AANP BOARD CERTIFICATION EXAM 2026/2027 | LEIK,
APEA & Sarah Michelle Review | 100% Correct Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR SYSTEM (40 Questions)
Q1: A 58-year-old male with a history of hypertension and type 2 diabetes presents for a
follow-up visit. His home blood pressure readings average 142/88 mmHg over the past
month. He is currently taking lisinopril 20 mg daily. His eGFR is 72 mL/min/1.73m²,
potassium 4.2 mEq/L, and urine albumin-to-creatinine ratio is 45 mg/g. According to the
2026 ADA Standards of Care and ACC/AHA guidelines, what is the most appropriate
next step in management?
A. Increase lisinopril to 40 mg daily and recheck in 4 weeks
B. Add amlodipine 5 mg daily to lisinopril 20 mg daily
C. Add chlorthalidone 12.5 mg daily to lisinopril 20 mg daily
D. Continue current regimen and recheck in 3 months
C. Add chlorthalidone 12.5 mg daily to lisinopril 20 mg daily [CORRECT]
Correct Answer: C
Rationale: The 2026 ADA Standards of Care recommend a blood pressure target of
<130/80 mmHg in patients with diabetes and albuminuria (UACR ≥30 mg/g). The
,ACC/AHA 2017/2022 guidelines classify this as Stage 2 hypertension (≥140/90)
requiring two first-line agents. An ACE inhibitor (lisinopril) plus a thiazide-like diuretic
(chlorthalidone) is a preferred combination per JNC 8 and ACC/AHA. Amlodipine is
acceptable but thiazide diuretics have superior outcomes in Black patients and those
with volume expansion; however, in a patient with albuminuria, maximizing ACE inhibitor
first or adding a CCB are both reasonable, but given the persistent elevation above goal
on monotherapy, intensification is required. Chlorthalidone is preferred over
hydrochlorothiazide due to better 24-hour BP control and cardiovascular outcome data.
(Verified by Leik, APEA & Sarah Michelle reviews)
Q2: A 72-year-old female with HFrEF (EF 35%) presents with worsening dyspnea and
peripheral edema. She is on lisinopril 20 mg, carvedilol 12.5 mg BID, and furosemide 40
mg daily. Her BP is 108/68 mmHg, HR 72 bpm, potassium 4.8 mEq/L, and creatinine 1.4
mg/dL. According to the 2022 AHA/ACC/HFSA Heart Failure Guidelines, what
medication should be added next?
A. Increase carvedilol to 25 mg BID
B. Add spironolactone 25 mg daily
C. Add hydralazine-isosorbide dinitrate
D. Add digoxin 0.125 mg daily
B. Add spironolactone 25 mg daily [CORRECT]
Correct Answer: B
Rationale: The 2022 AHA/ACC/HFSA guidelines recommend adding an MRA
(spironolactone or eplerenone) in patients with HFrEF (EF ≤35%) who remain
,symptomatic despite ACE inhibitor and beta-blocker therapy, provided potassium is <5.0
mEq/L and eGFR >30 mL/min. The EMPEROR-Reduced and DAPA-HF trials support
SGLT2 inhibitors as foundational therapy, but among the options provided,
spironolactone is the guideline-directed medical therapy (GDMT) to add next for
persistent NYHA Class II-III symptoms. Hydralazine-ISDN is reserved for Black patients
with persistent symptoms or those intolerant to ACE inhibitors. Digoxin is for symptom
control in persistent AFib or symptomatic HF despite GDMT. (Verified by Leik, APEA &
Sarah Michelle reviews)
Q3: A 65-year-old male with atrial fibrillation has a CHA₂DS₂-VASc score of 4 and
HAS-BLED score of 2. He has no mechanical heart valve. Which anticoagulation
strategy is most appropriate according to the 2024 ACC/AHA/ACCP/HRS AFib
Guidelines?
A. Aspirin 81 mg daily
B. Warfarin with INR target 2.0-3.0
C. Apixaban 5 mg BID
D. Dabigatran 75 mg BID
C. Apixaban 5 mg BID [CORRECT]
Correct Answer: C
Rationale: The 2024 ACC/AHA/ACCP/HRS guidelines recommend DOACs (apixaban,
rivaroxaban, dabigatran, edoxaban) over warfarin for non-valvular AFib in patients with
CHA₂DS₂-VASc ≥2 (men) or ≥3 (women), unless mechanical heart valves or
moderate-severe mitral stenosis are present. Apixaban 5 mg BID is preferred due to
, superior safety profile (lower bleeding risk) and efficacy data from ARISTOTLE trial.
Aspirin is insufficient for stroke prevention in AFib. Dabigatran 75 mg BID is only for
patients with CrCl 15-30 mL/min; standard dose is 150 mg BID. Warfarin is reserved for
mechanical valves or moderate-severe mitral stenosis. (Verified by Leik, APEA & Sarah
Michelle reviews)
Q4: A 55-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea for 45 minutes. ECG shows ST-segment elevation in leads
V1-V4. Vital signs: BP 88/56 mmHg, HR 110 bpm. What is the priority intervention?
A. Administer sublingual nitroglycerin
B. Obtain chest X-ray
C. Activate cath lab for primary PCI
D. Start heparin drip and wait for troponin
C. Activate cath lab for primary PCI [CORRECT]
Correct Answer: C
Rationale: This patient has an anterior STEMI with cardiogenic shock (SBP <90 mmHg).
The 2022 ACC/AHA/SCAI guidelines recommend immediate reperfusion therapy with
primary PCI within 90 minutes of first medical contact (door-to-balloon time).
Nitroglycerin is contraindicated in hypotension and RV infarction. Waiting for troponin
delays definitive therapy. While heparin is part of STEMI management, the priority is
emergent revascularization. In cardiogenic shock, PCI of the culprit lesion is indicated
regardless of timing. (Verified by Leik, APEA & Sarah Michelle reviews)
APEA & Sarah Michelle Review | 100% Correct Q&A | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR SYSTEM (40 Questions)
Q1: A 58-year-old male with a history of hypertension and type 2 diabetes presents for a
follow-up visit. His home blood pressure readings average 142/88 mmHg over the past
month. He is currently taking lisinopril 20 mg daily. His eGFR is 72 mL/min/1.73m²,
potassium 4.2 mEq/L, and urine albumin-to-creatinine ratio is 45 mg/g. According to the
2026 ADA Standards of Care and ACC/AHA guidelines, what is the most appropriate
next step in management?
A. Increase lisinopril to 40 mg daily and recheck in 4 weeks
B. Add amlodipine 5 mg daily to lisinopril 20 mg daily
C. Add chlorthalidone 12.5 mg daily to lisinopril 20 mg daily
D. Continue current regimen and recheck in 3 months
C. Add chlorthalidone 12.5 mg daily to lisinopril 20 mg daily [CORRECT]
Correct Answer: C
Rationale: The 2026 ADA Standards of Care recommend a blood pressure target of
<130/80 mmHg in patients with diabetes and albuminuria (UACR ≥30 mg/g). The
,ACC/AHA 2017/2022 guidelines classify this as Stage 2 hypertension (≥140/90)
requiring two first-line agents. An ACE inhibitor (lisinopril) plus a thiazide-like diuretic
(chlorthalidone) is a preferred combination per JNC 8 and ACC/AHA. Amlodipine is
acceptable but thiazide diuretics have superior outcomes in Black patients and those
with volume expansion; however, in a patient with albuminuria, maximizing ACE inhibitor
first or adding a CCB are both reasonable, but given the persistent elevation above goal
on monotherapy, intensification is required. Chlorthalidone is preferred over
hydrochlorothiazide due to better 24-hour BP control and cardiovascular outcome data.
(Verified by Leik, APEA & Sarah Michelle reviews)
Q2: A 72-year-old female with HFrEF (EF 35%) presents with worsening dyspnea and
peripheral edema. She is on lisinopril 20 mg, carvedilol 12.5 mg BID, and furosemide 40
mg daily. Her BP is 108/68 mmHg, HR 72 bpm, potassium 4.8 mEq/L, and creatinine 1.4
mg/dL. According to the 2022 AHA/ACC/HFSA Heart Failure Guidelines, what
medication should be added next?
A. Increase carvedilol to 25 mg BID
B. Add spironolactone 25 mg daily
C. Add hydralazine-isosorbide dinitrate
D. Add digoxin 0.125 mg daily
B. Add spironolactone 25 mg daily [CORRECT]
Correct Answer: B
Rationale: The 2022 AHA/ACC/HFSA guidelines recommend adding an MRA
(spironolactone or eplerenone) in patients with HFrEF (EF ≤35%) who remain
,symptomatic despite ACE inhibitor and beta-blocker therapy, provided potassium is <5.0
mEq/L and eGFR >30 mL/min. The EMPEROR-Reduced and DAPA-HF trials support
SGLT2 inhibitors as foundational therapy, but among the options provided,
spironolactone is the guideline-directed medical therapy (GDMT) to add next for
persistent NYHA Class II-III symptoms. Hydralazine-ISDN is reserved for Black patients
with persistent symptoms or those intolerant to ACE inhibitors. Digoxin is for symptom
control in persistent AFib or symptomatic HF despite GDMT. (Verified by Leik, APEA &
Sarah Michelle reviews)
Q3: A 65-year-old male with atrial fibrillation has a CHA₂DS₂-VASc score of 4 and
HAS-BLED score of 2. He has no mechanical heart valve. Which anticoagulation
strategy is most appropriate according to the 2024 ACC/AHA/ACCP/HRS AFib
Guidelines?
A. Aspirin 81 mg daily
B. Warfarin with INR target 2.0-3.0
C. Apixaban 5 mg BID
D. Dabigatran 75 mg BID
C. Apixaban 5 mg BID [CORRECT]
Correct Answer: C
Rationale: The 2024 ACC/AHA/ACCP/HRS guidelines recommend DOACs (apixaban,
rivaroxaban, dabigatran, edoxaban) over warfarin for non-valvular AFib in patients with
CHA₂DS₂-VASc ≥2 (men) or ≥3 (women), unless mechanical heart valves or
moderate-severe mitral stenosis are present. Apixaban 5 mg BID is preferred due to
, superior safety profile (lower bleeding risk) and efficacy data from ARISTOTLE trial.
Aspirin is insufficient for stroke prevention in AFib. Dabigatran 75 mg BID is only for
patients with CrCl 15-30 mL/min; standard dose is 150 mg BID. Warfarin is reserved for
mechanical valves or moderate-severe mitral stenosis. (Verified by Leik, APEA & Sarah
Michelle reviews)
Q4: A 55-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea for 45 minutes. ECG shows ST-segment elevation in leads
V1-V4. Vital signs: BP 88/56 mmHg, HR 110 bpm. What is the priority intervention?
A. Administer sublingual nitroglycerin
B. Obtain chest X-ray
C. Activate cath lab for primary PCI
D. Start heparin drip and wait for troponin
C. Activate cath lab for primary PCI [CORRECT]
Correct Answer: C
Rationale: This patient has an anterior STEMI with cardiogenic shock (SBP <90 mmHg).
The 2022 ACC/AHA/SCAI guidelines recommend immediate reperfusion therapy with
primary PCI within 90 minutes of first medical contact (door-to-balloon time).
Nitroglycerin is contraindicated in hypotension and RV infarction. Waiting for troponin
delays definitive therapy. While heparin is part of STEMI management, the priority is
emergent revascularization. In cardiogenic shock, PCI of the culprit lesion is indicated
regardless of timing. (Verified by Leik, APEA & Sarah Michelle reviews)
