SARAH MICHELLE CRASH COURSE Q&A 2026/2027 |
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SECTION 1: CARDIOVASCULAR & RESPIRATORY ESSENTIALS (25
Questions)
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. BP 88/52, HR 110, RR 24. EKG shows ST elevation in
leads V1-V4. Which is the priority intervention?
A. Administer aspirin 325 mg and obtain troponin
B. Start nitroglycerin drip for chest pain relief
C. Activate catheterization lab for primary PCI within 90 minutes [CORRECT]
D. Administer morphine 4 mg IV and reassess in 30 minutes
Correct Answer: C
Rationale: STEMI with anterior wall involvement (V1-V4) and hypotension indicates
cardiogenic shock; primary PCI is the gold standard. Time is muscle—door-to-balloon
≤90 minutes. "STEMI = PCI priority; NSTEMI = risk stratify first."
Q2: A 67-year-old female with HFrEF (EF 30%) presents with worsening dyspnea,
orthopnea, JVD, and peripheral edema. Which medication class reduces mortality in
HFrEF and must be included in her regimen?
A. Loop diuretics (furosemide)
B. ACE inhibitors or ARNI (sacubitril/valsartan) [CORRECT]
C. Digoxin
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Rationale: ACE inhibitors/ARNI, beta-blockers, MRAs, and SGLT2 inhibitors are the
mortality-reducing quartet in HFrEF. Diuretics relieve symptoms but do not reduce
mortality. "ARNI > ACEI in HFrEF—PARADIGM-HF trial."
,Q3: A 45-year-old male with HTN has BP 158/96 on two occasions. He is otherwise
healthy. Per JNC-8/2017 ACC/AHA guidelines, what is the best initial pharmacologic
therapy?
A. ACE inhibitor
B. Thiazide diuretic or calcium channel blocker [CORRECT]
C. Beta-blocker
D. Alpha-blocker
Correct Answer: B
Rationale: First-line for uncomplicated HTN in non-Black patients: thiazide, CCB, ACEI, or
ARB. For Black patients without CKD: thiazide or CCB preferred. "ABCD rule: ACEI/ARB,
Beta-blocker (compelling indication), CCB, Diuretic."
Q4: A 72-year-old male with AFib (CHADS₂-VASc = 4) is started on anticoagulation.
Which agent is preferred for stroke prevention in non-valvular AFib?
A. Aspirin 81 mg daily
B. Warfarin with INR goal 2.0-3.0
C. Apixaban or rivaroxaban (DOAC) [CORRECT]
D. Clopidogrel 75 mg daily
Correct Answer: C
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over
warfarin for non-valvular AFib due to lower bleeding risk and no INR monitoring.
"CHADS₂-VASc ≥2 (men) or ≥3 (women) = anticoagulate; <2 = consider aspirin or no
therapy."
Q5: A 55-year-old female presents with sudden onset pleuritic chest pain, dyspnea, and
tachycardia. D-dimer is 1200 ng/mL. What is the best initial imaging study?
A. Chest X-ray
B. CT pulmonary angiography (CTPA) [CORRECT]
C. Ventilation-perfusion (V/Q) scan
D. Lower extremity Doppler ultrasound
Correct Answer: B
Rationale: CTPA is the gold standard for PE diagnosis in hemodynamically stable
patients with high pretest probability. V/Q scan is reserved for CTPA contraindications
(e.g., renal failure, pregnancy). "Wells score >4 + high D-dimer = CTPA; pregnancy = V/Q
first."
,Q6: A 62-year-old male with COPD (FEV₁/FVC 0.62, FEV₁ 55% predicted) has 2
exacerbations in the past year. Which inhaled regimen is most appropriate?
A. SABA prn only
B. LABA + LAMA combination [CORRECT]
C. LABA + ICS alone
D. Oral theophylline
Correct Answer: B
Rationale: GOLD Group D (high symptoms, high exacerbation risk) requires LABA +
LAMA; add ICS if eosinophils ≥300 or frequent exacerbations despite dual
bronchodilation. "GOLD D = dual bronchodilation; eosinophil-guided ICS."
Q7: A 28-year-old female with asthma reports daytime symptoms 3x/week and
nighttime symptoms 1x/month. She uses albuterol 3x/week. Per GINA/NAEPP
guidelines, what is the best step-up therapy?
A. Increase albuterol to daily use
B. Add low-dose ICS-formoterol as needed [CORRECT]
C. Add oral montelukast
D. Start high-dose ICS + LABA
Correct Answer: B
Rationale: Step 2 asthma (intermittent/mild persistent) requires daily ICS or
ICS-formoterol as needed. ICS reduces exacerbations and mortality; SABA-only is no
longer recommended. "GINA 2023: ICS-formoterol reliever preferred over SABA-only."
Q8: A 50-year-old male presents with unilateral leg swelling, warmth, and Homan's sign.
Wells score = 6. What is the most appropriate next step?
A. Start empiric heparin and order CTPA
B. Compression ultrasound of proximal veins [CORRECT]
C. D-dimer testing
D. MRI venography
Correct Answer: B
Rationale: High pretest probability (Wells ≥2) + suspected DVT → compression
ultrasound without D-dimer. D-dimer is only useful to rule out DVT when pretest
probability is low. "Wells low + D-dimer negative = DVT excluded; Wells high =
ultrasound."
, Q9: A 70-year-old male with HTN and diabetes has LDL 140 mg/dL. Per 2018 ACC/AHA
cholesterol guidelines, what is the indicated statin intensity?
A. Low-intensity statin (pravastatin 10 mg)
B. Moderate-intensity statin (atorvastatin 10-20 mg)
C. High-intensity statin (atorvastatin 40-80 mg) [CORRECT]
D. Ezetimibe monotherapy
Correct Answer: C
Rationale: Clinical ASCVD, LDL ≥190, diabetes age 40-75, or 10-year risk ≥7.5% all
indicate high-intensity statin. This patient has diabetes + age >40 = high-intensity
indicated. "ASCVD + diabetes = high-intensity statin; aim LDL <70 if very high risk."
Q10: A 68-year-old female presents with exertional dyspnea, orthopnea, and a
holosystolic murmur at the apex radiating to the axilla. Echocardiogram shows severe
mitral regurgitation. What is the definitive management?
A. Afterload reduction with ACE inhibitors
B. Diuretics and salt restriction
C. Surgical mitral valve repair or replacement [CORRECT]
D. Cardiac resynchronization therapy
Correct Answer: C
Rationale: Severe symptomatic mitral regurgitation requires surgical intervention (repair
preferred over replacement). Medical therapy is temporizing. "Mitral regurgitation
murmur = holosystolic, apex, radiates to axilla; repair > replace."
Q11: A 35-year-old female presents with episodic palpitations, lightheadedness, and a
regular narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail. What is the
first-line pharmacologic treatment?
A. Metoprolol 25 mg PO
B. Adenosine 6 mg IV rapid push followed by flush [CORRECT]
C. Amiodarone 150 mg IV
D. Diltiazem 20 mg IV
Correct Answer: B
Rationale: Adenosine is first-line for stable SVT/AVNRT due to transient AV nodal
blockade. It has a very short half-life (seconds). "SVT = adenosine first; AVNRT = reentry
through AV node; give FAST with flush."
High-Yield Rapid Review for Board Exam Success | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY ESSENTIALS (25
Questions)
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. BP 88/52, HR 110, RR 24. EKG shows ST elevation in
leads V1-V4. Which is the priority intervention?
A. Administer aspirin 325 mg and obtain troponin
B. Start nitroglycerin drip for chest pain relief
C. Activate catheterization lab for primary PCI within 90 minutes [CORRECT]
D. Administer morphine 4 mg IV and reassess in 30 minutes
Correct Answer: C
Rationale: STEMI with anterior wall involvement (V1-V4) and hypotension indicates
cardiogenic shock; primary PCI is the gold standard. Time is muscle—door-to-balloon
≤90 minutes. "STEMI = PCI priority; NSTEMI = risk stratify first."
Q2: A 67-year-old female with HFrEF (EF 30%) presents with worsening dyspnea,
orthopnea, JVD, and peripheral edema. Which medication class reduces mortality in
HFrEF and must be included in her regimen?
A. Loop diuretics (furosemide)
B. ACE inhibitors or ARNI (sacubitril/valsartan) [CORRECT]
C. Digoxin
D. Hydralazine/isosorbide dinitrate
Correct Answer: B
Rationale: ACE inhibitors/ARNI, beta-blockers, MRAs, and SGLT2 inhibitors are the
mortality-reducing quartet in HFrEF. Diuretics relieve symptoms but do not reduce
mortality. "ARNI > ACEI in HFrEF—PARADIGM-HF trial."
,Q3: A 45-year-old male with HTN has BP 158/96 on two occasions. He is otherwise
healthy. Per JNC-8/2017 ACC/AHA guidelines, what is the best initial pharmacologic
therapy?
A. ACE inhibitor
B. Thiazide diuretic or calcium channel blocker [CORRECT]
C. Beta-blocker
D. Alpha-blocker
Correct Answer: B
Rationale: First-line for uncomplicated HTN in non-Black patients: thiazide, CCB, ACEI, or
ARB. For Black patients without CKD: thiazide or CCB preferred. "ABCD rule: ACEI/ARB,
Beta-blocker (compelling indication), CCB, Diuretic."
Q4: A 72-year-old male with AFib (CHADS₂-VASc = 4) is started on anticoagulation.
Which agent is preferred for stroke prevention in non-valvular AFib?
A. Aspirin 81 mg daily
B. Warfarin with INR goal 2.0-3.0
C. Apixaban or rivaroxaban (DOAC) [CORRECT]
D. Clopidogrel 75 mg daily
Correct Answer: C
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over
warfarin for non-valvular AFib due to lower bleeding risk and no INR monitoring.
"CHADS₂-VASc ≥2 (men) or ≥3 (women) = anticoagulate; <2 = consider aspirin or no
therapy."
Q5: A 55-year-old female presents with sudden onset pleuritic chest pain, dyspnea, and
tachycardia. D-dimer is 1200 ng/mL. What is the best initial imaging study?
A. Chest X-ray
B. CT pulmonary angiography (CTPA) [CORRECT]
C. Ventilation-perfusion (V/Q) scan
D. Lower extremity Doppler ultrasound
Correct Answer: B
Rationale: CTPA is the gold standard for PE diagnosis in hemodynamically stable
patients with high pretest probability. V/Q scan is reserved for CTPA contraindications
(e.g., renal failure, pregnancy). "Wells score >4 + high D-dimer = CTPA; pregnancy = V/Q
first."
,Q6: A 62-year-old male with COPD (FEV₁/FVC 0.62, FEV₁ 55% predicted) has 2
exacerbations in the past year. Which inhaled regimen is most appropriate?
A. SABA prn only
B. LABA + LAMA combination [CORRECT]
C. LABA + ICS alone
D. Oral theophylline
Correct Answer: B
Rationale: GOLD Group D (high symptoms, high exacerbation risk) requires LABA +
LAMA; add ICS if eosinophils ≥300 or frequent exacerbations despite dual
bronchodilation. "GOLD D = dual bronchodilation; eosinophil-guided ICS."
Q7: A 28-year-old female with asthma reports daytime symptoms 3x/week and
nighttime symptoms 1x/month. She uses albuterol 3x/week. Per GINA/NAEPP
guidelines, what is the best step-up therapy?
A. Increase albuterol to daily use
B. Add low-dose ICS-formoterol as needed [CORRECT]
C. Add oral montelukast
D. Start high-dose ICS + LABA
Correct Answer: B
Rationale: Step 2 asthma (intermittent/mild persistent) requires daily ICS or
ICS-formoterol as needed. ICS reduces exacerbations and mortality; SABA-only is no
longer recommended. "GINA 2023: ICS-formoterol reliever preferred over SABA-only."
Q8: A 50-year-old male presents with unilateral leg swelling, warmth, and Homan's sign.
Wells score = 6. What is the most appropriate next step?
A. Start empiric heparin and order CTPA
B. Compression ultrasound of proximal veins [CORRECT]
C. D-dimer testing
D. MRI venography
Correct Answer: B
Rationale: High pretest probability (Wells ≥2) + suspected DVT → compression
ultrasound without D-dimer. D-dimer is only useful to rule out DVT when pretest
probability is low. "Wells low + D-dimer negative = DVT excluded; Wells high =
ultrasound."
, Q9: A 70-year-old male with HTN and diabetes has LDL 140 mg/dL. Per 2018 ACC/AHA
cholesterol guidelines, what is the indicated statin intensity?
A. Low-intensity statin (pravastatin 10 mg)
B. Moderate-intensity statin (atorvastatin 10-20 mg)
C. High-intensity statin (atorvastatin 40-80 mg) [CORRECT]
D. Ezetimibe monotherapy
Correct Answer: C
Rationale: Clinical ASCVD, LDL ≥190, diabetes age 40-75, or 10-year risk ≥7.5% all
indicate high-intensity statin. This patient has diabetes + age >40 = high-intensity
indicated. "ASCVD + diabetes = high-intensity statin; aim LDL <70 if very high risk."
Q10: A 68-year-old female presents with exertional dyspnea, orthopnea, and a
holosystolic murmur at the apex radiating to the axilla. Echocardiogram shows severe
mitral regurgitation. What is the definitive management?
A. Afterload reduction with ACE inhibitors
B. Diuretics and salt restriction
C. Surgical mitral valve repair or replacement [CORRECT]
D. Cardiac resynchronization therapy
Correct Answer: C
Rationale: Severe symptomatic mitral regurgitation requires surgical intervention (repair
preferred over replacement). Medical therapy is temporizing. "Mitral regurgitation
murmur = holosystolic, apex, radiates to axilla; repair > replace."
Q11: A 35-year-old female presents with episodic palpitations, lightheadedness, and a
regular narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail. What is the
first-line pharmacologic treatment?
A. Metoprolol 25 mg PO
B. Adenosine 6 mg IV rapid push followed by flush [CORRECT]
C. Amiodarone 150 mg IV
D. Diltiazem 20 mg IV
Correct Answer: B
Rationale: Adenosine is first-line for stable SVT/AVNRT due to transient AV nodal
blockade. It has a very short half-life (seconds). "SVT = adenosine first; AVNRT = reentry
through AV node; give FAST with flush."
