FAMILY MEDICINE BOARD REVIEW | QUESTIONS AND
ANSWERS | 2026 UPDATE | RATED 100% CORRECT
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He
has no additional chronic medical problems and is otherwise asymptomatic. An
examination is significant for a blood pressure of 162/95 mm Hg but is
otherwise unremarkable.
Laboratory Findings unremarkable
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association
2017 guidelines, which one of the following would be the most appropriate
medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily Answer - ANSWER: C
This patient has hypertension and according to both JNC 8 and American
College of Cardiology/American Heart Association 2017 guidelines,
antihypertensive treatment should be initiated. For the general non-African-
American population, monotherapy with an ACE inhibitor, an angiotensin
receptor blocker, a calcium channel blocker, or a thiazide diuretic would be
appropriate for initial management. It is also appropriate to initiate
combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin receptor
blocker simultaneously. Studies have shown that blood pressure control is
,achieved faster with the initiation of combination therapy compared to
monotherapy, without an increase in morbidity. Lisinopril/hydrochlorothiazide
would be an appropriate choice in this patient. -Blockers, vasodilators, -
blockers, and potassium-sparing diuretics are not recommended as initial
choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to CDC
guidelines, who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms Answer - ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-
confirmed cases of influenza
within 72 hours in patients on the same unit. The CDC recommends
chemoprophylaxis for all asymptomatic residents of the affected unit. Any
resident exhibiting symptoms of influenza should be treated for influenza and
not given chemoprophylaxis dosing. Chemoprophylaxis is not recommended
for residents of other units unless there are two laboratory-confirmed cases in
those units. Facility staff of the affected unit can be considered for
chemoprophylaxis if they have not been vaccinated or if they had a recent
vaccination, but chemoprophylaxis is not recommended for all staff in the
entire facility.
A 24-year-old female presents with a 2-day history of mild to moderate pelvic
pain. She has had two male sex partners in the last 6 months and uses oral
contraceptives and sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate
cervical motion and uterine tenderness. Urine hCG and a urinalysis are
negative. Vaginal microscopy shows only WBCs.
,The initiation of antibiotics for treatment of pelvic inflammatory disease in this
patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography Answer - ANSWER:
A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should
be administered at the time of diagnosis and not delayed until the results of
the nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are
returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a
mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators
such as fever, leukocytosis, or an elevated C-reactive protein level may be
helpful but are neither sensitive nor specific. A positive NAAT is not required
for diagnosis and treatment because an upper tract infection may be present,
or the causative agent may not be gonorrhea or Chlamydia. PID should be
considered a polymicrobial infection. Pelvic ultrasonography may be used if
there is a concern about other pathology such as a tubo-ovarian abscess.
A 24-year-old patient wants to start the process of transitioning from female to
male. He has been working with a psychiatrist who has confirmed the diagnosis
of gender dysphoria. Which one of the following would be the best initial
treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone Answer - ANSWER: E
For patients with gender dysphoria or gender incongruence who desire
hormone treatment, the treatment goal is to suppress endogenous sex
, hormone production and maintain sex hormone levels in the normal range for
their affirmed gender. For a female-to-male transgender patient this is most
easily accomplished with testosterone. When testosterone levels are
maintained in the normal genetic male range, gonadotropins and ovarian
hormone production is suppressed, which accomplishes both goals for
hormonal treatment without the need for additional gonadotropin suppression
from medications such as leuprolide. Clomiphene can increase serum
testosterone levels, but only in the presence of a functioning testicle. Letrozole
is an estrogen receptor antagonist, but it would not increase serum
testosterone levels. Spironolactone has androgen receptor blocking effects and
would not accomplish either of the hormone treatment goals.
Based on American Cancer Society guidelines for cervical cancer screening,
when should HPV DNA co-testing first be performed along with Papanicolaou
testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35 Answer - ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening,
Papanicolaou (Pap) testing
should begin at age 21 irrespective of sexual activity and should be continued
every 3 years until age 29. The preferred screening strategy beginning at age 30
is Pap testing with HPV co-testing, which should be continued every 5 years
until age 65. Cervical screening may be discontinued at that time if the
patient's last two tests have been negative and the patient was tested within
the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
ANSWERS | 2026 UPDATE | RATED 100% CORRECT
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He
has no additional chronic medical problems and is otherwise asymptomatic. An
examination is significant for a blood pressure of 162/95 mm Hg but is
otherwise unremarkable.
Laboratory Findings unremarkable
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association
2017 guidelines, which one of the following would be the most appropriate
medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily Answer - ANSWER: C
This patient has hypertension and according to both JNC 8 and American
College of Cardiology/American Heart Association 2017 guidelines,
antihypertensive treatment should be initiated. For the general non-African-
American population, monotherapy with an ACE inhibitor, an angiotensin
receptor blocker, a calcium channel blocker, or a thiazide diuretic would be
appropriate for initial management. It is also appropriate to initiate
combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin receptor
blocker simultaneously. Studies have shown that blood pressure control is
,achieved faster with the initiation of combination therapy compared to
monotherapy, without an increase in morbidity. Lisinopril/hydrochlorothiazide
would be an appropriate choice in this patient. -Blockers, vasodilators, -
blockers, and potassium-sparing diuretics are not recommended as initial
choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to CDC
guidelines, who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms Answer - ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-
confirmed cases of influenza
within 72 hours in patients on the same unit. The CDC recommends
chemoprophylaxis for all asymptomatic residents of the affected unit. Any
resident exhibiting symptoms of influenza should be treated for influenza and
not given chemoprophylaxis dosing. Chemoprophylaxis is not recommended
for residents of other units unless there are two laboratory-confirmed cases in
those units. Facility staff of the affected unit can be considered for
chemoprophylaxis if they have not been vaccinated or if they had a recent
vaccination, but chemoprophylaxis is not recommended for all staff in the
entire facility.
A 24-year-old female presents with a 2-day history of mild to moderate pelvic
pain. She has had two male sex partners in the last 6 months and uses oral
contraceptives and sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate
cervical motion and uterine tenderness. Urine hCG and a urinalysis are
negative. Vaginal microscopy shows only WBCs.
,The initiation of antibiotics for treatment of pelvic inflammatory disease in this
patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography Answer - ANSWER:
A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should
be administered at the time of diagnosis and not delayed until the results of
the nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are
returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a
mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators
such as fever, leukocytosis, or an elevated C-reactive protein level may be
helpful but are neither sensitive nor specific. A positive NAAT is not required
for diagnosis and treatment because an upper tract infection may be present,
or the causative agent may not be gonorrhea or Chlamydia. PID should be
considered a polymicrobial infection. Pelvic ultrasonography may be used if
there is a concern about other pathology such as a tubo-ovarian abscess.
A 24-year-old patient wants to start the process of transitioning from female to
male. He has been working with a psychiatrist who has confirmed the diagnosis
of gender dysphoria. Which one of the following would be the best initial
treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone Answer - ANSWER: E
For patients with gender dysphoria or gender incongruence who desire
hormone treatment, the treatment goal is to suppress endogenous sex
, hormone production and maintain sex hormone levels in the normal range for
their affirmed gender. For a female-to-male transgender patient this is most
easily accomplished with testosterone. When testosterone levels are
maintained in the normal genetic male range, gonadotropins and ovarian
hormone production is suppressed, which accomplishes both goals for
hormonal treatment without the need for additional gonadotropin suppression
from medications such as leuprolide. Clomiphene can increase serum
testosterone levels, but only in the presence of a functioning testicle. Letrozole
is an estrogen receptor antagonist, but it would not increase serum
testosterone levels. Spironolactone has androgen receptor blocking effects and
would not accomplish either of the hormone treatment goals.
Based on American Cancer Society guidelines for cervical cancer screening,
when should HPV DNA co-testing first be performed along with Papanicolaou
testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35 Answer - ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening,
Papanicolaou (Pap) testing
should begin at age 21 irrespective of sexual activity and should be continued
every 3 years until age 29. The preferred screening strategy beginning at age 30
is Pap testing with HPV co-testing, which should be continued every 5 years
until age 65. Cervical screening may be discontinued at that time if the
patient's last two tests have been negative and the patient was tested within
the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
