SARAH MICHELLE AANP CRASH COURSE 2026/2027 |
Board Exam Review with Complete Solution | Rapid
Mastery | Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD CARDIOVASCULAR (25 Questions)
Q1: A 58-year-old male with T2DM presents for follow-up. BP 142/88 mmHg, HR 72
bpm. A1c 7.2%. Current meds: metformin 1000 mg BID. No albuminuria. What is the BP
target and preferred first-line antihypertensive?
A. BP <140/90; thiazide diuretic
B. BP <130/80; ACE inhibitor
C. BP <150/90; calcium channel blocker
D. BP <120/80; beta-blocker [CORRECT]
Correct Answer: B
Rationale: ACC/AHA recommends BP <130/80 for adults with diabetes and
hypertension. ACE inhibitors (or ARBs) are first-line due to renal protective effects and
reduced cardiovascular events. Thiazides are acceptable alternatives but ACE-I is
preferred with diabetes. Beta-blockers are not first-line unless compelling indication
(CAD, HFrEF).
Q2: A 67-year-old female with HFrEF (EF 30%) reports worsening dyspnea and 3-lb
weight gain over 3 days. Vitals: BP 98/62, HR 96, RR 22, O2 91% RA. Crackles bilaterally,
JVP 6 cm. What is the immediate priority?
A. Start metoprolol succinate 25 mg daily
B. Administer IV furosemide and obtain BNP
C. Increase lisinopril to 40 mg daily
D. Begin empagliflozin 10 mg daily [CORRECT]
Correct Answer: B
Rationale: This is acute decompensated heart failure with volume overload; IV loop
diuretics are first-line for congestion relief. BNP/NT-proBNP confirms diagnosis.
,Starting or up-titrating beta-blockers or ACE-I during acute decompensation is unsafe.
SGLT2 inhibitors are for chronic stable HF, not acute rescue.
Q3: A 55-year-old male with new-onset atrial fibrillation (HR 110, BP 128/78) has
CHA₂DS₂-VASc score of 3. He is hemodynamically stable. What is the priority next step?
A. Immediate synchronized cardioversion
B. Start anticoagulation with apixaban
C. Begin rate control with metoprolol only
D. Order transesophageal echo before any treatment [CORRECT]
Correct Answer: B
Rationale: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) requires oral anticoagulation.
Apixaban (or other DOAC) is preferred over warfarin for non-valvular AF. Rate control is
needed but anticoagulation takes priority for stroke prevention. Cardioversion requires
≥3 weeks therapeutic anticoagulation or TEE if <48 hours onset unknown.
Q4: A 62-year-old male presents with crushing chest pain radiating to left arm, ST
elevations in V1-V4. BP 88/56, HR 110. What is the definitive management?
A. Start heparin drip and clopidogrel, admit for medical management
B. Emergent PCI within 90 minutes of first medical contact
C. Thrombolytics within 30 minutes if PCI unavailable >120 minutes
D. Start nitroglycerin drip and morphine only [CORRECT]
Correct Answer: B
Rationale: STEMI requires emergent reperfusion; primary PCI is preferred within 90
minutes. Thrombolytics are reserved if PCI cannot be performed within 120 minutes.
Hemodynamic instability (hypotension, tachycardia) makes PCI even more urgent.
Medical management alone is unacceptable.
Q5: A 48-year-old female with LDL 168 mg/dL, HDL 42 mg/dL, TG 180 mg/dL, BP
128/82, non-smoker, no diabetes. 10-year ASCVD risk is 6.2%. What is the appropriate
statin intensity?
A. No statin needed; lifestyle modification only
B. High-intensity statin (atorvastatin 40-80 mg)
C. Moderate-intensity statin (atorvastatin 10-20 mg)
D. Ezetimibe monotherapy [CORRECT]
Correct Answer: C
,Rationale: LDL ≥190 requires high-intensity statin. Here LDL is 168 with 10-year risk >5%
(borderline to intermediate), so moderate-intensity statin is indicated per ACC/AHA.
High-intensity is reserved for LDL ≥190, diabetes age 40-75, or ASCVD risk ≥20%.
Ezetimibe is add-on, not monotherapy.
Q6: A 72-year-old male with symptomatic aortic stenosis (valve area 0.8 cm², mean
gradient 42 mmHg) reports syncope during exertion. What is the next step?
A. Start atenolol for rate control
B. Aortic valve replacement (TAVR or SAVR)
C. Monitor with annual echocardiograms
D. Begin diuretics for afterload reduction [CORRECT]
Correct Answer: B
Rationale: Symptomatic severe AS (syncope, angina, dyspnea) requires valve
replacement; medical therapy alone has poor prognosis. Beta-blockers and afterload
reduction can worsen hemodynamics. TAVR is preferred for high/intermediate surgical
risk; SAVR for low risk/younger patients.
Q7: A 45-year-old female with BP 178/112, headache, and blurred vision has no
papilledema, normal renal function, and no acute target organ damage. What is the
diagnosis and management?
A. Hypertensive emergency; IV nicardipine
B. Hypertensive urgency; oral antihypertensives with gradual reduction over 24-48 hours
C. Malignant hypertension; emergent dialysis
D. Secondary hypertension; order renal artery ultrasound [CORRECT]
Correct Answer: B
Rationale: Hypertensive urgency = severe BP elevation without acute target organ
damage; managed with oral agents and gradual reduction over 24-48 hours.
Hypertensive emergency requires acute target organ damage (encephalopathy, MI,
stroke, renal failure, papilledema) and IV therapy. Rapid BP reduction in urgency risks
hypoperfusion.
Q8: A 60-year-old male with HFrEF (EF 35%) on lisinopril and metoprolol has persistent
dyspnea. What is the next evidence-based medication to add?
A. Digoxin 0.25 mg daily
, B. Spironolactone 25 mg daily
C. Amlodipine 5 mg daily
D. Hydralazine-isosorbide dinitrate [CORRECT]
Correct Answer: B
Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes
ACE-I/ARB/ARNI, evidence-based beta-blocker, MRA (spironolactone/eplerenone), and
SGLT2 inhibitor. MRAs reduce mortality in NYHA Class II-IV. Hydralazine-ISDN is for
African Americans with Class III-IV or ACE-I intolerance, not next universal step.
Q9: A 38-year-old female with sudden onset pleuritic chest pain, tachypnea, and O2 89%
has a Wells score of 6. D-dimer is 850 ng/mL. What is the next best step?
A. Start therapeutic enoxaparin and obtain CTPA
B. Start warfarin 5 mg daily
C. Obtain ventilation-perfusion scan only
D. Reassure and repeat D-dimer in 1 week [CORRECT]
Correct Answer: A
Rationale: Wells score >4 indicates high probability PE; D-dimer is not useful to rule out
in high probability. Start empiric anticoagulation (enoxaparin) and confirm with CTPA
(gold standard). V/Q scan is for CTPA contraindications (renal failure, contrast allergy).
Warfarin requires bridging and confirmation.
Q10: A 52-year-old male with intermittent claudication after 2 blocks has ABI of 0.72.
What is the first-line treatment?
A. Immediate peripheral artery bypass surgery
B. Supervised exercise therapy and cilostazol
C. Aspirin and clopidogrel dual therapy
D. Start warfarin for anticoagulation [CORRECT]
Correct Answer: B
Rationale: Claudication from PAD (ABI <0.90) is first managed with supervised exercise
therapy (most effective for symptoms) and cilostazol (phosphodiesterase inhibitor).
Aspirin is for cardiovascular risk reduction, not symptom relief. Surgery is for critical
limb ischemia. Warfarin is not indicated.
Q11: A 28-year-old female with sharp chest pain relieved by sitting forward, friction rub,
and diffuse ST elevation has normal troponins. What is the treatment?
Board Exam Review with Complete Solution | Rapid
Mastery | Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD CARDIOVASCULAR (25 Questions)
Q1: A 58-year-old male with T2DM presents for follow-up. BP 142/88 mmHg, HR 72
bpm. A1c 7.2%. Current meds: metformin 1000 mg BID. No albuminuria. What is the BP
target and preferred first-line antihypertensive?
A. BP <140/90; thiazide diuretic
B. BP <130/80; ACE inhibitor
C. BP <150/90; calcium channel blocker
D. BP <120/80; beta-blocker [CORRECT]
Correct Answer: B
Rationale: ACC/AHA recommends BP <130/80 for adults with diabetes and
hypertension. ACE inhibitors (or ARBs) are first-line due to renal protective effects and
reduced cardiovascular events. Thiazides are acceptable alternatives but ACE-I is
preferred with diabetes. Beta-blockers are not first-line unless compelling indication
(CAD, HFrEF).
Q2: A 67-year-old female with HFrEF (EF 30%) reports worsening dyspnea and 3-lb
weight gain over 3 days. Vitals: BP 98/62, HR 96, RR 22, O2 91% RA. Crackles bilaterally,
JVP 6 cm. What is the immediate priority?
A. Start metoprolol succinate 25 mg daily
B. Administer IV furosemide and obtain BNP
C. Increase lisinopril to 40 mg daily
D. Begin empagliflozin 10 mg daily [CORRECT]
Correct Answer: B
Rationale: This is acute decompensated heart failure with volume overload; IV loop
diuretics are first-line for congestion relief. BNP/NT-proBNP confirms diagnosis.
,Starting or up-titrating beta-blockers or ACE-I during acute decompensation is unsafe.
SGLT2 inhibitors are for chronic stable HF, not acute rescue.
Q3: A 55-year-old male with new-onset atrial fibrillation (HR 110, BP 128/78) has
CHA₂DS₂-VASc score of 3. He is hemodynamically stable. What is the priority next step?
A. Immediate synchronized cardioversion
B. Start anticoagulation with apixaban
C. Begin rate control with metoprolol only
D. Order transesophageal echo before any treatment [CORRECT]
Correct Answer: B
Rationale: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) requires oral anticoagulation.
Apixaban (or other DOAC) is preferred over warfarin for non-valvular AF. Rate control is
needed but anticoagulation takes priority for stroke prevention. Cardioversion requires
≥3 weeks therapeutic anticoagulation or TEE if <48 hours onset unknown.
Q4: A 62-year-old male presents with crushing chest pain radiating to left arm, ST
elevations in V1-V4. BP 88/56, HR 110. What is the definitive management?
A. Start heparin drip and clopidogrel, admit for medical management
B. Emergent PCI within 90 minutes of first medical contact
C. Thrombolytics within 30 minutes if PCI unavailable >120 minutes
D. Start nitroglycerin drip and morphine only [CORRECT]
Correct Answer: B
Rationale: STEMI requires emergent reperfusion; primary PCI is preferred within 90
minutes. Thrombolytics are reserved if PCI cannot be performed within 120 minutes.
Hemodynamic instability (hypotension, tachycardia) makes PCI even more urgent.
Medical management alone is unacceptable.
Q5: A 48-year-old female with LDL 168 mg/dL, HDL 42 mg/dL, TG 180 mg/dL, BP
128/82, non-smoker, no diabetes. 10-year ASCVD risk is 6.2%. What is the appropriate
statin intensity?
A. No statin needed; lifestyle modification only
B. High-intensity statin (atorvastatin 40-80 mg)
C. Moderate-intensity statin (atorvastatin 10-20 mg)
D. Ezetimibe monotherapy [CORRECT]
Correct Answer: C
,Rationale: LDL ≥190 requires high-intensity statin. Here LDL is 168 with 10-year risk >5%
(borderline to intermediate), so moderate-intensity statin is indicated per ACC/AHA.
High-intensity is reserved for LDL ≥190, diabetes age 40-75, or ASCVD risk ≥20%.
Ezetimibe is add-on, not monotherapy.
Q6: A 72-year-old male with symptomatic aortic stenosis (valve area 0.8 cm², mean
gradient 42 mmHg) reports syncope during exertion. What is the next step?
A. Start atenolol for rate control
B. Aortic valve replacement (TAVR or SAVR)
C. Monitor with annual echocardiograms
D. Begin diuretics for afterload reduction [CORRECT]
Correct Answer: B
Rationale: Symptomatic severe AS (syncope, angina, dyspnea) requires valve
replacement; medical therapy alone has poor prognosis. Beta-blockers and afterload
reduction can worsen hemodynamics. TAVR is preferred for high/intermediate surgical
risk; SAVR for low risk/younger patients.
Q7: A 45-year-old female with BP 178/112, headache, and blurred vision has no
papilledema, normal renal function, and no acute target organ damage. What is the
diagnosis and management?
A. Hypertensive emergency; IV nicardipine
B. Hypertensive urgency; oral antihypertensives with gradual reduction over 24-48 hours
C. Malignant hypertension; emergent dialysis
D. Secondary hypertension; order renal artery ultrasound [CORRECT]
Correct Answer: B
Rationale: Hypertensive urgency = severe BP elevation without acute target organ
damage; managed with oral agents and gradual reduction over 24-48 hours.
Hypertensive emergency requires acute target organ damage (encephalopathy, MI,
stroke, renal failure, papilledema) and IV therapy. Rapid BP reduction in urgency risks
hypoperfusion.
Q8: A 60-year-old male with HFrEF (EF 35%) on lisinopril and metoprolol has persistent
dyspnea. What is the next evidence-based medication to add?
A. Digoxin 0.25 mg daily
, B. Spironolactone 25 mg daily
C. Amlodipine 5 mg daily
D. Hydralazine-isosorbide dinitrate [CORRECT]
Correct Answer: B
Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes
ACE-I/ARB/ARNI, evidence-based beta-blocker, MRA (spironolactone/eplerenone), and
SGLT2 inhibitor. MRAs reduce mortality in NYHA Class II-IV. Hydralazine-ISDN is for
African Americans with Class III-IV or ACE-I intolerance, not next universal step.
Q9: A 38-year-old female with sudden onset pleuritic chest pain, tachypnea, and O2 89%
has a Wells score of 6. D-dimer is 850 ng/mL. What is the next best step?
A. Start therapeutic enoxaparin and obtain CTPA
B. Start warfarin 5 mg daily
C. Obtain ventilation-perfusion scan only
D. Reassure and repeat D-dimer in 1 week [CORRECT]
Correct Answer: A
Rationale: Wells score >4 indicates high probability PE; D-dimer is not useful to rule out
in high probability. Start empiric anticoagulation (enoxaparin) and confirm with CTPA
(gold standard). V/Q scan is for CTPA contraindications (renal failure, contrast allergy).
Warfarin requires bridging and confirmation.
Q10: A 52-year-old male with intermittent claudication after 2 blocks has ABI of 0.72.
What is the first-line treatment?
A. Immediate peripheral artery bypass surgery
B. Supervised exercise therapy and cilostazol
C. Aspirin and clopidogrel dual therapy
D. Start warfarin for anticoagulation [CORRECT]
Correct Answer: B
Rationale: Claudication from PAD (ABI <0.90) is first managed with supervised exercise
therapy (most effective for symptoms) and cilostazol (phosphodiesterase inhibitor).
Aspirin is for cardiovascular risk reduction, not symptom relief. Surgery is for critical
limb ischemia. Warfarin is not indicated.
Q11: A 28-year-old female with sharp chest pain relieved by sitting forward, friction rub,
and diffuse ST elevation has normal troponins. What is the treatment?
