ADULT PRIMARY CARE EXAM 2 | COMPREHENSIVE STUDY GUIDE, PRACTICE
QUESTIONS & ANSWERS 2026/2027
Best lab test to rule out MI - correct answer ✔✔Cardiac-specific troponin I and T (rise within the first 2-4
hrs after MI and remain elevated for 7-10 days)
What should you do for the patient experiencing ACS? - correct answer ✔✔ASA, nitroglycerin and
transfer to ED (preferably at a hospital with a cath lab)
Number one symptom of CAD - correct answer ✔✔Angina
Characteristics of metabolic syndrome - correct answer ✔✔1) HTN
2) Obesity
3) Dyslipidemia
4) DM
CV risk factors - correct answer ✔✔1) HTN
2) Obesity
3) Dyslipidemia
4) DM
5) Cigarette smoking
6) Physical inactivity
7) Microalbuminuria
What manometers are best? - correct answer ✔✔Mercury bulb (if using digital, make sure they are
periodically recalibrated)
What are you listening for when measuring BP? - correct answer ✔✔1st and 5th Korotkoff sound
What factors can transiently elevate BP? - correct answer ✔✔1) Anxiety
2) Cold
3) A full bladder
4) Exercise, smoking or caffeine within the previous 30 minutes
Essential HTN risk factors - correct answer ✔✔1) Age (arteries stiffen with age)
2) Gender (male until age 60)
3) Race (AAs have higher rates than whites)
4) Obesity (10# wt loss can make a big difference; meds work better in conjunction with wt loss)
5) Family history
6) Alcohol intake (>2 oz per day)
7) Cigarette smoking
Physiologically what causes primary HTN - correct answer ✔✔Increased CO which results in increased
peripheral arterial resistance
Typical presentation of secondary HTN - correct answer ✔✔-Presentation is usually abrupt and severe
,-Usually < 35 y/o
-Negative family hx
-Failure to respond to empirical therapy despite compliance
#1 cause of secondary HTN - correct answer ✔✔Renal artery stenosis
Other causes of secondary HTN - correct answer ✔✔Pheochromocytoma, primary hyperaldosteronism,
coarctation of the aorta, Cushing's, Renal Parenchymal Disease, alcohol, medication
How would you diagnose Cushing's? - correct answer ✔✔24 urine to see if cortisol levels are elevated
Questions to ask about HTN - correct answer ✔✔1) When were they initially diagnosed?
2) Highest reading ever obtained
3) Have they been on any other anti-hypertensive meds previously? (If yes, why did they stop taking
them?)
Factors from chest pain article - correct answer ✔✔1) >55 in men; >65 in women
2) Known CAD or cerebrovascular disease
3) Pain not reproducible by palpation
4) Pain worse during exercise
5) Pt assumes pain is cardiogenic
(For scores of 2-5 order EKG; for scores of 4 and 5 give O2 and ASA -- arrange for ED transport)
What medications should you ask about when concerned about HTN? - correct answer ✔✔1) NSAIDs
2) OTC cold remedies
3) Oral contraceptives
4) Anabolic steroids
5) MOAIs
6) Tricyclic antidepressants
7) Diet pills
What candy (in excess) can elevate BP? - correct answer ✔✔Licorice
What are abnormal fundoscopic findings that are possible w/HTN? - correct answer ✔✔1) Abnormal
blood vessels
2) Vitreous hemorrhage
3) Flame hemorrhage
4) Cotton wool sports
5) Hard exudates
Why would you draw a CBC w/HTN? - correct answer ✔✔HTN drugs can cause anemia/polycythemia
Why would you draw a uric acid level w/HTN? - correct answer ✔✔Thiazide diuretics can increase uric
acid levels
Why would you draw a calcium level w/HTN? - correct answer ✔✔Low calcium intake in the diet can
increase BP
, HTN differentials - correct answer ✔✔1) White coat syndrome
2) Isolated systolic HTN
3) Any one of the secondary causes
4) Cocaine use
Recommended lifestyle modifications w/HTN - correct answer ✔✔1) Weight loss
2) Reduction of sodium intake (DASH diet)
3) Regular exercise (3-5x per week)
4) Reduce ETOH intake to no more than 2 oz. daily
What is the DASH diet? - correct answer ✔✔High fruits/vegetables, low-fat diet
Thresholds for initiating HTN treatment - correct answer ✔✔1) >= 60 yrs old >150 SBP or >90 DBP
2) <60 yrs old >140/90
First line HTN pharmacological agents - correct answer ✔✔1) Thiazide diuretic
2) ACEI
3) ARBs
4) CCB
What HTN drug should be used with diabetics? - correct answer ✔✔ACEI (possible caution in African-
Americans?)
When to refer w/HTN - correct answer ✔✔1) Unresponsive to usual therapy
2) Suspected secondary HTN
3) Those w/sign of renal failure or other target organ damage
When should you schedule follow up when a patient is started on an anti-hypertensive? - correct answer
✔✔Monthly visits until goal is reached; then see q3-6 months
(more frequent for its with elevated BP or co-morbid conditions)
Metabolic risk factors - correct answer ✔✔1) Abdominal obesity
2) Glucose intolerance (fasting glucose >110)
3) BP >130/85
4) High triglycerides (>150)
5) Low HDL
What should be targeted in patients w/L ventricular hypertrophy? - correct answer ✔✔1) Aggressive BP
management (weight loss, sodium restriction, and treatment w/first line meds)
What risk should be kept in mind with older adults with HTN? - correct answer ✔✔Postural HTN -- start
low and go slow on meds
Postural HTN definition - correct answer ✔✔A decrease in standing SBP of >10 mmHg
Who is most susceptible to postural HTN? - correct answer ✔✔Older adults w/ISH, diabetes and those
taking diuretics, ventilators and some psychotropic drugs
QUESTIONS & ANSWERS 2026/2027
Best lab test to rule out MI - correct answer ✔✔Cardiac-specific troponin I and T (rise within the first 2-4
hrs after MI and remain elevated for 7-10 days)
What should you do for the patient experiencing ACS? - correct answer ✔✔ASA, nitroglycerin and
transfer to ED (preferably at a hospital with a cath lab)
Number one symptom of CAD - correct answer ✔✔Angina
Characteristics of metabolic syndrome - correct answer ✔✔1) HTN
2) Obesity
3) Dyslipidemia
4) DM
CV risk factors - correct answer ✔✔1) HTN
2) Obesity
3) Dyslipidemia
4) DM
5) Cigarette smoking
6) Physical inactivity
7) Microalbuminuria
What manometers are best? - correct answer ✔✔Mercury bulb (if using digital, make sure they are
periodically recalibrated)
What are you listening for when measuring BP? - correct answer ✔✔1st and 5th Korotkoff sound
What factors can transiently elevate BP? - correct answer ✔✔1) Anxiety
2) Cold
3) A full bladder
4) Exercise, smoking or caffeine within the previous 30 minutes
Essential HTN risk factors - correct answer ✔✔1) Age (arteries stiffen with age)
2) Gender (male until age 60)
3) Race (AAs have higher rates than whites)
4) Obesity (10# wt loss can make a big difference; meds work better in conjunction with wt loss)
5) Family history
6) Alcohol intake (>2 oz per day)
7) Cigarette smoking
Physiologically what causes primary HTN - correct answer ✔✔Increased CO which results in increased
peripheral arterial resistance
Typical presentation of secondary HTN - correct answer ✔✔-Presentation is usually abrupt and severe
,-Usually < 35 y/o
-Negative family hx
-Failure to respond to empirical therapy despite compliance
#1 cause of secondary HTN - correct answer ✔✔Renal artery stenosis
Other causes of secondary HTN - correct answer ✔✔Pheochromocytoma, primary hyperaldosteronism,
coarctation of the aorta, Cushing's, Renal Parenchymal Disease, alcohol, medication
How would you diagnose Cushing's? - correct answer ✔✔24 urine to see if cortisol levels are elevated
Questions to ask about HTN - correct answer ✔✔1) When were they initially diagnosed?
2) Highest reading ever obtained
3) Have they been on any other anti-hypertensive meds previously? (If yes, why did they stop taking
them?)
Factors from chest pain article - correct answer ✔✔1) >55 in men; >65 in women
2) Known CAD or cerebrovascular disease
3) Pain not reproducible by palpation
4) Pain worse during exercise
5) Pt assumes pain is cardiogenic
(For scores of 2-5 order EKG; for scores of 4 and 5 give O2 and ASA -- arrange for ED transport)
What medications should you ask about when concerned about HTN? - correct answer ✔✔1) NSAIDs
2) OTC cold remedies
3) Oral contraceptives
4) Anabolic steroids
5) MOAIs
6) Tricyclic antidepressants
7) Diet pills
What candy (in excess) can elevate BP? - correct answer ✔✔Licorice
What are abnormal fundoscopic findings that are possible w/HTN? - correct answer ✔✔1) Abnormal
blood vessels
2) Vitreous hemorrhage
3) Flame hemorrhage
4) Cotton wool sports
5) Hard exudates
Why would you draw a CBC w/HTN? - correct answer ✔✔HTN drugs can cause anemia/polycythemia
Why would you draw a uric acid level w/HTN? - correct answer ✔✔Thiazide diuretics can increase uric
acid levels
Why would you draw a calcium level w/HTN? - correct answer ✔✔Low calcium intake in the diet can
increase BP
, HTN differentials - correct answer ✔✔1) White coat syndrome
2) Isolated systolic HTN
3) Any one of the secondary causes
4) Cocaine use
Recommended lifestyle modifications w/HTN - correct answer ✔✔1) Weight loss
2) Reduction of sodium intake (DASH diet)
3) Regular exercise (3-5x per week)
4) Reduce ETOH intake to no more than 2 oz. daily
What is the DASH diet? - correct answer ✔✔High fruits/vegetables, low-fat diet
Thresholds for initiating HTN treatment - correct answer ✔✔1) >= 60 yrs old >150 SBP or >90 DBP
2) <60 yrs old >140/90
First line HTN pharmacological agents - correct answer ✔✔1) Thiazide diuretic
2) ACEI
3) ARBs
4) CCB
What HTN drug should be used with diabetics? - correct answer ✔✔ACEI (possible caution in African-
Americans?)
When to refer w/HTN - correct answer ✔✔1) Unresponsive to usual therapy
2) Suspected secondary HTN
3) Those w/sign of renal failure or other target organ damage
When should you schedule follow up when a patient is started on an anti-hypertensive? - correct answer
✔✔Monthly visits until goal is reached; then see q3-6 months
(more frequent for its with elevated BP or co-morbid conditions)
Metabolic risk factors - correct answer ✔✔1) Abdominal obesity
2) Glucose intolerance (fasting glucose >110)
3) BP >130/85
4) High triglycerides (>150)
5) Low HDL
What should be targeted in patients w/L ventricular hypertrophy? - correct answer ✔✔1) Aggressive BP
management (weight loss, sodium restriction, and treatment w/first line meds)
What risk should be kept in mind with older adults with HTN? - correct answer ✔✔Postural HTN -- start
low and go slow on meds
Postural HTN definition - correct answer ✔✔A decrease in standing SBP of >10 mmHg
Who is most susceptible to postural HTN? - correct answer ✔✔Older adults w/ISH, diabetes and those
taking diuretics, ventilators and some psychotropic drugs
