Page 1 of 92
PRIMARY CARE FINAL EXAM
V|90Qs&As|GRADED A+|SOUTH
UNIVERSITY
Q1. A 55-year-old African American male with no other
comorbidities has a BP of 148/92 mmHg on two separate visits.
According to the 2017 ACC/AHA guideline, what is the most
appropriate initial treatment?
a) Lifestyle modifications alone for 6 months
b) Hydrochlorothiazide 12.5 mg daily
c) Amlodipine 5 mg daily plus lifestyle modifications
d) Lisinopril 10 mg daily
Correct Answer: c) Amlodipine 5 mg daily plus lifestyle
modifications
*Rationale: For stage 1 hypertension (130-139/80-89) with
ASCVD risk <10%, lifestyle only. For stage 2 hypertension
,Page 2 of 92
(≥140/90), pharmacotherapy is recommended. In African
Americans, initial monotherapy with CCB (amlodipine) or thiazide
is preferred over ACE inhibitors due to lower renin levels.
Lifestyle changes are always adjunct.*
Q2. A 68-year-old woman with DM type 2 and CKD stage 3
(eGFR 45) has BP 142/88 on lisinopril 20 mg daily. Which
addition is most appropriate?
a) Hydrochlorothiazide
b) Amlodipine
c) Spironolactone
d) Metoprolol
Correct Answer: b) Amlodipine
*Rationale: For diabetic CKD patients, ACEi/ARB is first-line. If
BP remains elevated, add a CCB (amlodipine) or thiazide. HCTZ
is less effective when eGFR <45. Spironolactone risks
,Page 3 of 92
hyperkalemia with ACEi. Beta-blockers are not first-line for
uncomplicated hypertension.*
Q3. A 70-year-old with hypertension and heart failure with
reduced ejection fraction (HFrEF) is on lisinopril, carvedilol, and
furosemide. BP is 110/70. Which medication should be added to
improve mortality?
a) Hydralazine
b) Spironolactone
c) Amlodipine
d) Clonidine
Correct Answer: b) Spironolactone
Rationale: In HFrEF, aldosterone antagonists (spironolactone,
eplerenone) reduce mortality when added to ACEi/ARB and beta-
blocker, provided potassium and renal function are acceptable.
Hydralazine/nitrates are used in African Americans with persistent
symptoms.
, Page 4 of 92
Q4. A 62-year-old with hypertension and gout is started on
HCTZ. One month later, he presents with acute painful swelling of
the first MTP joint. What is the most likely cause?
a) Septic arthritis
b) Pseudogout
c) Thiazide-induced hyperuricemia and gout flare
d) Trauma
Correct Answer: c) Thiazide-induced hyperuricemia and gout
flare
Rationale: Thiazide diuretics reduce uric acid excretion,
precipitating gout in predisposed individuals. Alternative
antihypertensives (ARB, CCB, losartan which lowers urate) should
be considered.
Q5. A 45-year-old with BP 150/95 has an LDL of 190 mg/dL.
What is the next step?
a) Start atorvastatin 20 mg and lifestyle modification
PRIMARY CARE FINAL EXAM
V|90Qs&As|GRADED A+|SOUTH
UNIVERSITY
Q1. A 55-year-old African American male with no other
comorbidities has a BP of 148/92 mmHg on two separate visits.
According to the 2017 ACC/AHA guideline, what is the most
appropriate initial treatment?
a) Lifestyle modifications alone for 6 months
b) Hydrochlorothiazide 12.5 mg daily
c) Amlodipine 5 mg daily plus lifestyle modifications
d) Lisinopril 10 mg daily
Correct Answer: c) Amlodipine 5 mg daily plus lifestyle
modifications
*Rationale: For stage 1 hypertension (130-139/80-89) with
ASCVD risk <10%, lifestyle only. For stage 2 hypertension
,Page 2 of 92
(≥140/90), pharmacotherapy is recommended. In African
Americans, initial monotherapy with CCB (amlodipine) or thiazide
is preferred over ACE inhibitors due to lower renin levels.
Lifestyle changes are always adjunct.*
Q2. A 68-year-old woman with DM type 2 and CKD stage 3
(eGFR 45) has BP 142/88 on lisinopril 20 mg daily. Which
addition is most appropriate?
a) Hydrochlorothiazide
b) Amlodipine
c) Spironolactone
d) Metoprolol
Correct Answer: b) Amlodipine
*Rationale: For diabetic CKD patients, ACEi/ARB is first-line. If
BP remains elevated, add a CCB (amlodipine) or thiazide. HCTZ
is less effective when eGFR <45. Spironolactone risks
,Page 3 of 92
hyperkalemia with ACEi. Beta-blockers are not first-line for
uncomplicated hypertension.*
Q3. A 70-year-old with hypertension and heart failure with
reduced ejection fraction (HFrEF) is on lisinopril, carvedilol, and
furosemide. BP is 110/70. Which medication should be added to
improve mortality?
a) Hydralazine
b) Spironolactone
c) Amlodipine
d) Clonidine
Correct Answer: b) Spironolactone
Rationale: In HFrEF, aldosterone antagonists (spironolactone,
eplerenone) reduce mortality when added to ACEi/ARB and beta-
blocker, provided potassium and renal function are acceptable.
Hydralazine/nitrates are used in African Americans with persistent
symptoms.
, Page 4 of 92
Q4. A 62-year-old with hypertension and gout is started on
HCTZ. One month later, he presents with acute painful swelling of
the first MTP joint. What is the most likely cause?
a) Septic arthritis
b) Pseudogout
c) Thiazide-induced hyperuricemia and gout flare
d) Trauma
Correct Answer: c) Thiazide-induced hyperuricemia and gout
flare
Rationale: Thiazide diuretics reduce uric acid excretion,
precipitating gout in predisposed individuals. Alternative
antihypertensives (ARB, CCB, losartan which lowers urate) should
be considered.
Q5. A 45-year-old with BP 150/95 has an LDL of 190 mg/dL.
What is the next step?
a) Start atorvastatin 20 mg and lifestyle modification
