1
CPJE Clinical Actual Exam 2026/2027:
Questions and Answers Graded A+ Assured
Success | Multiple Choices with Rationales –
Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR THERAPEUTICS (15 Questions)
Q1: A 58-year-old male with newly diagnosed hypertension (BP 158/96 mmHg), no diabetes,
and no CKD. According to JNC 8 and ACC/AHA guidelines, which is the most appropriate first-
line antihypertensive therapy?
A. Aliskiren (direct renin inhibitor) monotherapy
B. Thiazide diuretic, ACE inhibitor, ARB, or CCB [CORRECT]
C. Beta-blocker monotherapy
D. Alpha-blocker monotherapy
Correct Answer: B
Rationale: First-line options for uncomplicated hypertension include thiazide diuretics
(chlorthalidone, HCTZ), ACE inhibitors, ARBs, or dihydropyridine CCBs. Option A is not first-
line due to poor efficacy and safety profile. Option C (beta-blockers) are not first-line for
uncomplicated HTN per JNC 8. Option D (alpha-blockers) are reserved for resistant
hypertension or BPH. Choice depends on patient comorbidities and race (thiazides/CCBs
preferred in Black patients).
Q2: A 65-year-old with HFrEF (EF 35%) is on lisinopril 20mg daily and furosemide 40mg daily.
Which medication should be added next to reduce mortality per GDMT?
A. Diltiazem for rate control
B. Carvedilol (evidence-based beta-blocker) [CORRECT]
C. Verapamil for afterload reduction
D. Discontinue ACE inhibitor due to cough
Correct Answer: B
Rationale: GDMT for HFrEF includes ACE inhibitor/ARB/ARNI, evidence-based beta-blocker
(carvedilol, metoprolol succinate, or bisoprolol), MRA, and SGLT2 inhibitor. Options A and C
(non-DHP CCBs) are contraindicated in HFrEF due to negative inotropy. Option D is
,2
inappropriate—ACE inhibitors reduce mortality; ARNI (sacubitril/valsartan) is alternative if
cough occurs. Beta-blockers reduce mortality and reverse remodeling.
Q3: A patient with ASCVD (prior MI) has LDL 110 mg/dL on atorvastatin 20mg. According to
2018 AHA/ACC guidelines, the next step is:
A. Add ezetimibe to achieve LDL <70 mg/dL (very high risk) [CORRECT]
B. Switch to low-intensity statin
C. Discontinue statin due to adequate LDL
D. Add fenofibrate monotherapy
Correct Answer: A
Rationale: Very high-risk ASCVD patients benefit from LDL <70 mg/dL; add ezetimibe if not at
goal on maximally tolerated statin. Option B is incorrect—intensity should be increased, not
decreased. Option C is dangerous—LDL 110 is above goal. Option D (fibrates) don't reduce CV
events like statins/ezetimibe. PCSK9 inhibitor is third-line option.
Q4: A 72-year-old with atrial fibrillation has CHA₂DS₂-VASc score of 4 (hypertension, age 72,
female). The recommended stroke prevention is:
A. Aspirin 81mg daily
B. Warfarin or DOAC (apixaban, rivaroxaban, dabigatran, edoxaban) [CORRECT]
C. Clopidogrel monotherapy
D. No anticoagulation needed
Correct Answer: B
Rationale: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) indicates anticoagulation benefit outweighs
bleeding risk. Option A (aspirin) has minimal stroke prevention in AF and significant bleeding
risk. Option C is insufficient. Option D is incorrect—score of 4 indicates high stroke risk
(~4%/year). DOACs preferred over warfarin (unless mechanical valve or moderate-severe mitral
stenosis).
Q5: A patient on warfarin (INR 2.5) presents with major bleeding (GI hemorrhage). The
appropriate reversal agent is:
A. Vitamin K alone
B. 4-factor prothrombin complex concentrate (4F-PCC) plus vitamin K [CORRECT]
C. Fresh frozen plasma alone
D. Wait for warfarin to wear off
, 3
Correct Answer: B
Rationale: Major bleeding on warfarin requires rapid reversal: 4F-PCC (contains II, VII, IX, X)
plus IV vitamin K for sustained reversal. Option A is too slow. Option C is less effective and
higher volume. Option D is dangerous in major bleeding. INR should be checked post-reversal.
Q6: [Clinical Scenario] A 55-year-old with NSTEMI is on aspirin, clopidogrel, and heparin
infusion. The cardiologist asks about adding a GP IIb/IIIa inhibitor. Which patient factor would
contraindicate this?
A. History of PCI 2 years ago
B. Active bleeding or recent hemorrhagic stroke [CORRECT]
C. Diabetes mellitus
D. Prior aspirin use
Correct Answer: B
Rationale: GP IIb/IIIa inhibitors (eclizumab, tirofiban) increase bleeding risk; contraindicated
with active bleeding, recent stroke, or surgery. Option A is not a contraindication. Option C is
actually an indication (higher risk). Option D is irrelevant. These agents are used less frequently
with contemporary DAPT and rapid PCI.
Q7: A patient with chronic stable angina remains symptomatic on metoprolol succinate 100mg
daily. The next appropriate antianginal to add is:
A. Increase metoprolol to 200mg (maximum dose)
B. Add amlodipine (dihydropyridine CCB) [CORRECT]
C. Add verapamil (non-DHP CCB)
D. Discontinue beta-blocker
Correct Answer: B
Rationale: Beta-blockers and dihydropyridine CCBs (amlodipine) are effective combination for
angina without negative inotropic interaction. Option A may be limited by bradycardia. Option C
(non-DHP CCB) with beta-blocker risks bradycardia/heart block. Option D removes first-line
therapy. Ranolazine is alternative if CCB contraindicated.
Q8: A patient with DVT is started on apixaban. The correct dosing for the first 7 days is:
A. 2.5mg twice daily
B. 10mg twice daily [CORRECT]
C. 5mg once daily
CPJE Clinical Actual Exam 2026/2027:
Questions and Answers Graded A+ Assured
Success | Multiple Choices with Rationales –
Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR THERAPEUTICS (15 Questions)
Q1: A 58-year-old male with newly diagnosed hypertension (BP 158/96 mmHg), no diabetes,
and no CKD. According to JNC 8 and ACC/AHA guidelines, which is the most appropriate first-
line antihypertensive therapy?
A. Aliskiren (direct renin inhibitor) monotherapy
B. Thiazide diuretic, ACE inhibitor, ARB, or CCB [CORRECT]
C. Beta-blocker monotherapy
D. Alpha-blocker monotherapy
Correct Answer: B
Rationale: First-line options for uncomplicated hypertension include thiazide diuretics
(chlorthalidone, HCTZ), ACE inhibitors, ARBs, or dihydropyridine CCBs. Option A is not first-
line due to poor efficacy and safety profile. Option C (beta-blockers) are not first-line for
uncomplicated HTN per JNC 8. Option D (alpha-blockers) are reserved for resistant
hypertension or BPH. Choice depends on patient comorbidities and race (thiazides/CCBs
preferred in Black patients).
Q2: A 65-year-old with HFrEF (EF 35%) is on lisinopril 20mg daily and furosemide 40mg daily.
Which medication should be added next to reduce mortality per GDMT?
A. Diltiazem for rate control
B. Carvedilol (evidence-based beta-blocker) [CORRECT]
C. Verapamil for afterload reduction
D. Discontinue ACE inhibitor due to cough
Correct Answer: B
Rationale: GDMT for HFrEF includes ACE inhibitor/ARB/ARNI, evidence-based beta-blocker
(carvedilol, metoprolol succinate, or bisoprolol), MRA, and SGLT2 inhibitor. Options A and C
(non-DHP CCBs) are contraindicated in HFrEF due to negative inotropy. Option D is
,2
inappropriate—ACE inhibitors reduce mortality; ARNI (sacubitril/valsartan) is alternative if
cough occurs. Beta-blockers reduce mortality and reverse remodeling.
Q3: A patient with ASCVD (prior MI) has LDL 110 mg/dL on atorvastatin 20mg. According to
2018 AHA/ACC guidelines, the next step is:
A. Add ezetimibe to achieve LDL <70 mg/dL (very high risk) [CORRECT]
B. Switch to low-intensity statin
C. Discontinue statin due to adequate LDL
D. Add fenofibrate monotherapy
Correct Answer: A
Rationale: Very high-risk ASCVD patients benefit from LDL <70 mg/dL; add ezetimibe if not at
goal on maximally tolerated statin. Option B is incorrect—intensity should be increased, not
decreased. Option C is dangerous—LDL 110 is above goal. Option D (fibrates) don't reduce CV
events like statins/ezetimibe. PCSK9 inhibitor is third-line option.
Q4: A 72-year-old with atrial fibrillation has CHA₂DS₂-VASc score of 4 (hypertension, age 72,
female). The recommended stroke prevention is:
A. Aspirin 81mg daily
B. Warfarin or DOAC (apixaban, rivaroxaban, dabigatran, edoxaban) [CORRECT]
C. Clopidogrel monotherapy
D. No anticoagulation needed
Correct Answer: B
Rationale: CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) indicates anticoagulation benefit outweighs
bleeding risk. Option A (aspirin) has minimal stroke prevention in AF and significant bleeding
risk. Option C is insufficient. Option D is incorrect—score of 4 indicates high stroke risk
(~4%/year). DOACs preferred over warfarin (unless mechanical valve or moderate-severe mitral
stenosis).
Q5: A patient on warfarin (INR 2.5) presents with major bleeding (GI hemorrhage). The
appropriate reversal agent is:
A. Vitamin K alone
B. 4-factor prothrombin complex concentrate (4F-PCC) plus vitamin K [CORRECT]
C. Fresh frozen plasma alone
D. Wait for warfarin to wear off
, 3
Correct Answer: B
Rationale: Major bleeding on warfarin requires rapid reversal: 4F-PCC (contains II, VII, IX, X)
plus IV vitamin K for sustained reversal. Option A is too slow. Option C is less effective and
higher volume. Option D is dangerous in major bleeding. INR should be checked post-reversal.
Q6: [Clinical Scenario] A 55-year-old with NSTEMI is on aspirin, clopidogrel, and heparin
infusion. The cardiologist asks about adding a GP IIb/IIIa inhibitor. Which patient factor would
contraindicate this?
A. History of PCI 2 years ago
B. Active bleeding or recent hemorrhagic stroke [CORRECT]
C. Diabetes mellitus
D. Prior aspirin use
Correct Answer: B
Rationale: GP IIb/IIIa inhibitors (eclizumab, tirofiban) increase bleeding risk; contraindicated
with active bleeding, recent stroke, or surgery. Option A is not a contraindication. Option C is
actually an indication (higher risk). Option D is irrelevant. These agents are used less frequently
with contemporary DAPT and rapid PCI.
Q7: A patient with chronic stable angina remains symptomatic on metoprolol succinate 100mg
daily. The next appropriate antianginal to add is:
A. Increase metoprolol to 200mg (maximum dose)
B. Add amlodipine (dihydropyridine CCB) [CORRECT]
C. Add verapamil (non-DHP CCB)
D. Discontinue beta-blocker
Correct Answer: B
Rationale: Beta-blockers and dihydropyridine CCBs (amlodipine) are effective combination for
angina without negative inotropic interaction. Option A may be limited by bradycardia. Option C
(non-DHP CCB) with beta-blocker risks bradycardia/heart block. Option D removes first-line
therapy. Ranolazine is alternative if CCB contraindicated.
Q8: A patient with DVT is started on apixaban. The correct dosing for the first 7 days is:
A. 2.5mg twice daily
B. 10mg twice daily [CORRECT]
C. 5mg once daily
