SARAH MICHELLE PAGES 234-256 EXAM Q&A
2026/2027 | Targeted Content Review | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY
Q1: A 58-year-old male presents for a follow-up visit. His home blood pressure log
shows an average of 138/86 mmHg over the past 2 weeks. He has no history of
cardiovascular disease, diabetes, or chronic kidney disease. His 10-year PREVENT risk
score is 6.5%. According to the 2025 ACC/AHA hypertension guidelines, what is the
most appropriate next step in management?
A. Initiate combination antihypertensive therapy immediately
B. Recommend lifestyle modifications and reassess in 3-6 months [CORRECT]
C. Start a thiazide-type diuretic as monotherapy
D. Order 24-hour ambulatory blood pressure monitoring
Correct Answer: B
Rationale: According to the 2025 ACC/AHA guidelines, for adults with Stage 1
hypertension (SBP 130-139 or DBP 80-89 mmHg) without clinical CVD, diabetes, or CKD,
,and with a 10-year CVD risk <7.5%, lifestyle modifications are recommended first with
reassessment in 3-6 months before considering medication. This patient has Stage 1
HTN with a PREVENT score of 6.5%, so lifestyle intervention is the appropriate initial
approach. (Sarah Michelle Review, pages 234-256)
Q2: A 72-year-old female with a history of HFrEF (EF 35%) presents with worsening
dyspnea and peripheral edema. Her current medications include lisinopril 20 mg daily,
metoprolol succinate 50 mg daily, and furosemide 40 mg daily. Her vital signs are BP
110/68 mmHg, HR 78 bpm. Which medication should be added next to her regimen
according to current GDMT for HFrEF?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily [CORRECT]
C. Amlodipine 5 mg daily
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Rationale: For HFrEF, guideline-directed medical therapy (GDMT) includes ACE
inhibitor/ARB/ARNI, beta-blocker, MRA (mineralocorticoid receptor antagonist), and
SGLT2 inhibitor. This patient is on an ACEi and beta-blocker but not an MRA.
Spironolactone is the next medication to add as it reduces mortality and hospitalization
in HFrEF. Digoxin is reserved for symptom control in persistent symptoms, and
,hydralazine/isosorbide is for African American patients or those intolerant to ACEi.
(Sarah Michelle Review, pages 234-256)
Q3: A 68-year-old male with newly diagnosed nonvalvular atrial fibrillation has a
CHA₂DS₂-VASc score of 4 and HAS-BLED score of 2. He has no contraindications to
anticoagulation. Which is the most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0-3.0
C. Apixaban 5 mg twice daily [CORRECT]
D. Clopidogrel 75 mg daily
Correct Answer: C
Rationale: For nonvalvular AF with a CHA₂DS₂-VASc score ≥2 in men (or ≥3 in women),
oral anticoagulation is indicated. Direct oral anticoagulants (DOACs) such as apixaban
are preferred over warfarin for nonvalvular AF due to lower bleeding risk and no need for
INR monitoring. Aspirin and clopidogrel are not appropriate for stroke prevention in AF.
(Sarah Michelle Review, pages 234-256)
, Q4: According to the 2025 ACC/AHA hypertension guidelines, what is the recommended
blood pressure treatment goal for most adults with hypertension?
A. <140/90 mmHg
B. <130/80 mmHg [CORRECT]
C. <120/80 mmHg
D. <135/85 mmHg
Correct Answer: B
Rationale: The 2025 ACC/AHA hypertension guidelines maintain the universal blood
pressure treatment goal of <130/80 mmHg for most adults with hypertension. While
getting closer to 120/80 mmHg is encouraged when tolerated, <130/80 mmHg remains
the primary target. This is a key concept emphasized in cardiovascular review content.
(Sarah Michelle Review, pages 234-256)
Q5: A 64-year-old male with a 40 pack-year smoking history presents with progressive
dyspnea on exertion and chronic cough with sputum production. Spirometry shows
FEV₁/FVC ratio of 0.62 and FEV₁ 55% of predicted. He has had two exacerbations in the
past year requiring oral steroids. Which is the most appropriate initial maintenance
pharmacotherapy?
A. Albuterol PRN only
2026/2027 | Targeted Content Review | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY
Q1: A 58-year-old male presents for a follow-up visit. His home blood pressure log
shows an average of 138/86 mmHg over the past 2 weeks. He has no history of
cardiovascular disease, diabetes, or chronic kidney disease. His 10-year PREVENT risk
score is 6.5%. According to the 2025 ACC/AHA hypertension guidelines, what is the
most appropriate next step in management?
A. Initiate combination antihypertensive therapy immediately
B. Recommend lifestyle modifications and reassess in 3-6 months [CORRECT]
C. Start a thiazide-type diuretic as monotherapy
D. Order 24-hour ambulatory blood pressure monitoring
Correct Answer: B
Rationale: According to the 2025 ACC/AHA guidelines, for adults with Stage 1
hypertension (SBP 130-139 or DBP 80-89 mmHg) without clinical CVD, diabetes, or CKD,
,and with a 10-year CVD risk <7.5%, lifestyle modifications are recommended first with
reassessment in 3-6 months before considering medication. This patient has Stage 1
HTN with a PREVENT score of 6.5%, so lifestyle intervention is the appropriate initial
approach. (Sarah Michelle Review, pages 234-256)
Q2: A 72-year-old female with a history of HFrEF (EF 35%) presents with worsening
dyspnea and peripheral edema. Her current medications include lisinopril 20 mg daily,
metoprolol succinate 50 mg daily, and furosemide 40 mg daily. Her vital signs are BP
110/68 mmHg, HR 78 bpm. Which medication should be added next to her regimen
according to current GDMT for HFrEF?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily [CORRECT]
C. Amlodipine 5 mg daily
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Rationale: For HFrEF, guideline-directed medical therapy (GDMT) includes ACE
inhibitor/ARB/ARNI, beta-blocker, MRA (mineralocorticoid receptor antagonist), and
SGLT2 inhibitor. This patient is on an ACEi and beta-blocker but not an MRA.
Spironolactone is the next medication to add as it reduces mortality and hospitalization
in HFrEF. Digoxin is reserved for symptom control in persistent symptoms, and
,hydralazine/isosorbide is for African American patients or those intolerant to ACEi.
(Sarah Michelle Review, pages 234-256)
Q3: A 68-year-old male with newly diagnosed nonvalvular atrial fibrillation has a
CHA₂DS₂-VASc score of 4 and HAS-BLED score of 2. He has no contraindications to
anticoagulation. Which is the most appropriate anticoagulation strategy?
A. Aspirin 81 mg daily
B. Warfarin with target INR 2.0-3.0
C. Apixaban 5 mg twice daily [CORRECT]
D. Clopidogrel 75 mg daily
Correct Answer: C
Rationale: For nonvalvular AF with a CHA₂DS₂-VASc score ≥2 in men (or ≥3 in women),
oral anticoagulation is indicated. Direct oral anticoagulants (DOACs) such as apixaban
are preferred over warfarin for nonvalvular AF due to lower bleeding risk and no need for
INR monitoring. Aspirin and clopidogrel are not appropriate for stroke prevention in AF.
(Sarah Michelle Review, pages 234-256)
, Q4: According to the 2025 ACC/AHA hypertension guidelines, what is the recommended
blood pressure treatment goal for most adults with hypertension?
A. <140/90 mmHg
B. <130/80 mmHg [CORRECT]
C. <120/80 mmHg
D. <135/85 mmHg
Correct Answer: B
Rationale: The 2025 ACC/AHA hypertension guidelines maintain the universal blood
pressure treatment goal of <130/80 mmHg for most adults with hypertension. While
getting closer to 120/80 mmHg is encouraged when tolerated, <130/80 mmHg remains
the primary target. This is a key concept emphasized in cardiovascular review content.
(Sarah Michelle Review, pages 234-256)
Q5: A 64-year-old male with a 40 pack-year smoking history presents with progressive
dyspnea on exertion and chronic cough with sputum production. Spirometry shows
FEV₁/FVC ratio of 0.62 and FEV₁ 55% of predicted. He has had two exacerbations in the
past year requiring oral steroids. Which is the most appropriate initial maintenance
pharmacotherapy?
A. Albuterol PRN only
