Primary Care (Dunphy 6th Ed.) –
Comprehensive Practice Review Guide
2025/2026
1. What is the first-line recommended pharmacologic therapy for hypertension in the general
non-Black population without compelling indications (e.g., heart failure, CKD)?
A) Beta-blocker
B) ACE Inhibitor or ARB
C) Thiazide Diuretic
D) Calcium Channel Blocker
Answer: C) Thiazide Diuretic (✓)
2. A 65-year-old patient presents with sudden-onset "tearing" chest pain radiating to the
back. BP is 180/100 in the right arm and 140/80 in the left arm. What is the most likely
diagnosis?
A) Myocardial Infarction
B) Pulmonary Embolism
C) Aortic Dissection
D) Pericarditis
Answer: C) Aortic Dissection (✓)
3. Which finding on ECG is diagnostic for atrial fibrillation?
A) P waves with varying morphology
B) Irregularly irregular R-R intervals with no distinct P waves
C) A sawtooth pattern of atrial waves
D) A prolonged PR interval
Answer: B) Irregularly irregular R-R intervals with no distinct P waves (✓)
4. The most common cause of heart failure with preserved ejection fraction (HFpEF) is:
A) Uncontrolled Atrial Fibrillation
B) Long-standing, uncontrolled Hypertension
C) Alcoholism
D) Viral Myocarditis
Answer: B) Long-standing, uncontrolled Hypertension (✓)
5. First-line therapy for symptomatic heart failure with reduced ejection fraction (HFrEF)
includes which combination?
,A) ACE-I, Beta-blocker, SGLT2 Inhibitor
B) Digoxin, Loop Diuretic, Nitrate
C) Calcium Channel Blocker, Statin, Aspirin
D) ARB, MRA, Ivabradine
Answer: A) ACE-I, Beta-blocker, SGLT2 Inhibitor (✓)
6. For a patient with stable angina, what is the first-line medication for symptom prevention?
A) Aspirin
B) Sublingual Nitroglycerin
C) Beta-blocker
D) Ranolazine
Answer: C) Beta-blocker (✓)
7. The most common symptom of a myocardial infarction in women is:
A) Left arm pain
B) Chest pain or discomfort
C) Jaw pain
D) Nausea and vomiting
Answer: B) Chest pain or discomfort (✓)
8. Which murmur is described as a midsystolic, crescendo-decrescendo murmur best heard at
the right upper sternal border?
A) Mitral Regurgitation
B) Aortic Stenosis
C) Mitral Stenosis
D) Aortic Regurgitation
Answer: B) Aortic Stenosis (✓)
9. According to JNC 8 guidelines, the blood pressure goal for patients over 60 years of age is:
A) < 140/90 mmHg
B) < 130/80 mmHg
C) < 150/90 mmHg
D) < 120/80 mmHg
Answer: C) < 150/90 mmHg (✓)
10. A patient with a mechanical heart valve requires lifelong anticoagulation with:
A) Aspirin
B) Clopidogrel
C) Warfarin
,D) Apixaban
Answer: C) Warfarin (✓)
11. The most common valvular heart disease in developed countries is:
A) Rheumatic Heart Disease
B) Aortic Stenosis
C) Mitral Valve Prolapse
D) Infective Endocarditis
Answer: B) Aortic Stenosis (✓)
12. What is the first-line diagnostic test for suspected stable ischemic heart disease?
A) Coronary Angiography
B) Exercise Stress Echocardiography
C) Coronary CT Angiography
D) ECG
Answer: B) Exercise Stress Echocardiography (✓)
13. Which medication is contraindicated in acute heart failure with hypotension?
A) Furosemide
B) Nitroprusside
C) Metoprolol
D) Dobutamine
Answer: C) Metoprolol (✓)
14. The most common cause of sudden cardiac death in young athletes is:
A) Atherosclerotic Coronary Artery Disease
B) Hypertrophic Cardiomyopathy
C) Long QT Syndrome
D) Myocardial Infarction
Answer: B) Hypertrophic Cardiomyopathy (✓)
15. Digoxin toxicity is strongly associated with which electrolyte abnormality?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B) Hypokalemia (✓)
Pulmonology (Questions 16-25)
, 16. The first-line long-term controller medication for persistent asthma is:
A) Short-acting beta-agonist (SABA)
B) Inhaled Corticosteroid (ICS)
C) Leukotriene Receptor Antagonist (LTRA)
D) Theophylline
Answer: B) Inhaled Corticosteroid (ICS) (✓)
17. The diagnostic test of choice for suspected pulmonary embolism is:
A) D-dimer
B) Chest X-ray
C) CT Pulmonary Angiography (CTPA)
D) V/Q Scan
Answer: C) CT Pulmonary Angiography (CTPA) (✓)
18. Which of the following is the most common cause of Community-Acquired Pneumonia
(CAP) in adults?
A) Haemophilus influenzae
B) Mycoplasma pneumoniae
C) Streptococcus pneumoniae
D) Legionella pneumophila
Answer: C) Streptococcus pneumoniae (✓)
19. The GOLD criteria classification for COPD severity is primarily based on:
A) FEV1/FVC ratio
B) Symptom burden and exacerbation history
C) Arterial Blood Gas results
D) Chest CT findings
Answer: B) Symptom burden and exacerbation history (✓)
20. A 45-year-old smoker with a 30-pack-year history presents with dyspnea and a barrel
chest. Spirometry shows FEV1/FVC < 0.70. This is diagnostic for:
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Bronchiectasis
D) Interstitial Lung Disease
Answer: B) Chronic Obstructive Pulmonary Disease (COPD) (✓)
21. The first-line treatment for an acute COPD exacerbation is:
A) Antibiotics
B) Inhaled Bronchodilators
Comprehensive Practice Review Guide
2025/2026
1. What is the first-line recommended pharmacologic therapy for hypertension in the general
non-Black population without compelling indications (e.g., heart failure, CKD)?
A) Beta-blocker
B) ACE Inhibitor or ARB
C) Thiazide Diuretic
D) Calcium Channel Blocker
Answer: C) Thiazide Diuretic (✓)
2. A 65-year-old patient presents with sudden-onset "tearing" chest pain radiating to the
back. BP is 180/100 in the right arm and 140/80 in the left arm. What is the most likely
diagnosis?
A) Myocardial Infarction
B) Pulmonary Embolism
C) Aortic Dissection
D) Pericarditis
Answer: C) Aortic Dissection (✓)
3. Which finding on ECG is diagnostic for atrial fibrillation?
A) P waves with varying morphology
B) Irregularly irregular R-R intervals with no distinct P waves
C) A sawtooth pattern of atrial waves
D) A prolonged PR interval
Answer: B) Irregularly irregular R-R intervals with no distinct P waves (✓)
4. The most common cause of heart failure with preserved ejection fraction (HFpEF) is:
A) Uncontrolled Atrial Fibrillation
B) Long-standing, uncontrolled Hypertension
C) Alcoholism
D) Viral Myocarditis
Answer: B) Long-standing, uncontrolled Hypertension (✓)
5. First-line therapy for symptomatic heart failure with reduced ejection fraction (HFrEF)
includes which combination?
,A) ACE-I, Beta-blocker, SGLT2 Inhibitor
B) Digoxin, Loop Diuretic, Nitrate
C) Calcium Channel Blocker, Statin, Aspirin
D) ARB, MRA, Ivabradine
Answer: A) ACE-I, Beta-blocker, SGLT2 Inhibitor (✓)
6. For a patient with stable angina, what is the first-line medication for symptom prevention?
A) Aspirin
B) Sublingual Nitroglycerin
C) Beta-blocker
D) Ranolazine
Answer: C) Beta-blocker (✓)
7. The most common symptom of a myocardial infarction in women is:
A) Left arm pain
B) Chest pain or discomfort
C) Jaw pain
D) Nausea and vomiting
Answer: B) Chest pain or discomfort (✓)
8. Which murmur is described as a midsystolic, crescendo-decrescendo murmur best heard at
the right upper sternal border?
A) Mitral Regurgitation
B) Aortic Stenosis
C) Mitral Stenosis
D) Aortic Regurgitation
Answer: B) Aortic Stenosis (✓)
9. According to JNC 8 guidelines, the blood pressure goal for patients over 60 years of age is:
A) < 140/90 mmHg
B) < 130/80 mmHg
C) < 150/90 mmHg
D) < 120/80 mmHg
Answer: C) < 150/90 mmHg (✓)
10. A patient with a mechanical heart valve requires lifelong anticoagulation with:
A) Aspirin
B) Clopidogrel
C) Warfarin
,D) Apixaban
Answer: C) Warfarin (✓)
11. The most common valvular heart disease in developed countries is:
A) Rheumatic Heart Disease
B) Aortic Stenosis
C) Mitral Valve Prolapse
D) Infective Endocarditis
Answer: B) Aortic Stenosis (✓)
12. What is the first-line diagnostic test for suspected stable ischemic heart disease?
A) Coronary Angiography
B) Exercise Stress Echocardiography
C) Coronary CT Angiography
D) ECG
Answer: B) Exercise Stress Echocardiography (✓)
13. Which medication is contraindicated in acute heart failure with hypotension?
A) Furosemide
B) Nitroprusside
C) Metoprolol
D) Dobutamine
Answer: C) Metoprolol (✓)
14. The most common cause of sudden cardiac death in young athletes is:
A) Atherosclerotic Coronary Artery Disease
B) Hypertrophic Cardiomyopathy
C) Long QT Syndrome
D) Myocardial Infarction
Answer: B) Hypertrophic Cardiomyopathy (✓)
15. Digoxin toxicity is strongly associated with which electrolyte abnormality?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B) Hypokalemia (✓)
Pulmonology (Questions 16-25)
, 16. The first-line long-term controller medication for persistent asthma is:
A) Short-acting beta-agonist (SABA)
B) Inhaled Corticosteroid (ICS)
C) Leukotriene Receptor Antagonist (LTRA)
D) Theophylline
Answer: B) Inhaled Corticosteroid (ICS) (✓)
17. The diagnostic test of choice for suspected pulmonary embolism is:
A) D-dimer
B) Chest X-ray
C) CT Pulmonary Angiography (CTPA)
D) V/Q Scan
Answer: C) CT Pulmonary Angiography (CTPA) (✓)
18. Which of the following is the most common cause of Community-Acquired Pneumonia
(CAP) in adults?
A) Haemophilus influenzae
B) Mycoplasma pneumoniae
C) Streptococcus pneumoniae
D) Legionella pneumophila
Answer: C) Streptococcus pneumoniae (✓)
19. The GOLD criteria classification for COPD severity is primarily based on:
A) FEV1/FVC ratio
B) Symptom burden and exacerbation history
C) Arterial Blood Gas results
D) Chest CT findings
Answer: B) Symptom burden and exacerbation history (✓)
20. A 45-year-old smoker with a 30-pack-year history presents with dyspnea and a barrel
chest. Spirometry shows FEV1/FVC < 0.70. This is diagnostic for:
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Bronchiectasis
D) Interstitial Lung Disease
Answer: B) Chronic Obstructive Pulmonary Disease (COPD) (✓)
21. The first-line treatment for an acute COPD exacerbation is:
A) Antibiotics
B) Inhaled Bronchodilators
