiating to the left arm,
diaphoresis, and nausea. An ECG shows ST-segment elevation in leads V1-V4.
Which of the following is the MOST appropriate immediate intervention?
A) Administer sublingual nitroglycerin and admit for observation
B) Perform a chest X-ray to rule out aortic dissection
C) CORRECT ANSWER: Initiate percutaneous coronary intervention (PCI)
protocol
D) Administer intravenous heparin and schedule a stress test
Rationale: ST-elevation in V1-V4 indicates an anterior myocardial infarction. PCI
is the gold standard for reperfusion and must be initiated emergently. Nitroglycerin
is adjunctive but not definitive. Delaying for X-ray or stress testing is
contraindicated in acute STEMI.
2. A 67-year-old male with a history of hypertension and type 2 diabetes presents
with sudden onset of severe, tearing back pain. Blood pressure is 180/110 mmHg
in the right arm and 100/70 mmHg in the left arm. What is the MOST likely
diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) CORRECT ANSWER: Aortic dissection
D) Musculoskeletal back strain
,Rationale: Aortic dissection presents with sudden, severe tearing pain and pulse or
blood pressure differentials between limbs. Hypertension is a major risk factor. MI
and PE typically do not cause extremity BP discrepancies.
3. A 28-year-old woman with a history of asthma presents with acute shortness of
breath, wheezing, and use of accessory muscles. She is unable to speak in full
sentences. Her peak expiratory flow is 35% of predicted. Which medication should
be administered FIRST?
A) Oral prednisone 60 mg
B) Inhaled fluticasone
C) CORRECT ANSWER: Nebulized albuterol with ipratropium
D) Intravenous magnesium sulfate
Rationale: Severe acute asthma exacerbation requires rapid-acting bronchodilators.
Nebulized albuterol combined with ipratropium is first-line. Steroids are given
concurrently but take hours to work. Magnesium is adjunctive if no response.
4. A patient with cirrhosis presents with confusion, asterixis, and a serum ammonia
level of 120 µmol/L. Which dietary intervention is MOST appropriate?
A) High-protein diet to promote healing
B) Low-sodium diet to reduce ascites
C) CORRECT ANSWER: Low-protein diet with lactulose therapy
D) High-carbohydrate, low-fat diet
Rationale: Hepatic encephalopathy is managed by reducing ammonia production.
A low-protein diet and lactulose (to acidify the gut and trap ammonia) are
standard. High protein worsens encephalopathy.
,5. A 55-year-old smoker presents with a non-healing ulcer on the heel, cool lower
extremities, and absent dorsalis pedis pulses. What is the BEST initial diagnostic
test?
A) Venous Doppler ultrasound
B) CORRECT ANSWER: Ankle-brachial index (ABI)
C) Arteriography
D) Transcutaneous oximetry
Rationale: ABI is the first-line, non-invasive test for peripheral artery disease
(PAD). An ABI <0.90 confirms PAD. Venous Doppler is for DVT, not arterial
ulcers.
6. A 32-year-old pregnant woman at 28 weeks gestation develops gestational
diabetes. Her fasting glucose is 110 mg/dL. What is the FIRST-LINE
pharmacological treatment?
A) Metformin
B) Glyburide
C) CORRECT ANSWER: Insulin therapy
D) Sitagliptin
Rationale: Insulin is the preferred and FDA-approved first-line agent for
gestational diabetes when diet and exercise fail, as it does not cross the placenta
significantly. Metformin and glyburide are sometimes used but are not first-line in
all guidelines.
7. A child presents with a petechial rash, fever, and nuchal rigidity. A lumbar
puncture shows gram-negative diplococci. What is the empiric antibiotic of
choice?
A) Vancomycin
, B) Ceftriaxone
C) CORRECT ANSWER: Ceftriaxone plus vancomycin
D) Ampicillin
Rationale: For suspected bacterial meningitis in a child, empiric coverage includes
ceftriaxone (for Neisseria meningitidis and S. pneumoniae) plus vancomycin (for
resistant S. pneumoniae) until cultures confirm susceptibility.
8. A 70-year-old patient is on warfarin for atrial fibrillation. His INR is 9.0 with no
bleeding. What is the appropriate management?
A) Administer vitamin K 10 mg subcutaneously
B) Hold warfarin and restart at a lower dose
C) CORRECT ANSWER: Hold warfarin and administer oral vitamin K 1-2.5 mg
D) Transfuse fresh frozen plasma
Rationale: For an INR >5 but <9 with no bleeding, holding warfarin and giving
low-dose oral vitamin K (1-2.5 mg) is recommended. IV vitamin K and FFP are
reserved for active bleeding or INR >9.
9. A 48-year-old man with chronic kidney disease stage 4 has a hemoglobin of 8.5
g/dL. He is asymptomatic. What is the MOST appropriate therapy?
A) Blood transfusion
B) CORRECT ANSWER: Erythropoiesis-stimulating agent (ESA) with iron
supplementation
C) Oral folic acid
D) High-dose corticosteroids
