Page 1 of 476
ABFM HYPERTENSION EXAM COMPLETE 850+ QUESTIONS
AND CORRECT DETAILED ANSWERS – LATEST UPDATE THIS
YEAR JUST RELEASED
ABFM HYPERTENSION EXAM
QUESTION: Which one of the following conditions is associated with isolated systolic
hypertension?
Aortic stenosis
Hypothyroidism
Paget's disease
Renovascular hypertension
Severe osteoporosis - ANSWER-C
Isolated elevation of systolic blood pressure can be secondary to conditions associated with
elevated cardiac output, such as anemia, Paget's disease, hyperthyroidism, arteriovenous
fistula, and aortic insufficiency.
QUESTION: A 59-year-old African-American male with a history of hypercholesterolemia and
gout sees you for a health maintenance visit. A physical examination is notable only for a blood
pressure of 144/85 mm Hg.Laboratory FindingsLDL-cholesterol............82 mg/dLHDL-
cholesterol............47 mg/dLSerum triglycerides............134 mg/dLLiver
panel............normalSerum creatinine............1.7 mg/dL (N 0.7-1.3)Estimated glomerular
filtration rate............56 mL/min/1.73 m2Which one of the following does the JNC 8 panel
recommend as initial management of this patient's blood pressure elevation?
Lifestyle measures only
1
,Page 2 of 476
An ACE inhibitor
A calcium channel blocker
Hydralazine
Hydrochlorothiazide - ANSWER-B
The JNC 8 panel recommends the initiation of pharmacologic treatment to lower blood
pressure in patients ≥18 years of age with a systolic blood pressure ≥140 mm Hg or a diastolic
blood pressure ≥90 mm Hg if they have chronic kidney disease (CKD), defined as an estimated
or measured glomerular filtration rate (GFR) <60 mL/min/1.73 m2. Treatment is recommended
for patients of any age with these blood pressure values who also have albuminuria, defined as
>30 mg of albumin/g of creatinine regardless of GFR (SOR C).Although a thiazide diuretic or a
calcium channel blocker is generally recommended as first-line antihypertensive therapy in
African-Americans, for patients ≥18 years of age who have CKD, the JNC 8 panel recommends
initial (or add-on) antihypertensive treatment with an ACE inhibitor or angiotensin receptor
blocker to improve kidney outcomes, regardless of ethnicity or diabetes status (SOR B).The
2017 American College of Cardiology/American Heart Association hypertension guidelines
similarly recommend use of an ACE inhibitor in patients with stage 3 CKD, as well as in patients
who have stages 1 or 2 CKD with albuminuria >300 mg/day.
QUESTION: A 67-year-old male with a history of hypertension and type 2 diabetes has
inadequately controlled blood pressure. His current medications are lisinopril (Prinivil, Zestril),
40 mg daily; hydrochlorothiazide, 25 mg daily; and extended-release metformin (Glucophage
XR), 1500 mg daily. Laboratory testing reveals a hemoglobin A1c of 6.8%, normal serum
electrolytes, a serum creatinine level of 1.0 mg/dL (N 0.6-1.5), and a urinary albumin/creatinine
ratio of 80 mg/g (N <30).Which one of the following agents should be AVOIDED in this patient?
Aliskiren (Tekturna)
Atenolol (Tenormin)
Diltiazem (Cardizem)
Doxazosin (Cardura)
Felodipine (Plendil) - ANSWER-A
2
,Page 3 of 476
The ALTITUDE study (Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints) was a
randomized, double-blind, placebo-controlled international multicenter trial undertaken to
determine whether the addition of the direct renin inhibitor aliskiren to standard therapy with
renin-angiotensin system blockade would be beneficial for patients with type 2 diabetes who
are at high risk for cardiovascular and renal events. The study was terminated prematurely after
a median follow-up of 27 months when no benefit was apparent, and a higher risk of
hyperkalemia and hypotension was seen in patients receiving aliskiren. Based on this study, the
FDA issued a drug safety warning in 2012 that announced two additions to the drug labeling of
aliskiren-containing products. The first addition was a contraindication to the use of aliskiren in
patients with diabetes mellitus who are taking angiotensin receptor blockers (ARBs) or ACE
inhibitors, because of an increased risk of renal impairment, hypotension, and hyperkalemia.
The second addition was a warning to avoid the use of aliskiren with ARBs or ACE inhibitors in
patients with moderate to severe renal impairment (glomerular filtration rate <60 mL/min/1.73
m2).The use of ACE inhibitors, ARBs, β-blockers, diuretics, and calcium channel blockers has
been shown to be effective in reducing cardiovascular events in patients with diabetes mellitus.
Although no such benefit has been seen with doxazosin, there is no contraindication to its use
in patients with diabetes.
QUESTION: A 44-year-old male has a 1-week history of generalized headaches and nonspecific
dizziness. His past medical history is notable only for a 3-year history of hypertension, which
has been poorly controlled because of a lack of adherence to his drug regimen. His renal status
was normal 1 month ago. On examination his blood pressure is 250/150 mm Hg, and you note
cotton-wool exudates on funduscopic examination. Laboratory evaluation reveals normal
serum electrolytes, a serum creatinine level of 3.8 mg/dL (N 0.7-1.3), and a BUN level of 60
mg/dL (N 6-20). A urinalysis shows gross hematuria and 3+ proteinuria.Which one of the
following will rapidly lower his blood pressure and increase renal blood flow?
Diazoxide (Proglycem)
Enalaprilat (Vasotec)
Esmolol (Brevibloc)
Fenoldopam (Corlopam)
Nitroprusside (Nitropress) - ANSWER-D
3
, Page 4 of 476
Fenoldopam is a selective peripheral dopamine-receptor agonist used for the treatment of
severe hypertension. In studies investigating fenoldopam use in severe hypertension, its
efficacy in lowering blood pressure was found to be comparable to that of nitroprusside. It is
FDA-approved for the in-hospital management of severe hypertension when rapid but quickly
reversible reduction of blood pressure is required, such as in a patient with malignant
hypertension who has deteriorating end-organ function. By virtue of its actions on peripheral
dopamine receptors, fenoldopam produces renal arterial vasodilation and natriuresis, and thus
can provide a renal protective effect in clinical situations associated with impaired renal
function. In addition, there is evidence that it may improve creatinine clearance and urine flow
rates in severely hypertensive patients with either normal or impaired renal function. The 2017
American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines
include fenoldopam as a preferred agent for treating hypertensive emergencies associated with
acute renal failure. Other options include nicardipine and clevidipine.
A 39-year-old male sees you for evaluation of high blood pressure. His past medical history is
unremarkable. On examination he has a BMI of 32 kg/m2 and you note that he has a round face
and a plethoric complexion. His blood pressure is 150/98 mm Hg, his pulse rate is 88 beats/min,
and his respiratory rate is 16/min. Other notable findings include a prominent dorsal cervical fat
pad and supraclavicular fat pads, as well as violaceous striae on his trunk. Laboratory findings
are notable only for a fasting glucose level of 114 mg/dL.Which one of the following is the most
likely cause of his hypertension?
Addison's disease
Cushing syndrome
Hemochromatosis
Pheochromocytoma
Primary hyperaldosteronism - ANSWER-B
This patient's clinical findings are consistent with Cushing syndrome, or hyperadrenocorticism.
This is a clinical syndrome and metabolic disorder resulting from chronic excess of
glucocorticoids. The most common cause is corticosteroid use, but adrenal neoplasms account
for 20%-25% of cases. Findings include general weakness, osteoporosis, moon facies, facial
4
ABFM HYPERTENSION EXAM COMPLETE 850+ QUESTIONS
AND CORRECT DETAILED ANSWERS – LATEST UPDATE THIS
YEAR JUST RELEASED
ABFM HYPERTENSION EXAM
QUESTION: Which one of the following conditions is associated with isolated systolic
hypertension?
Aortic stenosis
Hypothyroidism
Paget's disease
Renovascular hypertension
Severe osteoporosis - ANSWER-C
Isolated elevation of systolic blood pressure can be secondary to conditions associated with
elevated cardiac output, such as anemia, Paget's disease, hyperthyroidism, arteriovenous
fistula, and aortic insufficiency.
QUESTION: A 59-year-old African-American male with a history of hypercholesterolemia and
gout sees you for a health maintenance visit. A physical examination is notable only for a blood
pressure of 144/85 mm Hg.Laboratory FindingsLDL-cholesterol............82 mg/dLHDL-
cholesterol............47 mg/dLSerum triglycerides............134 mg/dLLiver
panel............normalSerum creatinine............1.7 mg/dL (N 0.7-1.3)Estimated glomerular
filtration rate............56 mL/min/1.73 m2Which one of the following does the JNC 8 panel
recommend as initial management of this patient's blood pressure elevation?
Lifestyle measures only
1
,Page 2 of 476
An ACE inhibitor
A calcium channel blocker
Hydralazine
Hydrochlorothiazide - ANSWER-B
The JNC 8 panel recommends the initiation of pharmacologic treatment to lower blood
pressure in patients ≥18 years of age with a systolic blood pressure ≥140 mm Hg or a diastolic
blood pressure ≥90 mm Hg if they have chronic kidney disease (CKD), defined as an estimated
or measured glomerular filtration rate (GFR) <60 mL/min/1.73 m2. Treatment is recommended
for patients of any age with these blood pressure values who also have albuminuria, defined as
>30 mg of albumin/g of creatinine regardless of GFR (SOR C).Although a thiazide diuretic or a
calcium channel blocker is generally recommended as first-line antihypertensive therapy in
African-Americans, for patients ≥18 years of age who have CKD, the JNC 8 panel recommends
initial (or add-on) antihypertensive treatment with an ACE inhibitor or angiotensin receptor
blocker to improve kidney outcomes, regardless of ethnicity or diabetes status (SOR B).The
2017 American College of Cardiology/American Heart Association hypertension guidelines
similarly recommend use of an ACE inhibitor in patients with stage 3 CKD, as well as in patients
who have stages 1 or 2 CKD with albuminuria >300 mg/day.
QUESTION: A 67-year-old male with a history of hypertension and type 2 diabetes has
inadequately controlled blood pressure. His current medications are lisinopril (Prinivil, Zestril),
40 mg daily; hydrochlorothiazide, 25 mg daily; and extended-release metformin (Glucophage
XR), 1500 mg daily. Laboratory testing reveals a hemoglobin A1c of 6.8%, normal serum
electrolytes, a serum creatinine level of 1.0 mg/dL (N 0.6-1.5), and a urinary albumin/creatinine
ratio of 80 mg/g (N <30).Which one of the following agents should be AVOIDED in this patient?
Aliskiren (Tekturna)
Atenolol (Tenormin)
Diltiazem (Cardizem)
Doxazosin (Cardura)
Felodipine (Plendil) - ANSWER-A
2
,Page 3 of 476
The ALTITUDE study (Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints) was a
randomized, double-blind, placebo-controlled international multicenter trial undertaken to
determine whether the addition of the direct renin inhibitor aliskiren to standard therapy with
renin-angiotensin system blockade would be beneficial for patients with type 2 diabetes who
are at high risk for cardiovascular and renal events. The study was terminated prematurely after
a median follow-up of 27 months when no benefit was apparent, and a higher risk of
hyperkalemia and hypotension was seen in patients receiving aliskiren. Based on this study, the
FDA issued a drug safety warning in 2012 that announced two additions to the drug labeling of
aliskiren-containing products. The first addition was a contraindication to the use of aliskiren in
patients with diabetes mellitus who are taking angiotensin receptor blockers (ARBs) or ACE
inhibitors, because of an increased risk of renal impairment, hypotension, and hyperkalemia.
The second addition was a warning to avoid the use of aliskiren with ARBs or ACE inhibitors in
patients with moderate to severe renal impairment (glomerular filtration rate <60 mL/min/1.73
m2).The use of ACE inhibitors, ARBs, β-blockers, diuretics, and calcium channel blockers has
been shown to be effective in reducing cardiovascular events in patients with diabetes mellitus.
Although no such benefit has been seen with doxazosin, there is no contraindication to its use
in patients with diabetes.
QUESTION: A 44-year-old male has a 1-week history of generalized headaches and nonspecific
dizziness. His past medical history is notable only for a 3-year history of hypertension, which
has been poorly controlled because of a lack of adherence to his drug regimen. His renal status
was normal 1 month ago. On examination his blood pressure is 250/150 mm Hg, and you note
cotton-wool exudates on funduscopic examination. Laboratory evaluation reveals normal
serum electrolytes, a serum creatinine level of 3.8 mg/dL (N 0.7-1.3), and a BUN level of 60
mg/dL (N 6-20). A urinalysis shows gross hematuria and 3+ proteinuria.Which one of the
following will rapidly lower his blood pressure and increase renal blood flow?
Diazoxide (Proglycem)
Enalaprilat (Vasotec)
Esmolol (Brevibloc)
Fenoldopam (Corlopam)
Nitroprusside (Nitropress) - ANSWER-D
3
, Page 4 of 476
Fenoldopam is a selective peripheral dopamine-receptor agonist used for the treatment of
severe hypertension. In studies investigating fenoldopam use in severe hypertension, its
efficacy in lowering blood pressure was found to be comparable to that of nitroprusside. It is
FDA-approved for the in-hospital management of severe hypertension when rapid but quickly
reversible reduction of blood pressure is required, such as in a patient with malignant
hypertension who has deteriorating end-organ function. By virtue of its actions on peripheral
dopamine receptors, fenoldopam produces renal arterial vasodilation and natriuresis, and thus
can provide a renal protective effect in clinical situations associated with impaired renal
function. In addition, there is evidence that it may improve creatinine clearance and urine flow
rates in severely hypertensive patients with either normal or impaired renal function. The 2017
American College of Cardiology/American Heart Association (ACC/AHA) hypertension guidelines
include fenoldopam as a preferred agent for treating hypertensive emergencies associated with
acute renal failure. Other options include nicardipine and clevidipine.
A 39-year-old male sees you for evaluation of high blood pressure. His past medical history is
unremarkable. On examination he has a BMI of 32 kg/m2 and you note that he has a round face
and a plethoric complexion. His blood pressure is 150/98 mm Hg, his pulse rate is 88 beats/min,
and his respiratory rate is 16/min. Other notable findings include a prominent dorsal cervical fat
pad and supraclavicular fat pads, as well as violaceous striae on his trunk. Laboratory findings
are notable only for a fasting glucose level of 114 mg/dL.Which one of the following is the most
likely cause of his hypertension?
Addison's disease
Cushing syndrome
Hemochromatosis
Pheochromocytoma
Primary hyperaldosteronism - ANSWER-B
This patient's clinical findings are consistent with Cushing syndrome, or hyperadrenocorticism.
This is a clinical syndrome and metabolic disorder resulting from chronic excess of
glucocorticoids. The most common cause is corticosteroid use, but adrenal neoplasms account
for 20%-25% of cases. Findings include general weakness, osteoporosis, moon facies, facial
4
