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CLINICAL GUIDELINES IN PRIMARY CARE Original Practice Questions with
Answers & Detailed Rationales
SECTION 1: CARDIOVASCULAR DISORDERS
1. According to current ACC/AHA guidelines, what is the
recommended blood pressure threshold for initiating
pharmacologic treatment in most adults?
A) ≥ 120/80 mm Hg
B) ≥ 130/80 mm Hg
C) ≥ 140/90 mm Hg
D) ≥ 150/95 mm Hg
Answer: B
Rationale: Current ACC/AHA guidelines (2017) recommend
initiating antihypertensive medication for most adults when
blood pressure is ≥ 130/80 mm Hg, particularly in those with
high cardiovascular risk, diabetes, or chronic kidney disease.
2. What is the first-line medication class for hypertension in
African American patients without compelling indications?
A) ACE inhibitor
B) Beta blocker
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C) Thiazide diuretic or calcium channel blocker
D) Alpha blocker
Answer: C
Rationale: Guidelines recommend thiazide diuretics or calcium
channel blockers as first-line agents for African American
patients. These medications demonstrate better blood pressure
response in this population compared to ACE inhibitors or ARBs
when used as monotherapy.
3. What is the recommended statin intensity for a patient with
clinical atherosclerotic cardiovascular disease (ASCVD)?
A) Low-intensity statin
B) Moderate-intensity statin
C) High-intensity statin
D) No statin therapy needed
Answer: C
Rationale: High-intensity statin therapy is recommended for
patients with clinical ASCVD to achieve at least a 50% reduction
in LDL cholesterol.
4. At what age should routine lipid screening begin for men
without cardiovascular risk factors?
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A) 20 years
B) 25 years
C) 30 years
D) 35 years
Answer: D
Rationale: Current guidelines recommend routine lipid
screening beginning at age 35 for men and age 45 for women
without risk factors. Screening should begin at age 20 if risk
factors are present.
5. What is the target LDL cholesterol for a patient with
established ASCVD?
A) < 130 mg/dL
B) < 100 mg/dL
C) < 70 mg/dL
D) < 50 mg/dL
Answer: C
Rationale: For patients with clinical ASCVD, the target LDL is
less than 70 mg/dL, typically achieved with high-intensity statin
therapy.
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6. A 62-year-old patient with hypertension and diabetes has a
blood pressure of 142/88 mm Hg. According to guidelines, the
target blood pressure is:
A) < 140/90 mm Hg
B) < 130/80 mm Hg
C) < 150/90 mm Hg
D) < 120/80 mm Hg
Answer: B
Rationale: For patients with diabetes or chronic kidney disease,
the blood pressure target is less than 130/80 mm Hg according
to current guidelines.
7. Which medication class is preferred for a patient with heart
failure with reduced ejection fraction (HFrEF)?
A) Non-dihydropyridine calcium channel blocker
B) ACE inhibitor or ARB
C) Alpha blocker
D) Short-acting nifedipine
Answer: B
Rationale: ACE inhibitors or ARBs are foundational therapy for
HFrEF, reducing mortality and hospitalizations. Calcium channel
blockers (especially non-dihydropyridines) are generally avoided
in HFrEF.
CLINICAL GUIDELINES IN PRIMARY CARE Original Practice Questions with
Answers & Detailed Rationales
SECTION 1: CARDIOVASCULAR DISORDERS
1. According to current ACC/AHA guidelines, what is the
recommended blood pressure threshold for initiating
pharmacologic treatment in most adults?
A) ≥ 120/80 mm Hg
B) ≥ 130/80 mm Hg
C) ≥ 140/90 mm Hg
D) ≥ 150/95 mm Hg
Answer: B
Rationale: Current ACC/AHA guidelines (2017) recommend
initiating antihypertensive medication for most adults when
blood pressure is ≥ 130/80 mm Hg, particularly in those with
high cardiovascular risk, diabetes, or chronic kidney disease.
2. What is the first-line medication class for hypertension in
African American patients without compelling indications?
A) ACE inhibitor
B) Beta blocker
, Page |2
C) Thiazide diuretic or calcium channel blocker
D) Alpha blocker
Answer: C
Rationale: Guidelines recommend thiazide diuretics or calcium
channel blockers as first-line agents for African American
patients. These medications demonstrate better blood pressure
response in this population compared to ACE inhibitors or ARBs
when used as monotherapy.
3. What is the recommended statin intensity for a patient with
clinical atherosclerotic cardiovascular disease (ASCVD)?
A) Low-intensity statin
B) Moderate-intensity statin
C) High-intensity statin
D) No statin therapy needed
Answer: C
Rationale: High-intensity statin therapy is recommended for
patients with clinical ASCVD to achieve at least a 50% reduction
in LDL cholesterol.
4. At what age should routine lipid screening begin for men
without cardiovascular risk factors?
, Page |3
A) 20 years
B) 25 years
C) 30 years
D) 35 years
Answer: D
Rationale: Current guidelines recommend routine lipid
screening beginning at age 35 for men and age 45 for women
without risk factors. Screening should begin at age 20 if risk
factors are present.
5. What is the target LDL cholesterol for a patient with
established ASCVD?
A) < 130 mg/dL
B) < 100 mg/dL
C) < 70 mg/dL
D) < 50 mg/dL
Answer: C
Rationale: For patients with clinical ASCVD, the target LDL is
less than 70 mg/dL, typically achieved with high-intensity statin
therapy.
, Page |4
6. A 62-year-old patient with hypertension and diabetes has a
blood pressure of 142/88 mm Hg. According to guidelines, the
target blood pressure is:
A) < 140/90 mm Hg
B) < 130/80 mm Hg
C) < 150/90 mm Hg
D) < 120/80 mm Hg
Answer: B
Rationale: For patients with diabetes or chronic kidney disease,
the blood pressure target is less than 130/80 mm Hg according
to current guidelines.
7. Which medication class is preferred for a patient with heart
failure with reduced ejection fraction (HFrEF)?
A) Non-dihydropyridine calcium channel blocker
B) ACE inhibitor or ARB
C) Alpha blocker
D) Short-acting nifedipine
Answer: B
Rationale: ACE inhibitors or ARBs are foundational therapy for
HFrEF, reducing mortality and hospitalizations. Calcium channel
blockers (especially non-dihydropyridines) are generally avoided
in HFrEF.
