AGNP CORE EXAM SET 2025/2026 QUESTIONS AND
SOLUTIONS RANKED A+
✔✔Specificity - ✔✔likelihood that a healthy pt has negative test (- in health); Dx test has
few false-positives & confirms absence of disease. Used to confirm a Dx or to rule out
disease.
SPIN
✔✔+ Predictive values - ✔✔Probability of a disease given a positive test result.
✔✔- Predictive values - ✔✔Probability of no disease given a negative test result.
✔✔LR+ - ✔✔LR+ is equivalent to the probability that a person with the disease tested
positive for the disease (true positive) divided by the probability that a person without
the disease tested positive for the disease (false positive)
=sensitivity / 1- specificity
✔✔LR- - ✔✔LR- is equivalent to the probability that a person with the disease tested
negative for the disease (false negative) divided by the probability that a person without
the disease tested negative for the disease (true positive).
=1- sensitivity / specificity
✔✔Pay for Performance - ✔✔A concept that government and private insurers are
adopting to reward practitioners who track and maintain updated required screenings
and quality measures
e.g. financial incentives to practices that track and adhere
to screening guidelines and quality measures such as periodic A1C checks on patients
with diabetes.
✔✔Aortic Dissection Priority - ✔✔decrease SBP<120 within 10 mins using BB or
vasodilator (nitroprusside)
-get CT & TEE
✔✔HTN Emergency goal - ✔✔mean arterial BP reduced to 110 to 115 in 30 to 60 min.
(or decreased by 20-25%)
✔✔HTN urgency BP lowering - ✔✔gradual reduction 24-48 hours using Captopril,
Clonidine & Labetolol
✔✔HTN urgency= - ✔✔BP >180/110
NO evidence of target end-organ damage
-progressive symptoms: HA, SOB, pedal edema
✔✔HTN emergency= - ✔✔BP>220/140
Symptomatic, Evidence of end-organ damage
,-ICH, ARF, AMI, encephalopathy, Acute pulmonary edema
✔✔fundoscopic exam shows - ✔✔papilledema
✔✔Hypertensive encephalopathy - ✔✔reduce MAP 25% over 8hrs
-use labetolol, cardene & esmolol
avoid nitroprusside & hydralazine
✔✔lowering BP in ischemic stroke may may cause - ✔✔cerebral ischemia
✔✔groups identified who should receive statin therapy: - ✔✔1. People with
atherosclerotic cardiovascular disease (ASCVD) - hx of MI, acute coronary syndromes,
angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial
disease
2. People with LDL-C > 190 mg/dL and no ASCVD
3. People with Diabetes age 40 to 75 years, LDL-C between 70 and 189 mg/dL and no
ASCVD
4. People with NO Diabetes or ASCVD age 40 to 75 years, LDL-C between 70 and 189,
and an estimated 10-year ASCVD risk of 7.5% or higher
✔✔ASA - ✔✔Inhibits cyclo-oxygenase
-given to UA/NSTEMI on D/C
✔✔Clopidogrel (Plavix), Prasugrel (Effient), Ticlopidine (Ticlid) - ✔✔Interfere with ADP-
mediated activation
✔✔PPIs are strong inhibitors of - ✔✔CYP2C19
✔✔Bare metal stents - ✔✔Higher risk of in-stent restenosis
Recommended for patients with: higher bleeding risk,
inability to comply with dual antiplatelet therapy, anticipated invasive or surgical
procedure within the next year
-requires P2Y12 receptor inhibitor therapy x at least 12mo
✔✔Drug-eluting stents - ✔✔Lower risk of restenosis
-requires P2Y12 receptor inhibitor therapy x at least 12mo
✔✔BB contraindications - ✔✔HR < 60, 2nd or 3rd degree heart block, P-R interval >
0.24 sec, Systolic BP < 100, Moderate to severe heart failure, Asthma or reactive airway
disease, Signs of peripheral hypoperfusion
✔✔Aldosterone Receptor Blocker - ✔✔Patients already taking ACE inhibitors, Ejection
fraction < .40, Heart failure, Diabetes Mellitus
✔✔ACE-I class I - ✔✔Anterior MI, Pulmonary Congestion, LVEF < 0.40
, ✔✔ACE-I class IIa - ✔✔Mild ventricular impairment (EF 40-50%) with hx of old MI,
Acute MI within 1st 24 hours
✔✔ARB - ✔✔Intolerance to ACEI, Heart failure or EF < .40
✔✔Stages of Heart FailureStage A - ✔✔A: At risk for heart failure
B: Structural disorder but no symptoms
C: Past or current history of symptoms and structural disorder
D: End-stage disease requiring support
✔✔NYHA HF Classification - ✔✔Stage I: No symptoms with ordinary activity
Stage II: Symptoms with ordinary activity; slight limitation
Stage III: Symptoms with less than ordinary activity; marked limitation
Stage IV: Symptoms with any activity; also at rest
✔✔HF PE findings - ✔✔JVD and Hepatojugular reflux, Hepatomegaly, Rales, Edema:
legs, abdomen, Presacral area, Scrotum, Ascites
✔✔Stage A tx - ✔✔Treat/eliminate risk factors: Hypertension, Lipid disorders, Diabetes,
Obesity, Smoking
✔✔Stage B tx - ✔✔All patients with recent or remote history of MI or ACS and reduced
EF should receive:
ACEI inhibitors (reduce mortality)
*ARBs may be used if intolerant to ACE inhibitors*
Beta blockers (reduce mortality)
Statins
✔✔ACE-I in HF - ✔✔Suppress angiotensin II
Inhibit the activation of aldosterone
Enhance the action of kinins
Augment kinin-mediated prostaglandins
Reduce deleterious cardiac remodeling
Improve HF survival
Start low and go slow
Assess BUN, creat, K+ in 1-2 weeks
*Watch out for azotemia & hyperkalemia*
✔✔ARB in HF - ✔✔Attempt ACEI therapy first, if patient is unable to tolerate, use ARB
Side Effects
Worsening renal function
Hyperkalemia
SOLUTIONS RANKED A+
✔✔Specificity - ✔✔likelihood that a healthy pt has negative test (- in health); Dx test has
few false-positives & confirms absence of disease. Used to confirm a Dx or to rule out
disease.
SPIN
✔✔+ Predictive values - ✔✔Probability of a disease given a positive test result.
✔✔- Predictive values - ✔✔Probability of no disease given a negative test result.
✔✔LR+ - ✔✔LR+ is equivalent to the probability that a person with the disease tested
positive for the disease (true positive) divided by the probability that a person without
the disease tested positive for the disease (false positive)
=sensitivity / 1- specificity
✔✔LR- - ✔✔LR- is equivalent to the probability that a person with the disease tested
negative for the disease (false negative) divided by the probability that a person without
the disease tested negative for the disease (true positive).
=1- sensitivity / specificity
✔✔Pay for Performance - ✔✔A concept that government and private insurers are
adopting to reward practitioners who track and maintain updated required screenings
and quality measures
e.g. financial incentives to practices that track and adhere
to screening guidelines and quality measures such as periodic A1C checks on patients
with diabetes.
✔✔Aortic Dissection Priority - ✔✔decrease SBP<120 within 10 mins using BB or
vasodilator (nitroprusside)
-get CT & TEE
✔✔HTN Emergency goal - ✔✔mean arterial BP reduced to 110 to 115 in 30 to 60 min.
(or decreased by 20-25%)
✔✔HTN urgency BP lowering - ✔✔gradual reduction 24-48 hours using Captopril,
Clonidine & Labetolol
✔✔HTN urgency= - ✔✔BP >180/110
NO evidence of target end-organ damage
-progressive symptoms: HA, SOB, pedal edema
✔✔HTN emergency= - ✔✔BP>220/140
Symptomatic, Evidence of end-organ damage
,-ICH, ARF, AMI, encephalopathy, Acute pulmonary edema
✔✔fundoscopic exam shows - ✔✔papilledema
✔✔Hypertensive encephalopathy - ✔✔reduce MAP 25% over 8hrs
-use labetolol, cardene & esmolol
avoid nitroprusside & hydralazine
✔✔lowering BP in ischemic stroke may may cause - ✔✔cerebral ischemia
✔✔groups identified who should receive statin therapy: - ✔✔1. People with
atherosclerotic cardiovascular disease (ASCVD) - hx of MI, acute coronary syndromes,
angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial
disease
2. People with LDL-C > 190 mg/dL and no ASCVD
3. People with Diabetes age 40 to 75 years, LDL-C between 70 and 189 mg/dL and no
ASCVD
4. People with NO Diabetes or ASCVD age 40 to 75 years, LDL-C between 70 and 189,
and an estimated 10-year ASCVD risk of 7.5% or higher
✔✔ASA - ✔✔Inhibits cyclo-oxygenase
-given to UA/NSTEMI on D/C
✔✔Clopidogrel (Plavix), Prasugrel (Effient), Ticlopidine (Ticlid) - ✔✔Interfere with ADP-
mediated activation
✔✔PPIs are strong inhibitors of - ✔✔CYP2C19
✔✔Bare metal stents - ✔✔Higher risk of in-stent restenosis
Recommended for patients with: higher bleeding risk,
inability to comply with dual antiplatelet therapy, anticipated invasive or surgical
procedure within the next year
-requires P2Y12 receptor inhibitor therapy x at least 12mo
✔✔Drug-eluting stents - ✔✔Lower risk of restenosis
-requires P2Y12 receptor inhibitor therapy x at least 12mo
✔✔BB contraindications - ✔✔HR < 60, 2nd or 3rd degree heart block, P-R interval >
0.24 sec, Systolic BP < 100, Moderate to severe heart failure, Asthma or reactive airway
disease, Signs of peripheral hypoperfusion
✔✔Aldosterone Receptor Blocker - ✔✔Patients already taking ACE inhibitors, Ejection
fraction < .40, Heart failure, Diabetes Mellitus
✔✔ACE-I class I - ✔✔Anterior MI, Pulmonary Congestion, LVEF < 0.40
, ✔✔ACE-I class IIa - ✔✔Mild ventricular impairment (EF 40-50%) with hx of old MI,
Acute MI within 1st 24 hours
✔✔ARB - ✔✔Intolerance to ACEI, Heart failure or EF < .40
✔✔Stages of Heart FailureStage A - ✔✔A: At risk for heart failure
B: Structural disorder but no symptoms
C: Past or current history of symptoms and structural disorder
D: End-stage disease requiring support
✔✔NYHA HF Classification - ✔✔Stage I: No symptoms with ordinary activity
Stage II: Symptoms with ordinary activity; slight limitation
Stage III: Symptoms with less than ordinary activity; marked limitation
Stage IV: Symptoms with any activity; also at rest
✔✔HF PE findings - ✔✔JVD and Hepatojugular reflux, Hepatomegaly, Rales, Edema:
legs, abdomen, Presacral area, Scrotum, Ascites
✔✔Stage A tx - ✔✔Treat/eliminate risk factors: Hypertension, Lipid disorders, Diabetes,
Obesity, Smoking
✔✔Stage B tx - ✔✔All patients with recent or remote history of MI or ACS and reduced
EF should receive:
ACEI inhibitors (reduce mortality)
*ARBs may be used if intolerant to ACE inhibitors*
Beta blockers (reduce mortality)
Statins
✔✔ACE-I in HF - ✔✔Suppress angiotensin II
Inhibit the activation of aldosterone
Enhance the action of kinins
Augment kinin-mediated prostaglandins
Reduce deleterious cardiac remodeling
Improve HF survival
Start low and go slow
Assess BUN, creat, K+ in 1-2 weeks
*Watch out for azotemia & hyperkalemia*
✔✔ARB in HF - ✔✔Attempt ACEI therapy first, if patient is unable to tolerate, use ARB
Side Effects
Worsening renal function
Hyperkalemia
