Sarah Michelle Crash Course Questions
and Answers 2026/2027 Comprehensive
Exam Review
Domain 1: The Cardiology, the Hypertension & the EKG Interpretation (12 Questions)
1. A 68-year-old patient with a history of atrial fibrillation presents for a blood pressure
check. Which medication would be most appropriate to provide both rate control and blood
pressure management?
A. Amlodipine
B. Verapamil
C. Lisinopril
D. Hydrochlorothiazide
[CORRECT]
Rationale: Verapamil is a non-dihydropyridine calcium channel blocker. Unlike dihydropyridines
(like Amlodipine), non-dihydropyridines act on the sinoatrial and atrioventricular nodes, making
them the specific pharmacologic choice for patients needing concurrent rate control for atrial
fibrillation.
2. Which of the following best describes the clinical utility of Amlodipine compared to
Verapamil in a patient with a rapid heart rate?
A. Amlodipine is preferred for rate control.
B. Amlodipine is a dihydropyridine that primarily causes vasodilation.
C. Verapamil is a dihydropyridine that primarily causes vasodilation.
D. Both medications act equally on the heart rate.
[CORRECT]
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that works primarily by
peripheral vasodilation to lower blood pressure. It does not possess the negative dromotropic
effects on the AV node that non-dihydropyridines like Verapamil do, which are required for
managing atrial fibrillation.
,3. True or False: Non-dihydropyridine calcium channel blockers are contraindicated in
patients with a history of systolic heart failure due to their negative inotropic effects.
[CORRECT]
Rationale: This is true. Medications like Verapamil and Diltiazem decrease the contractility of the
heart (negative inotropy), which can worsen the ejection fraction in patients with systolic heart
failure.
4. A patient presents to the clinic with crushing chest pain radiating to the left jaw. The EKG
shows ST-elevation in leads II, III, and aVF. What is the immediate pharmacological priority?
A. Enteric-coated Aspirin 81 mg
B. Non-enteric coated Aspirin 325 mg (chewed)
C. Atorvastatin 80 mg
D. Metoprolol 25 mg
[CORRECT]
Rationale: In a suspected STEMI, the immediate priority is a loading dose of 325 mg of non-enteric
coated aspirin, which should be crushed or chewed to ensure rapid absorption and inhibition of
platelet aggregation.
5. For a patient diagnosed with an acute STEMI, what is the specific timeframe goal for "door-
to-balloon" time?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
[CORRECT]
Rationale: The standard of care for a STEMI is the activation of the cardiac catheterization lab with
a goal of achieving reperfusion (door-to-balloon) within 90 minutes of medical contact to minimize
myocardial necrosis.
, 6. Select All That Apply: Which of the following are immediate management steps for a
patient with a confirmed STEMI prior to transport?
• [ ] Activation of the cardiac cath lab
• [ ] Administration of a P2Y12 inhibitor (e.g., Clopidogrel)
• [ ] Administration of a full-dose crushed Aspirin
• [ ] Initiating a high-intensity thiazide diuretic
[CORRECT]
Rationale: Proper STEMI management includes immediate activation of the cath lab (within 90
minutes), loading with a P2Y12 inhibitor, and a loading dose of Aspirin. Thiazide diuretics have no
role in the acute management of a myocardial infarction.
7. A 55-year-old diabetic patient has a blood pressure of 145/85 mmHg and a urinalysis
positive for proteinuria. According to JNC 8 and ADA guidelines, what is the goal blood
pressure?
A. < 140/90 mmHg
B. < 130/80 mmHg
C. < 150/80 mmHg
D. < 120/70 mmHg
[CORRECT]
Rationale: For patients with diabetes and concurrent proteinuria, the specific blood pressure
target is more stringent (< 130/80 mmHg) to prevent the progression of diabetic nephropathy.
8. Which class of medication is specifically indicated for renal protection in a diabetic patient
with albuminuria?
A. Thiazide diuretics
B. Loop diuretics
C. ACE Inhibitors
D. Beta-blockers
[CORRECT]
and Answers 2026/2027 Comprehensive
Exam Review
Domain 1: The Cardiology, the Hypertension & the EKG Interpretation (12 Questions)
1. A 68-year-old patient with a history of atrial fibrillation presents for a blood pressure
check. Which medication would be most appropriate to provide both rate control and blood
pressure management?
A. Amlodipine
B. Verapamil
C. Lisinopril
D. Hydrochlorothiazide
[CORRECT]
Rationale: Verapamil is a non-dihydropyridine calcium channel blocker. Unlike dihydropyridines
(like Amlodipine), non-dihydropyridines act on the sinoatrial and atrioventricular nodes, making
them the specific pharmacologic choice for patients needing concurrent rate control for atrial
fibrillation.
2. Which of the following best describes the clinical utility of Amlodipine compared to
Verapamil in a patient with a rapid heart rate?
A. Amlodipine is preferred for rate control.
B. Amlodipine is a dihydropyridine that primarily causes vasodilation.
C. Verapamil is a dihydropyridine that primarily causes vasodilation.
D. Both medications act equally on the heart rate.
[CORRECT]
Rationale: Amlodipine is a dihydropyridine calcium channel blocker that works primarily by
peripheral vasodilation to lower blood pressure. It does not possess the negative dromotropic
effects on the AV node that non-dihydropyridines like Verapamil do, which are required for
managing atrial fibrillation.
,3. True or False: Non-dihydropyridine calcium channel blockers are contraindicated in
patients with a history of systolic heart failure due to their negative inotropic effects.
[CORRECT]
Rationale: This is true. Medications like Verapamil and Diltiazem decrease the contractility of the
heart (negative inotropy), which can worsen the ejection fraction in patients with systolic heart
failure.
4. A patient presents to the clinic with crushing chest pain radiating to the left jaw. The EKG
shows ST-elevation in leads II, III, and aVF. What is the immediate pharmacological priority?
A. Enteric-coated Aspirin 81 mg
B. Non-enteric coated Aspirin 325 mg (chewed)
C. Atorvastatin 80 mg
D. Metoprolol 25 mg
[CORRECT]
Rationale: In a suspected STEMI, the immediate priority is a loading dose of 325 mg of non-enteric
coated aspirin, which should be crushed or chewed to ensure rapid absorption and inhibition of
platelet aggregation.
5. For a patient diagnosed with an acute STEMI, what is the specific timeframe goal for "door-
to-balloon" time?
A. 30 minutes
B. 60 minutes
C. 90 minutes
D. 120 minutes
[CORRECT]
Rationale: The standard of care for a STEMI is the activation of the cardiac catheterization lab with
a goal of achieving reperfusion (door-to-balloon) within 90 minutes of medical contact to minimize
myocardial necrosis.
, 6. Select All That Apply: Which of the following are immediate management steps for a
patient with a confirmed STEMI prior to transport?
• [ ] Activation of the cardiac cath lab
• [ ] Administration of a P2Y12 inhibitor (e.g., Clopidogrel)
• [ ] Administration of a full-dose crushed Aspirin
• [ ] Initiating a high-intensity thiazide diuretic
[CORRECT]
Rationale: Proper STEMI management includes immediate activation of the cath lab (within 90
minutes), loading with a P2Y12 inhibitor, and a loading dose of Aspirin. Thiazide diuretics have no
role in the acute management of a myocardial infarction.
7. A 55-year-old diabetic patient has a blood pressure of 145/85 mmHg and a urinalysis
positive for proteinuria. According to JNC 8 and ADA guidelines, what is the goal blood
pressure?
A. < 140/90 mmHg
B. < 130/80 mmHg
C. < 150/80 mmHg
D. < 120/70 mmHg
[CORRECT]
Rationale: For patients with diabetes and concurrent proteinuria, the specific blood pressure
target is more stringent (< 130/80 mmHg) to prevent the progression of diabetic nephropathy.
8. Which class of medication is specifically indicated for renal protection in a diabetic patient
with albuminuria?
A. Thiazide diuretics
B. Loop diuretics
C. ACE Inhibitors
D. Beta-blockers
[CORRECT]
