Module IX: Respiratory Disorders (Asthma, COPD, Allergic Rhinitis)
✅ Question 1
A 26-year-old male presents with mild intermittent asthma exacerbations once per month. He
uses albuterol PRN. Which treatment recommendation aligns with GINA guidelines for him?
A. Continue PRN albuterol without additional therapy
B. Add low-dose ICS/formoterol as needed
C. Add montelukast daily
D. Begin daily LABA therapy
Correct Answer: B ✅
Rationale:
✅ B: GINA guidelines now recommend low-dose ICS/formoterol as-needed even in
mild intermittent asthma due to inflammation control.
❌ A: Albuterol PRN alone doesn’t address underlying inflammation.
❌ C: Montelukast is less effective than ICS and not first-line for intermittent asthma.
❌ D: LABA monotherapy is contraindicated due to increased asthma-related mortality
without ICS.
✅ Question 2
A 65-year-old patient with COPD (Group D) continues to experience exacerbations despite a
LABA/LAMA regimen. Which is the appropriate next step according to GOLD guidelines?
A. Add roflumilast
B. Add ICS
C. Switch to SABA only
D. Add theophylline
Correct Answer: B ✅
Rationale:
✅ B: ICS should be considered in patients who continue exacerbating despite
LABA/LAMA, especially if eosinophil counts are elevated (>100 cells/μL).
, ❌ A: Roflumilast is considered if chronic bronchitis is prominent, but ICS is often
preferred first.
❌ C: SABA monotherapy is inadequate for Group D COPD.
❌ D: Theophylline has fallen out of favor due to narrow therapeutic range and adverse
effects.
Module X: Hypertension & Heart Failure
✅ Question 3
A 54-year-old African American male with newly diagnosed hypertension and no CKD or DM
should first start therapy with:
A. Lisinopril
B. Metoprolol
C. Hydrochlorothiazide
D. Doxazosin
Correct Answer: C ✅
Rationale:
✅ C: Thiazides or CCBs are first-line therapies for African American patients without
CKD or DM.
❌ A: ACE inhibitors are less effective initially as monotherapy in African Americans
unless CKD or proteinuria is present.
❌ B: Beta-blockers aren't first-line for primary hypertension without specific
indications.
❌ D: Alpha-blockers are second-line and not recommended as first-line monotherapy.
✅ Question 4
A 62-year-old woman has HFrEF (EF 30%) with fluid retention. She takes lisinopril and
carvedilol. Which medication should be initiated next?
A. Hydralazine-isosorbide dinitrate
, B. Spironolactone
C. Furosemide
D. Digoxin
Correct Answer: C ✅
Rationale:
✅ C: Loop diuretics (furosemide) are indicated for symptomatic fluid retention.
❌ A: Hydralazine/isosorbide is recommended if intolerant to ACE-I/ARB, especially in
African American patients.
❌ B: Spironolactone reduces mortality but not first for acute fluid overload.
❌ D: Digoxin can decrease hospitalizations but not recommended before loop diuretics.
Module XI: Ischemic Heart Disease
✅ Question 5
A patient with stable angina experiences symptoms twice weekly. She currently takes sublingual
nitroglycerin PRN. What is the next recommended chronic therapy per ACC/AHA guidelines?
A. Diltiazem
B. Ranolazine
C. Metoprolol
D. Isosorbide mononitrate
Correct Answer: C ✅
Rationale:
✅ C: Beta-blockers are first-line therapy to reduce angina frequency and improve
survival.
❌ A: Non-dihydropyridine CCBs (diltiazem) second-line if beta-blockers
contraindicated or ineffective.
❌ B: Ranolazine reserved for persistent symptoms despite beta-blocker and nitrate use.
❌ D: Long-acting nitrates are second-line after beta-blockers due to tolerance.
✅ Question 1
A 26-year-old male presents with mild intermittent asthma exacerbations once per month. He
uses albuterol PRN. Which treatment recommendation aligns with GINA guidelines for him?
A. Continue PRN albuterol without additional therapy
B. Add low-dose ICS/formoterol as needed
C. Add montelukast daily
D. Begin daily LABA therapy
Correct Answer: B ✅
Rationale:
✅ B: GINA guidelines now recommend low-dose ICS/formoterol as-needed even in
mild intermittent asthma due to inflammation control.
❌ A: Albuterol PRN alone doesn’t address underlying inflammation.
❌ C: Montelukast is less effective than ICS and not first-line for intermittent asthma.
❌ D: LABA monotherapy is contraindicated due to increased asthma-related mortality
without ICS.
✅ Question 2
A 65-year-old patient with COPD (Group D) continues to experience exacerbations despite a
LABA/LAMA regimen. Which is the appropriate next step according to GOLD guidelines?
A. Add roflumilast
B. Add ICS
C. Switch to SABA only
D. Add theophylline
Correct Answer: B ✅
Rationale:
✅ B: ICS should be considered in patients who continue exacerbating despite
LABA/LAMA, especially if eosinophil counts are elevated (>100 cells/μL).
, ❌ A: Roflumilast is considered if chronic bronchitis is prominent, but ICS is often
preferred first.
❌ C: SABA monotherapy is inadequate for Group D COPD.
❌ D: Theophylline has fallen out of favor due to narrow therapeutic range and adverse
effects.
Module X: Hypertension & Heart Failure
✅ Question 3
A 54-year-old African American male with newly diagnosed hypertension and no CKD or DM
should first start therapy with:
A. Lisinopril
B. Metoprolol
C. Hydrochlorothiazide
D. Doxazosin
Correct Answer: C ✅
Rationale:
✅ C: Thiazides or CCBs are first-line therapies for African American patients without
CKD or DM.
❌ A: ACE inhibitors are less effective initially as monotherapy in African Americans
unless CKD or proteinuria is present.
❌ B: Beta-blockers aren't first-line for primary hypertension without specific
indications.
❌ D: Alpha-blockers are second-line and not recommended as first-line monotherapy.
✅ Question 4
A 62-year-old woman has HFrEF (EF 30%) with fluid retention. She takes lisinopril and
carvedilol. Which medication should be initiated next?
A. Hydralazine-isosorbide dinitrate
, B. Spironolactone
C. Furosemide
D. Digoxin
Correct Answer: C ✅
Rationale:
✅ C: Loop diuretics (furosemide) are indicated for symptomatic fluid retention.
❌ A: Hydralazine/isosorbide is recommended if intolerant to ACE-I/ARB, especially in
African American patients.
❌ B: Spironolactone reduces mortality but not first for acute fluid overload.
❌ D: Digoxin can decrease hospitalizations but not recommended before loop diuretics.
Module XI: Ischemic Heart Disease
✅ Question 5
A patient with stable angina experiences symptoms twice weekly. She currently takes sublingual
nitroglycerin PRN. What is the next recommended chronic therapy per ACC/AHA guidelines?
A. Diltiazem
B. Ranolazine
C. Metoprolol
D. Isosorbide mononitrate
Correct Answer: C ✅
Rationale:
✅ C: Beta-blockers are first-line therapy to reduce angina frequency and improve
survival.
❌ A: Non-dihydropyridine CCBs (diltiazem) second-line if beta-blockers
contraindicated or ineffective.
❌ B: Ranolazine reserved for persistent symptoms despite beta-blocker and nitrate use.
❌ D: Long-acting nitrates are second-line after beta-blockers due to tolerance.
