LATEST AAFP BOARD 2026/2027 EXAM FAMILY
MEDICINE CERTIFICATION QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
Core Domains
• Acute Care and Diagnosis
• Chronic Care Management
• Emergent and Urgent Care
• Preventive Care
• Foundations of Care
Introduction
This examination assesses the family physician's clinical knowledge
across the spectrum of conditions treated in family medicine. It
evaluates competency in diagnosis, management, and preventive care
based on the ABFM blueprint. Questions include multiple-choice and
scenario-based formats designed to test clinical judgment and decision-
making. Candidates must demonstrate mastery of evidence-based
guidelines, pharmacotherapy, and patient-centered care. The exam
emphasizes real-world application and critical thinking in family
medicine practice.
Section One: Questions 1–100
1. A 54-year-old male with cervical disc disease, generalized anxiety
disorder, and opioid use disorder on maintenance therapy presents
with a 5-day history of pain and numbness in both hands and feet.
He reports increased urinary frequency and feeling less steady on
his feet. Neurologic examination shows wide-based gait, decreased
sensation in upper extremities to forearms and lower extremities to
calves, brisk Achilles reflexes with clonus, and normal strength.
What is the most likely diagnosis?
,A. Cervical myelopathy
B. Epidural abscess
C. Guillain-Barré syndrome
D. Multiple sclerosis
A. Cervical myelopathy
RATIONALE: The findings suggest cord compression. Cervical
myelopathy presents with loss of sensation in all four extremities,
hyperreflexia, gait instability, and can lead to bladder/bowel
dysfunction. Epidural abscess typically presents with localized
tenderness and fever. Guillain-Barré presents with ascending numbness
and weakness with associated loss of reflexes, not hyperreflexia .
2. An otherwise healthy 70-year-old male presents with a 6-month
history of hives recurring every week. No causative factor
identified on history and physical. What is the recommended first-
line treatment?
A. First-generation H1-antihistamine
B. Second-generation H1-antihistamine
C. Oral corticosteroid
D. Omalizumab
B. Second-generation H1-antihistamine
RATIONALE: For chronic idiopathic urticaria, second-generation
H1-antihistamines (e.g., cetirizine, loratadine) are first-line due to
efficacy and fewer side effects compared to first-generation agents .
3. A 38-year-old female at 38 weeks gestation presents with
epigastric pain, headache, and 2+ pitting edema. What is the most
appropriate management?
A. Strict bed rest at home with reexamination in 48 hours
B. Admission for bed rest and monitoring of BP, weight, and proteinuria
,C. Admission and begin hydralazine to maintain BP below 140
D. Admission, parenteral magnesium sulfate, and prompt delivery
D. Admission, parenteral magnesium sulfate, and prompt delivery
RATIONALE: This patient has severe preeclampsia at term,
indicated by epigastric pain and headache. These symptoms suggest the
process is advanced with convulsions imminent. Treatment requires
rapid control of symptoms and delivery of the infant. Magnesium sulfate
prevents seizures, and delivery is the definitive treatment .
4. What is the most common cause of hypertension in children under
6 years of age?
A. Essential hypertension
B. Renal artery stenosis
C. Renal parenchymal disease
D. Coarctation of the aorta
C. Renal parenchymal disease
RATIONALE: Renal parenchymal disease is the most common
cause of hypertension in children under 6 years of age. Essential
hypertension becomes more common in older children and adolescents.
Renal artery stenosis and coarctation of the aorta are less common
causes in this age group .
5. A 62-year-old female with stage 3 CKD (eGFR 37 mL/min/1.73
m2) has a mildly low ionized calcium level. What laboratory
finding would you expect if her hypocalcemia is secondary to
CKD?
A. Elevated PTH and elevated phosphorus
B. Elevated PTH and low phosphorus
C. Low PTH and elevated phosphorus
D. Low PTH and low phosphorus
, A. Elevated PTH and elevated phosphorus
RATIONALE: CKD-mineral and bone disorder (CKD-MBD)
occurs when phosphate is not excreted, causing PTH to increase. The
kidney produces less calcitriol, leading to hypocalcemic
hyperparathyroidism with elevated phosphorus .
6. A 2-year-old child stumbles but is caught by his mother pulling up
on his right hand. One hour later, he refuses to use his right arm
and cries when his mother tries to move it. What is the most likely
diagnosis?
A. Dislocation of the ulna
B. Subluxation of the radial head
C. Subluxation of the ulnar head
D. Anterior dislocation of the humeral head
B. Subluxation of the radial head
RATIONALE: This is nursemaid's elbow (radial head subluxation),
common in children under 5 years. It occurs when the child's hand is
suddenly jerked, forcing the elbow into extension and causing the radial
head to slip out from the annular ligament .
7. A 38-year-old female with a 6-month history of mild SOB and
intermittent wheezing during URIs has suspected asthma. PFT
shows normal FEV1/FVC ratio. What is the most appropriate next
step?
A. Consider alternative diagnosis
B. Assess bronchodilator response
C. Perform methacholine challenge
D. Prescribe inhaled corticosteroid
C. Perform methacholine challenge
RATIONALE: A normal FEV1/FVC ratio does not confirm or deny
asthma. Methacholine challenge assesses airway hyperresponsiveness,
MEDICINE CERTIFICATION QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
Core Domains
• Acute Care and Diagnosis
• Chronic Care Management
• Emergent and Urgent Care
• Preventive Care
• Foundations of Care
Introduction
This examination assesses the family physician's clinical knowledge
across the spectrum of conditions treated in family medicine. It
evaluates competency in diagnosis, management, and preventive care
based on the ABFM blueprint. Questions include multiple-choice and
scenario-based formats designed to test clinical judgment and decision-
making. Candidates must demonstrate mastery of evidence-based
guidelines, pharmacotherapy, and patient-centered care. The exam
emphasizes real-world application and critical thinking in family
medicine practice.
Section One: Questions 1–100
1. A 54-year-old male with cervical disc disease, generalized anxiety
disorder, and opioid use disorder on maintenance therapy presents
with a 5-day history of pain and numbness in both hands and feet.
He reports increased urinary frequency and feeling less steady on
his feet. Neurologic examination shows wide-based gait, decreased
sensation in upper extremities to forearms and lower extremities to
calves, brisk Achilles reflexes with clonus, and normal strength.
What is the most likely diagnosis?
,A. Cervical myelopathy
B. Epidural abscess
C. Guillain-Barré syndrome
D. Multiple sclerosis
A. Cervical myelopathy
RATIONALE: The findings suggest cord compression. Cervical
myelopathy presents with loss of sensation in all four extremities,
hyperreflexia, gait instability, and can lead to bladder/bowel
dysfunction. Epidural abscess typically presents with localized
tenderness and fever. Guillain-Barré presents with ascending numbness
and weakness with associated loss of reflexes, not hyperreflexia .
2. An otherwise healthy 70-year-old male presents with a 6-month
history of hives recurring every week. No causative factor
identified on history and physical. What is the recommended first-
line treatment?
A. First-generation H1-antihistamine
B. Second-generation H1-antihistamine
C. Oral corticosteroid
D. Omalizumab
B. Second-generation H1-antihistamine
RATIONALE: For chronic idiopathic urticaria, second-generation
H1-antihistamines (e.g., cetirizine, loratadine) are first-line due to
efficacy and fewer side effects compared to first-generation agents .
3. A 38-year-old female at 38 weeks gestation presents with
epigastric pain, headache, and 2+ pitting edema. What is the most
appropriate management?
A. Strict bed rest at home with reexamination in 48 hours
B. Admission for bed rest and monitoring of BP, weight, and proteinuria
,C. Admission and begin hydralazine to maintain BP below 140
D. Admission, parenteral magnesium sulfate, and prompt delivery
D. Admission, parenteral magnesium sulfate, and prompt delivery
RATIONALE: This patient has severe preeclampsia at term,
indicated by epigastric pain and headache. These symptoms suggest the
process is advanced with convulsions imminent. Treatment requires
rapid control of symptoms and delivery of the infant. Magnesium sulfate
prevents seizures, and delivery is the definitive treatment .
4. What is the most common cause of hypertension in children under
6 years of age?
A. Essential hypertension
B. Renal artery stenosis
C. Renal parenchymal disease
D. Coarctation of the aorta
C. Renal parenchymal disease
RATIONALE: Renal parenchymal disease is the most common
cause of hypertension in children under 6 years of age. Essential
hypertension becomes more common in older children and adolescents.
Renal artery stenosis and coarctation of the aorta are less common
causes in this age group .
5. A 62-year-old female with stage 3 CKD (eGFR 37 mL/min/1.73
m2) has a mildly low ionized calcium level. What laboratory
finding would you expect if her hypocalcemia is secondary to
CKD?
A. Elevated PTH and elevated phosphorus
B. Elevated PTH and low phosphorus
C. Low PTH and elevated phosphorus
D. Low PTH and low phosphorus
, A. Elevated PTH and elevated phosphorus
RATIONALE: CKD-mineral and bone disorder (CKD-MBD)
occurs when phosphate is not excreted, causing PTH to increase. The
kidney produces less calcitriol, leading to hypocalcemic
hyperparathyroidism with elevated phosphorus .
6. A 2-year-old child stumbles but is caught by his mother pulling up
on his right hand. One hour later, he refuses to use his right arm
and cries when his mother tries to move it. What is the most likely
diagnosis?
A. Dislocation of the ulna
B. Subluxation of the radial head
C. Subluxation of the ulnar head
D. Anterior dislocation of the humeral head
B. Subluxation of the radial head
RATIONALE: This is nursemaid's elbow (radial head subluxation),
common in children under 5 years. It occurs when the child's hand is
suddenly jerked, forcing the elbow into extension and causing the radial
head to slip out from the annular ligament .
7. A 38-year-old female with a 6-month history of mild SOB and
intermittent wheezing during URIs has suspected asthma. PFT
shows normal FEV1/FVC ratio. What is the most appropriate next
step?
A. Consider alternative diagnosis
B. Assess bronchodilator response
C. Perform methacholine challenge
D. Prescribe inhaled corticosteroid
C. Perform methacholine challenge
RATIONALE: A normal FEV1/FVC ratio does not confirm or deny
asthma. Methacholine challenge assesses airway hyperresponsiveness,
