FAMILY MEDICINE PAEA EXAM
2025/2026 – QUESTIONS WITH CORRECT
SOLUTIONS
what is the most common cause of heart failure? specifically left sided? right sided? -
answers -MC is CAD (coronary artery disease)
-L sided: *CAD* & HTN
-R sided: *L sided HF* & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop
(filling of dilated ventricle) is associated with systolic or diastolic heart failure? - answers
systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop
(atrial contraction into a stiff ventricle) is associated with systolic or diastolic heart
failure? - answers diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure? - answers -systolic: post *MI*,
*dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t
thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the bone)
this is termed ________ heart failure - answers high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what are some causes of acute vs chronic heart failure? - answers -acute: *largely
systolic*; hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)
explain class I-IV New York Heart Association functional classes - answers -class I: *no
sx's*, *no limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary activity
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even with
minimal exertion
,-class IV: *sx's even while at rest*, severe limitations, inability to carry out physical
activity
what compensations does the body make when heart failure (can be due to something
that causes either inc pre/afterload or dec contractility) begins? - answers 1.
sympathetic nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-
productive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4,
pale skin/cool extremities, sinus tachy, fatigue - answers L-sided HF
the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V,
hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver
palpation) - answers R-sided HF
-CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion,
pulmonary edema
-echo with dec EF
-inc BNP on labs
are all signs of? - answers heart failure
*BNP released from atrium with preload too high (volume overload)
what drugs have shown to decrease mortality rates in pts with heart failure? - answers
*ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates,
spironolactone
in pts who experience the following common side effects of an ACE inhibitor to treat
heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema - answers
ARBs (-sartans)
what vasodilators are often used to treat heart failure? - answers hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
what is the most effective treatment for symptoms of heart failure? - answers diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on
these electrolytes), other s/e: hyperglycemia, hyperuricemia
,-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e:
hyperkalemia, gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia, hyperuricemia,
hyperglycemia
what medications are used to treat acute severe heart failure? - answers
*sympathomimetics* (positive inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can cause arrhythmias, seizures,
dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab
-*dobutamine*: inc contractility (B1 agonist), peripheral vasodilation
-*dopamine*: inc contractility
giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart failure? -
answers -dec RAAS activity
-inc Na+/H2O excretion
why are beta-blockers started after ACE inhibitors/diuretics in heart failure? - answers
want to decrease afterload/preload before slowing down the heart rate
at what EF do heart failure patients need to receive an implantable cardioverter
defibrillator? - answers EF <35% because they tolerate arrhythmias poorly and there is
inc mortality rate
what medication used to treat *systolic* heart failure is a selective sinus node inhibitor
that slows the sinus rate? - answers *ivabradine*: dec mortality rate in pts w/ EF ≤35%,
in sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB dose or unable to
take BB
what medication used to treat *systolic* heart failure works by increasing levels of
natriuretic peptides? - answers *sacubitril-valsartan*: decreases mortality rate in class
II-IV HF w/ reduced EF
what is the treatment for acute pulmonary edema/congestive (aka decompensated)
heart failure? - answers *LMNOP*
-*L*asix: removes fluids- improves sx's
-*M*orphine: reduces preload reducing heart strain
-*N*itrates: vasodilator to reduce pre/afterload
-*O*xygen
-*P*osition: upright to dec venous return
if severe may also need inotropic support
hypertension is defined as ____/____ blood pressures on ____ or more visits - answers
≥130/80 on 2 or more visits
, -stage 1 is 130-139/80-89
-stage 2 is ≥140/90
although primary HTN makes up 95% of cases, when should secondary HTN be
considered? what are some causes of secondary HTN? - answers -if refractory to
antihypertensives or severely elevated
-causes: *renal artery stenosis*, fibromuscular dysplasia, atherosclerosis, 1°
hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the aorta,
sleep apnea, EtOH, OCPs, COX-2 inhibitors
what are the complications of HTN? - answers -CV (CAD, HF, MI, LVH, aortic
dissection, aortic aneurysm, PVD)
-neurologic (TIA, CVA, rutured aneurysms, encephalopathy)
-nephropathy (renal stenosis & sclerosis leading to ESRD)
-optic (retinal hemorrhage, blindness, retinopathy)
thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the
nephron to increase water excretion? what are the side effects? - answers -distal
diluting tubule
-s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in gout
and DM pts)
*these are 1st line in uncomplicated HTN
loop diuretics (furosemide, bumetanide) are the strongest class of diuretics and can
cause s/e's of volume depletion, hypokalemia/natremia/calcemia,
hyperuricemia/glycemia, hypochloremic metabolic alkalosis, and ototoxicity; what are
they contraindicated in? - answers sulfa allergy
what are the DHP (dihydropyridine) and non-DHP calcium channel blockers? what are
they indicated and contraindicated in? - answers -DHP CCBs: nife*dipine*, amlo*dipine*
(potent vasodilators)
-non-DHP CCBs: verapamil, diltiazem (vasodilators but also act on heart to dec
contractility and conduction/HR) so often used in pts w/ HTN w/ concomitant Afib
-indications: HTN, angina, raynauds
-contraindications: CHF (esp non-DHPs), 2nd/3rd degree heart block
what are the cardioselective and nonselective beta blockers? - answers -cardioselection
(B1): atenolol, metoprolol, esmolol
-nonselective (B1, B2): propranolol
-a, B1, B2: labetalol, carvedilol
what are contraindications for using beta-blockers? - answers -2nd/3rd degree heart
block, decompensated heart failure
2025/2026 – QUESTIONS WITH CORRECT
SOLUTIONS
what is the most common cause of heart failure? specifically left sided? right sided? -
answers -MC is CAD (coronary artery disease)
-L sided: *CAD* & HTN
-R sided: *L sided HF* & pulmonary dz
decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop
(filling of dilated ventricle) is associated with systolic or diastolic heart failure? - answers
systolic (MC form of CHF)
*(the sound is actually heard in the diastole though)
-memory trick: "sys-to-lic" 3 consonants = S3
normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop
(atrial contraction into a stiff ventricle) is associated with systolic or diastolic heart
failure? - answers diastolic
-memory trick: "di-a-sto-lic" 4 consonants = S4
what are the causes of systolic vs diastolic heart failure? - answers -systolic: post *MI*,
*dilated cardiomyopathy*, myocarditis
-diastolic: *HTN*, *LVH*, *elderly*, valvular heart dz, hypertrophic or restrictive
cardiomyopathy, constrictive pericarditis
when the metabolic demands of the body exceed normal cardiac function (d/t
thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the bone)
this is termed ________ heart failure - answers high-output
*fairly uncommon
-low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN
what are some causes of acute vs chronic heart failure? - answers -acute: *largely
systolic*; hypertensive crisis, acute MI, papillary muscle rupture
-chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic)
explain class I-IV New York Heart Association functional classes - answers -class I: *no
sx's*, *no limitation* during ordinary physical activity
-class II: *mild sx's* (dyspnea or angina), *slight limitation* during ordinary activity
-class III: *comfortable only at rest* (sx's caused maked limitation in activity even with
minimal exertion
,-class IV: *sx's even while at rest*, severe limitations, inability to carry out physical
activity
what compensations does the body make when heart failure (can be due to something
that causes either inc pre/afterload or dec contractility) begins? - answers 1.
sympathetic nervous system activation
2. myocyte hypertrophy/remodeling
3. RAAS activation: fluid overload
the following are signs/sx's of what sided heart failure?
inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic non-
productive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4,
pale skin/cool extremities, sinus tachy, fatigue - answers L-sided HF
the following are signs/sx's of what sided heart failure?
inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V,
hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver
palpation) - answers R-sided HF
-CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion,
pulmonary edema
-echo with dec EF
-inc BNP on labs
are all signs of? - answers heart failure
*BNP released from atrium with preload too high (volume overload)
what drugs have shown to decrease mortality rates in pts with heart failure? - answers
*ACE inhibitors* (-prils), ARBs, *beta-blockers* (-lols), hydralazine + nitrates,
spironolactone
in pts who experience the following common side effects of an ACE inhibitor to treat
heart failure, what is the alternative medication?
-1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema - answers
ARBs (-sartans)
what vasodilators are often used to treat heart failure? - answers hydralazine + nitrates
-good for african americans
-safe in pregnancy
-acts to dec pre/afterload
-used if pt not able to tolerate ACEi/ARBs/BB or if more control needed
what is the most effective treatment for symptoms of heart failure? - answers diuretics
-loop diuretics (-semides) act on inc excretion of Na, Cl, K, H2O (so can go hypo on
these electrolytes), other s/e: hyperglycemia, hyperuricemia
,-K-sparing diuretics (spironolactone, eplerenone) aldosterone antagonists; s/e:
hyperkalemia, gynecomastia with spirono
-HCTZ or metolazone (thiazide like diuretic)- s/e: hyponatremia/kalemia, hyperuricemia,
hyperglycemia
what medications are used to treat acute severe heart failure? - answers
*sympathomimetics* (positive inotropes to inc contractility)
-*digoxin*: but has a narrow therapeutic index (can cause arrhythmias, seizures,
dizziness, GI upset, visual disturbances, gynecomastia); toxicity = downsloping ST
segment; antidote: Digoxin Immune Fab
-*dobutamine*: inc contractility (B1 agonist), peripheral vasodilation
-*dopamine*: inc contractility
giving a synthetic BNP, Nesiritide, works by what mechanism to treat heart failure? -
answers -dec RAAS activity
-inc Na+/H2O excretion
why are beta-blockers started after ACE inhibitors/diuretics in heart failure? - answers
want to decrease afterload/preload before slowing down the heart rate
at what EF do heart failure patients need to receive an implantable cardioverter
defibrillator? - answers EF <35% because they tolerate arrhythmias poorly and there is
inc mortality rate
what medication used to treat *systolic* heart failure is a selective sinus node inhibitor
that slows the sinus rate? - answers *ivabradine*: dec mortality rate in pts w/ EF ≤35%,
in sinus rhythm, w/ resting pulse ≥70bpm, & already maxed out on BB dose or unable to
take BB
what medication used to treat *systolic* heart failure works by increasing levels of
natriuretic peptides? - answers *sacubitril-valsartan*: decreases mortality rate in class
II-IV HF w/ reduced EF
what is the treatment for acute pulmonary edema/congestive (aka decompensated)
heart failure? - answers *LMNOP*
-*L*asix: removes fluids- improves sx's
-*M*orphine: reduces preload reducing heart strain
-*N*itrates: vasodilator to reduce pre/afterload
-*O*xygen
-*P*osition: upright to dec venous return
if severe may also need inotropic support
hypertension is defined as ____/____ blood pressures on ____ or more visits - answers
≥130/80 on 2 or more visits
, -stage 1 is 130-139/80-89
-stage 2 is ≥140/90
although primary HTN makes up 95% of cases, when should secondary HTN be
considered? what are some causes of secondary HTN? - answers -if refractory to
antihypertensives or severely elevated
-causes: *renal artery stenosis*, fibromuscular dysplasia, atherosclerosis, 1°
hyperaldosteronism, pheochromocytoma, cushing's syndrome, coarctation of the aorta,
sleep apnea, EtOH, OCPs, COX-2 inhibitors
what are the complications of HTN? - answers -CV (CAD, HF, MI, LVH, aortic
dissection, aortic aneurysm, PVD)
-neurologic (TIA, CVA, rutured aneurysms, encephalopathy)
-nephropathy (renal stenosis & sclerosis leading to ESRD)
-optic (retinal hemorrhage, blindness, retinopathy)
thiazide type diuretics (HCTZ, chlorthalidone, metolazone) act on what part of the
nephron to increase water excretion? what are the side effects? - answers -distal
diluting tubule
-s/e: hyponatremia/kalemia/calcemia, hyperuricemia/glycemia (use w/ caution in gout
and DM pts)
*these are 1st line in uncomplicated HTN
loop diuretics (furosemide, bumetanide) are the strongest class of diuretics and can
cause s/e's of volume depletion, hypokalemia/natremia/calcemia,
hyperuricemia/glycemia, hypochloremic metabolic alkalosis, and ototoxicity; what are
they contraindicated in? - answers sulfa allergy
what are the DHP (dihydropyridine) and non-DHP calcium channel blockers? what are
they indicated and contraindicated in? - answers -DHP CCBs: nife*dipine*, amlo*dipine*
(potent vasodilators)
-non-DHP CCBs: verapamil, diltiazem (vasodilators but also act on heart to dec
contractility and conduction/HR) so often used in pts w/ HTN w/ concomitant Afib
-indications: HTN, angina, raynauds
-contraindications: CHF (esp non-DHPs), 2nd/3rd degree heart block
what are the cardioselective and nonselective beta blockers? - answers -cardioselection
(B1): atenolol, metoprolol, esmolol
-nonselective (B1, B2): propranolol
-a, B1, B2: labetalol, carvedilol
what are contraindications for using beta-blockers? - answers -2nd/3rd degree heart
block, decompensated heart failure
