SARAH MICHELLE LIVE REVIEW STUDY GUIDE 2026/2027 |
Comprehensive Exam Q&A | 100% Correct Verified Answers |
Graded A+ | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR SYSTEM - COMPREHENSIVE (45
Questions)
Q1: A 68-year-old African American male with a history of hypertension and type 2
diabetes presents for follow-up. His home BP readings average 138/82 mmHg. He is
currently taking lisinopril 20 mg daily. His eGFR is 55 mL/min/1.73m², and urine
albumin-to-creatinine ratio is 45 mg/g. According to the 2024 ACC/AHA Hypertension
Guideline, what is the next best step in management?
A. Continue current lisinopril dose and recheck in 3 months
B. Add amlodipine 5 mg daily to achieve a BP target <130/80 mmHg
C. Increase lisinopril to 40 mg daily and add hydrochlorothiazide 25 mg
D. Switch to losartan 50 mg daily due to ACE inhibitor intolerance risk
B. Add amlodipine 5 mg daily to achieve a BP target <130/80 mmHg [CORRECT]
Correct Answer: B
,Rationale: The 2024 ACC/AHA guideline recommends a BP target <130/80 mmHg for
patients with diabetes and albuminuria (UACR ≥30 mg/g). This patient is above goal on
maximum tolerated ACE inhibitor monotherapy. Adding a dihydropyridine CCB
(amlodipine) is preferred over thiazide diuretics in CKD stage 3a (eGFR 45-59) due to
metabolic neutrality and reduced risk of acute kidney injury. Option A delays
intensification in a high-risk patient. Option C risks hyperkalemia and AKI with ACEi +
thiazide in borderline eGFR. Option D is inappropriate as there is no ACEi intolerance. A+
PEARL: In diabetes with albuminuria, ACEi/ARB + CCB is the preferred dual therapy per
2024 ACC/AHA. 100% CORRECT ✅ A+ GRADED
Q2: A 72-year-old female with HFrEF (EF 30%) on guideline-directed medical therapy
(GDMT) presents with worsening dyspnea and 3+ peripheral edema. She is on lisinopril
20 mg, metoprolol succinate 50 mg, and furosemide 40 mg daily. Her potassium is 4.8
mEq/L, creatinine 1.4 mg/dL, and BNP 1200 pg/mL. What is the most appropriate next
step?
A. Increase metoprolol succinate to 100 mg daily
B. Add spironolactone 25 mg daily
C. Increase furosemide to 80 mg daily and reassess in 48 hours
D. Start sacubitril/valsartan 49/51 mg twice daily
C. Increase furosemide to 80 mg daily and reassess in 48 hours [CORRECT]
Correct Answer: C
,Rationale: This patient has acute decompensated heart failure with volume overload
manifesting as dyspnea and edema. The 2022 AHA/ACC/HFSA Heart Failure Guideline
emphasizes decongestion as the priority in acute exacerbation. Diuretic escalation is
first-line before adding or uptitrating neurohormonal blockers. Option A (beta-blocker
uptitration) could worsen acute congestion. Option B (spironolactone) is
contraindicated with K+ 4.8 and creatinine 1.4 (risk of hyperkalemia). Option D (ARNI)
requires ACEi washout and is not appropriate during acute decompensation. A+ PEARL:
"Decongest first, then neurohormonally block" — never up-titrate beta-blockers or add
MRAs during acute volume overload. 100% CORRECT ✅ A+ GRADED
Q3: A 58-year-old male with atrial fibrillation (CHADS₂-VASc = 4) and severe GERD is
started on anticoagulation. He has no liver disease. Which anticoagulant regimen is
most appropriate based on 2024 AHA/ACC/HRS AFib Guideline updates?
A. Apixaban 5 mg twice daily
B. Rivaroxaban 20 mg daily with evening meal
C. Dabigatran 150 mg twice daily
D. Warfarin with INR goal 2.0-3.0
A. Apixaban 5 mg twice daily [CORRECT]
Correct Answer: A
, Rationale: The 2024 AHA/ACC/HRS Guideline maintains DOAC preference over warfarin
for non-valvular AFib (NVAF) unless mechanical valve or moderate-severe mitral
stenosis. Apixaban has the best safety profile with lowest GI bleeding risk and no
requirement for evening meal administration. Option B (rivaroxaban) has higher GI
bleeding risk, problematic for severe GERD. Option C (dabigatran) has the highest GI
adverse effects and dyspepsia rates. Option D (warfarin) is inferior unless specific
contraindications to DOACs exist. A+ PEARL: "Apixaban = safest DOAC for GI-sensitive
patients" — remember the ARISTOTLE trial GI bleeding superiority. 100% CORRECT ✅
A+ GRADED
Q4: A 45-year-old female presents with chest pain on exertion. Stress testing reveals
2mm ST depression in leads V5-V6. Coronary angiography shows 60% stenosis of the
left anterior descending artery. Her LDL is 142 mg/dL. According to 2022 AHA/ACC
Chest Pain Guideline and 2024 Cholesterol Guideline, what is the optimal management?
A. High-intensity statin + aspirin 81 mg daily + lifestyle modification
B. PCI with drug-eluting stent
C. Moderate-intensity statin + aspirin + beta-blocker
D. High-intensity statin alone with repeat stress test in 6 months
A. High-intensity statin + aspirin 81 mg daily + lifestyle modification [CORRECT]
Correct Answer: A
Comprehensive Exam Q&A | 100% Correct Verified Answers |
Graded A+ | Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR SYSTEM - COMPREHENSIVE (45
Questions)
Q1: A 68-year-old African American male with a history of hypertension and type 2
diabetes presents for follow-up. His home BP readings average 138/82 mmHg. He is
currently taking lisinopril 20 mg daily. His eGFR is 55 mL/min/1.73m², and urine
albumin-to-creatinine ratio is 45 mg/g. According to the 2024 ACC/AHA Hypertension
Guideline, what is the next best step in management?
A. Continue current lisinopril dose and recheck in 3 months
B. Add amlodipine 5 mg daily to achieve a BP target <130/80 mmHg
C. Increase lisinopril to 40 mg daily and add hydrochlorothiazide 25 mg
D. Switch to losartan 50 mg daily due to ACE inhibitor intolerance risk
B. Add amlodipine 5 mg daily to achieve a BP target <130/80 mmHg [CORRECT]
Correct Answer: B
,Rationale: The 2024 ACC/AHA guideline recommends a BP target <130/80 mmHg for
patients with diabetes and albuminuria (UACR ≥30 mg/g). This patient is above goal on
maximum tolerated ACE inhibitor monotherapy. Adding a dihydropyridine CCB
(amlodipine) is preferred over thiazide diuretics in CKD stage 3a (eGFR 45-59) due to
metabolic neutrality and reduced risk of acute kidney injury. Option A delays
intensification in a high-risk patient. Option C risks hyperkalemia and AKI with ACEi +
thiazide in borderline eGFR. Option D is inappropriate as there is no ACEi intolerance. A+
PEARL: In diabetes with albuminuria, ACEi/ARB + CCB is the preferred dual therapy per
2024 ACC/AHA. 100% CORRECT ✅ A+ GRADED
Q2: A 72-year-old female with HFrEF (EF 30%) on guideline-directed medical therapy
(GDMT) presents with worsening dyspnea and 3+ peripheral edema. She is on lisinopril
20 mg, metoprolol succinate 50 mg, and furosemide 40 mg daily. Her potassium is 4.8
mEq/L, creatinine 1.4 mg/dL, and BNP 1200 pg/mL. What is the most appropriate next
step?
A. Increase metoprolol succinate to 100 mg daily
B. Add spironolactone 25 mg daily
C. Increase furosemide to 80 mg daily and reassess in 48 hours
D. Start sacubitril/valsartan 49/51 mg twice daily
C. Increase furosemide to 80 mg daily and reassess in 48 hours [CORRECT]
Correct Answer: C
,Rationale: This patient has acute decompensated heart failure with volume overload
manifesting as dyspnea and edema. The 2022 AHA/ACC/HFSA Heart Failure Guideline
emphasizes decongestion as the priority in acute exacerbation. Diuretic escalation is
first-line before adding or uptitrating neurohormonal blockers. Option A (beta-blocker
uptitration) could worsen acute congestion. Option B (spironolactone) is
contraindicated with K+ 4.8 and creatinine 1.4 (risk of hyperkalemia). Option D (ARNI)
requires ACEi washout and is not appropriate during acute decompensation. A+ PEARL:
"Decongest first, then neurohormonally block" — never up-titrate beta-blockers or add
MRAs during acute volume overload. 100% CORRECT ✅ A+ GRADED
Q3: A 58-year-old male with atrial fibrillation (CHADS₂-VASc = 4) and severe GERD is
started on anticoagulation. He has no liver disease. Which anticoagulant regimen is
most appropriate based on 2024 AHA/ACC/HRS AFib Guideline updates?
A. Apixaban 5 mg twice daily
B. Rivaroxaban 20 mg daily with evening meal
C. Dabigatran 150 mg twice daily
D. Warfarin with INR goal 2.0-3.0
A. Apixaban 5 mg twice daily [CORRECT]
Correct Answer: A
, Rationale: The 2024 AHA/ACC/HRS Guideline maintains DOAC preference over warfarin
for non-valvular AFib (NVAF) unless mechanical valve or moderate-severe mitral
stenosis. Apixaban has the best safety profile with lowest GI bleeding risk and no
requirement for evening meal administration. Option B (rivaroxaban) has higher GI
bleeding risk, problematic for severe GERD. Option C (dabigatran) has the highest GI
adverse effects and dyspepsia rates. Option D (warfarin) is inferior unless specific
contraindications to DOACs exist. A+ PEARL: "Apixaban = safest DOAC for GI-sensitive
patients" — remember the ARISTOTLE trial GI bleeding superiority. 100% CORRECT ✅
A+ GRADED
Q4: A 45-year-old female presents with chest pain on exertion. Stress testing reveals
2mm ST depression in leads V5-V6. Coronary angiography shows 60% stenosis of the
left anterior descending artery. Her LDL is 142 mg/dL. According to 2022 AHA/ACC
Chest Pain Guideline and 2024 Cholesterol Guideline, what is the optimal management?
A. High-intensity statin + aspirin 81 mg daily + lifestyle modification
B. PCI with drug-eluting stent
C. Moderate-intensity statin + aspirin + beta-blocker
D. High-intensity statin alone with repeat stress test in 6 months
A. High-intensity statin + aspirin 81 mg daily + lifestyle modification [CORRECT]
Correct Answer: A
