SARAH MICHELLE CRASH COURSE 2026/2027 | High-Yield
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SECTION 1: HIGH-YIELD CARDIOVASCULAR & RESPIRATORY (20 Questions)
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. BP 88/52 mmHg, HR 48 bpm, RR 24. ECG shows ST
elevation in leads II, III, and aVF with complete heart block. What is the highest priority
intervention?
A. Immediate aspirin 325 mg chewable
B. Emergent transcutaneous pacing and PCI activation [CORRECT]
C. Sublingual nitroglycerin 0.4 mg
D. IV morphine 4 mg for pain control
Correct Answer: B
Rationale: Inferior STEMI with hemodynamic instability and complete heart block =
high-grade AV block requiring emergent pacing. PCI activation is immediate priority.
Nitroglycerin is contraindicated in RV infarct (often accompanies inferior MI) due to
preload dependence. PEARL: "DONT MORPHINE THE BLOCK" — inferior MI + brady =
pacing first.
Q2: A 72-year-old female with HFrEF (EF 30%) presents with worsening dyspnea, JVD,
and bilateral crackles. BP 158/92, HR 110, SpO2 89% on room air. She is on lisinopril,
metoprolol, and furosemide. What is the best next step?
A. Add spironolactone 25 mg daily
B. Increase furosemide to IV 80 mg and apply BiPAP [CORRECT]
C. Initiate digoxin 0.25 mg loading dose
,D. Start dobutamine drip
Correct Answer: B
Rationale: Acute decompensated HF with pulmonary edema requires IV loop diuretic +
noninvasive positive pressure ventilation (BiPAP) to reduce preload and improve
oxygenation. PEARL: "LMNOP" for acute HF — Lasix, Morphine (caution), Nitrates,
Oxygen, Position (upright).
Q3: A 45-year-old male with asthma presents with wheezing, using accessory muscles,
and unable to speak in full sentences. Peak flow 35% of predicted. HR 118, RR 28. What
is the first-line acute management?
A. Oral prednisone 40 mg
B. Nebulized albuterol + ipratropium and systemic steroids [CORRECT]
C. IM epinephrine 0.3 mg
D. IV magnesium sulfate 2 g
Correct Answer: B
Rationale: Severe asthma exacerbation (peak flow <50% predicted) requires continuous
nebulized SABA + ipratropium (anticholinergic synergy) PLUS systemic steroids within 1
hour. Magnesium is adjunct for severe/refractory cases. PEARL: "SABA + SAMA =
SEVERE ASTHMA SAVED"
Q4: A 68-year-old male with COPD (FEV1 45% predicted) presents with increased
dyspnea, purulent sputum, and fever. SpO2 86% on room air. What is the most
appropriate initial antibiotic choice?
A. Azithromycin 500 mg daily
B. Amoxicillin-clavulanate 875/125 mg BID [CORRECT]
C. Levofloxacin 750 mg daily
D. Doxycycline 100 mg BID
Correct Answer: B
,Rationale: Moderate COPD exacerbation (2 of 3 Anthonisen criteria: increased dyspnea,
sputum volume, purulence) with risk factors requires amoxicillin-clavulanate or
doxycycline. Levofloxacin reserved for severe with risk factors/Pseudomonas concern.
PEARL: "PURULENT = ANTIBIOTIC" — only 1 criterion met = no antibiotics needed.
Q5: A 55-year-old female presents with sudden onset dyspnea, pleuritic chest pain, and
tachycardia. D-dimer 850 ng/mL. Wells score = 4.5. What is the next best step?
A. Start empiric heparin and obtain CTA chest [CORRECT]
B. Obtain duplex ultrasound of lower extremities
C. Start rivaroxaban 15 mg BID
D. Repeat D-dimer in 48 hours
Correct Answer: A
Rationale: Wells score >4 = high probability PE. Do NOT wait for imaging — start
anticoagulation immediately if no contraindications while awaiting CTA. PEARL: "HIGH
WELLS = HIT WITH HEPARIN"
Q6: A 62-year-old male with HTN presents for follow-up. Home BP readings average
148/92 mmHg on HCTZ 25 mg. What is the best next step per JNC-8?
A. Increase HCTZ to 50 mg
B. Add amlodipine 5 mg daily [CORRECT]
C. Add lisinopril 10 mg daily
D. Add metoprolol 50 mg BID
Correct Answer: B
Rationale: JNC-8 recommends thiazide + CCB or thiazide + ACEI for Black patients;
thiazide + CCB or ACEI + CCB for non-Black. Amlodipine is first-line add-on. PEARL:
"BLACK = CCB BACKUP"
, Q7: A 38-year-old female presents with palpitations, irregular pulse, and ECG showing
irregularly irregular rhythm with no P waves and variable R-R intervals. HR 142. BP
110/72. What is the best initial management?
A. Immediate synchronized cardioversion
B. Rate control with IV metoprolol and anticoagulation assessment [CORRECT]
C. Adenosine 6 mg rapid IV push
D. Start amiodarone loading dose
Correct Answer: B
Rationale: New-onset AF with rapid ventricular response but hemodynamically stable =
rate control (beta-blocker or CCB) + CHA2DS2-VASc assessment for anticoagulation.
Cardioversion only if unstable. Adenosine will NOT convert AF. PEARL: "STABLE AF =
RATE THEN ANTICOAGULATE"
Q8: A 50-year-old male with a 40 pack-year smoking history presents with a new harsh
systolic murmur at the right upper sternal border radiating to the carotids. What is the
most likely diagnosis?
A. Aortic regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral regurgitation
D. Pulmonic stenosis
Correct Answer: B
Rationale: Harsh crescendo-decrescendo systolic murmur at RUSB radiating to carotids
= classic aortic stenosis. "Dagger-shaped" pulse, syncope, angina, dyspnea are red
flags. PEARL: "SAD = Aortic Stenosis (Syncope, Angina, Dyspnea) = Surgical referral"
Q9: A 28-year-old male presents with sudden onset chest pain and dyspnea after a
coughing fit. Decreased breath sounds on the right, hyperresonance to percussion, and
tracheal deviation to the left. What is the immediate intervention?
Rapid Review Study Guide | Board Certification Success |
Pass Guaranteed - A+ Graded
SECTION 1: HIGH-YIELD CARDIOVASCULAR & RESPIRATORY (20 Questions)
Q1: A 58-year-old male presents with crushing substernal chest pain radiating to the left
arm, diaphoresis, and nausea. BP 88/52 mmHg, HR 48 bpm, RR 24. ECG shows ST
elevation in leads II, III, and aVF with complete heart block. What is the highest priority
intervention?
A. Immediate aspirin 325 mg chewable
B. Emergent transcutaneous pacing and PCI activation [CORRECT]
C. Sublingual nitroglycerin 0.4 mg
D. IV morphine 4 mg for pain control
Correct Answer: B
Rationale: Inferior STEMI with hemodynamic instability and complete heart block =
high-grade AV block requiring emergent pacing. PCI activation is immediate priority.
Nitroglycerin is contraindicated in RV infarct (often accompanies inferior MI) due to
preload dependence. PEARL: "DONT MORPHINE THE BLOCK" — inferior MI + brady =
pacing first.
Q2: A 72-year-old female with HFrEF (EF 30%) presents with worsening dyspnea, JVD,
and bilateral crackles. BP 158/92, HR 110, SpO2 89% on room air. She is on lisinopril,
metoprolol, and furosemide. What is the best next step?
A. Add spironolactone 25 mg daily
B. Increase furosemide to IV 80 mg and apply BiPAP [CORRECT]
C. Initiate digoxin 0.25 mg loading dose
,D. Start dobutamine drip
Correct Answer: B
Rationale: Acute decompensated HF with pulmonary edema requires IV loop diuretic +
noninvasive positive pressure ventilation (BiPAP) to reduce preload and improve
oxygenation. PEARL: "LMNOP" for acute HF — Lasix, Morphine (caution), Nitrates,
Oxygen, Position (upright).
Q3: A 45-year-old male with asthma presents with wheezing, using accessory muscles,
and unable to speak in full sentences. Peak flow 35% of predicted. HR 118, RR 28. What
is the first-line acute management?
A. Oral prednisone 40 mg
B. Nebulized albuterol + ipratropium and systemic steroids [CORRECT]
C. IM epinephrine 0.3 mg
D. IV magnesium sulfate 2 g
Correct Answer: B
Rationale: Severe asthma exacerbation (peak flow <50% predicted) requires continuous
nebulized SABA + ipratropium (anticholinergic synergy) PLUS systemic steroids within 1
hour. Magnesium is adjunct for severe/refractory cases. PEARL: "SABA + SAMA =
SEVERE ASTHMA SAVED"
Q4: A 68-year-old male with COPD (FEV1 45% predicted) presents with increased
dyspnea, purulent sputum, and fever. SpO2 86% on room air. What is the most
appropriate initial antibiotic choice?
A. Azithromycin 500 mg daily
B. Amoxicillin-clavulanate 875/125 mg BID [CORRECT]
C. Levofloxacin 750 mg daily
D. Doxycycline 100 mg BID
Correct Answer: B
,Rationale: Moderate COPD exacerbation (2 of 3 Anthonisen criteria: increased dyspnea,
sputum volume, purulence) with risk factors requires amoxicillin-clavulanate or
doxycycline. Levofloxacin reserved for severe with risk factors/Pseudomonas concern.
PEARL: "PURULENT = ANTIBIOTIC" — only 1 criterion met = no antibiotics needed.
Q5: A 55-year-old female presents with sudden onset dyspnea, pleuritic chest pain, and
tachycardia. D-dimer 850 ng/mL. Wells score = 4.5. What is the next best step?
A. Start empiric heparin and obtain CTA chest [CORRECT]
B. Obtain duplex ultrasound of lower extremities
C. Start rivaroxaban 15 mg BID
D. Repeat D-dimer in 48 hours
Correct Answer: A
Rationale: Wells score >4 = high probability PE. Do NOT wait for imaging — start
anticoagulation immediately if no contraindications while awaiting CTA. PEARL: "HIGH
WELLS = HIT WITH HEPARIN"
Q6: A 62-year-old male with HTN presents for follow-up. Home BP readings average
148/92 mmHg on HCTZ 25 mg. What is the best next step per JNC-8?
A. Increase HCTZ to 50 mg
B. Add amlodipine 5 mg daily [CORRECT]
C. Add lisinopril 10 mg daily
D. Add metoprolol 50 mg BID
Correct Answer: B
Rationale: JNC-8 recommends thiazide + CCB or thiazide + ACEI for Black patients;
thiazide + CCB or ACEI + CCB for non-Black. Amlodipine is first-line add-on. PEARL:
"BLACK = CCB BACKUP"
, Q7: A 38-year-old female presents with palpitations, irregular pulse, and ECG showing
irregularly irregular rhythm with no P waves and variable R-R intervals. HR 142. BP
110/72. What is the best initial management?
A. Immediate synchronized cardioversion
B. Rate control with IV metoprolol and anticoagulation assessment [CORRECT]
C. Adenosine 6 mg rapid IV push
D. Start amiodarone loading dose
Correct Answer: B
Rationale: New-onset AF with rapid ventricular response but hemodynamically stable =
rate control (beta-blocker or CCB) + CHA2DS2-VASc assessment for anticoagulation.
Cardioversion only if unstable. Adenosine will NOT convert AF. PEARL: "STABLE AF =
RATE THEN ANTICOAGULATE"
Q8: A 50-year-old male with a 40 pack-year smoking history presents with a new harsh
systolic murmur at the right upper sternal border radiating to the carotids. What is the
most likely diagnosis?
A. Aortic regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral regurgitation
D. Pulmonic stenosis
Correct Answer: B
Rationale: Harsh crescendo-decrescendo systolic murmur at RUSB radiating to carotids
= classic aortic stenosis. "Dagger-shaped" pulse, syncope, angina, dyspnea are red
flags. PEARL: "SAD = Aortic Stenosis (Syncope, Angina, Dyspnea) = Surgical referral"
Q9: A 28-year-old male presents with sudden onset chest pain and dyspnea after a
coughing fit. Decreased breath sounds on the right, hyperresonance to percussion, and
tracheal deviation to the left. What is the immediate intervention?
