AAFP 2026 BOARD EXAM MASTER BANK
150 HIGH YIELD SCENARIO Q&AS +
RATIONALES [PASSED]
AAFP Family Medicine Board Examination (High-
Yield 1–50)
1. A 64-year-old male presents with a 4-month history of
progressive difficulty walking, described as a feeling of
"heavy legs," along with worsening clumsiness in both
hands when buttoning his shirt. Physical examination
reveals hyperreflexia in the lower extremities, a positive
Hoffman sign bilaterally, and an upward plantar response
on Babinski testing, combined with decreased
proprioception in the toes. What is the most appropriate
next step in the diagnostic management of this patient?
• Initiate high-dose oral prednisone for suspected acute
transverse myelitis.
• Obtain an urgent magnetic resonance imaging
(MRI) of the cervical spine to evaluate for cervical
spondylotic myelopathy.
• Order an electromyogram and nerve conduction study
(EMG/NCS) to evaluate for amyotrophic lateral sclerosis.
• Perform a lumbar puncture for cerebrospinal fluid analysis
to check for oligoclonal bands.
• Rationale: This patient presents with classic signs of
cervical myelopathy, a critical upper motor neuron
compression condition. An urgent cervical MRI is the
, gold standard diagnostic test to evaluate spinal cord
compression. Correct Answer:
2. A 72-year-old female with a history of permanent atrial
fibrillation and severe chronic kidney disease (estimated
glomerular filtration rate [eGFR] of 24 mL/min/1.73m²)
presents to the clinic for a routine follow-up. She requires
long-term anticoagulation for stroke prevention, but has a
history of poor compliance with international normalized
ratio (INR) monitoring. Which of the following is the most
appropriate anticoagulation strategy for this patient?
• Initiate enoxaparin 1 mg/kg subcutaneously every 12
hours.
• Prescribe apixaban 2.5 mg orally twice daily,
adjusted for her age and renal function.
• Initiate warfarin therapy with a target international
normalized ratio (INR) of 2.0 to 3.0.
• Prescribe dabigatran 150 mg orally twice daily.
• Rationale: Apixaban can be safely used in advanced
chronic kidney disease. Because she meets at least two
dose-reduction criteria (Age ≥ 80, body weight ≤ 60 kg,
or serum creatinine ≥ 1.5 mg/dL), the reduced dose of 2.5
mg twice daily is indicated and avoids the strict
monitoring required by warfarin, which she cannot
comply with. Correct Answer:
3. A 6-year-old male is brought to the clinic by his mother
due to a 2-day history of high fever, sore throat, and a rash
that started on his neck and spread to his trunk and
extremities. Physical examination reveals an erythematous
pharynx with tonsillar exudates, palatal petechiae, a
tongue with a prominent "strawberry" appearance, and a
diffuse, blanching prominence in the skin folds (Pastia
, lines) that feels like sandpaper. What is the first-line
antibiotic treatment of choice for this patient's condition?
• Oral Penicillin V or Amoxicillin for a total
duration of 10 days.
• A single oral dose of azithromycin 10 mg/kg followed by 5
mg/kg daily for 4 days.
• Oral cephalexin 500 mg three times daily for 7 days.
• Intravenous vancomycin 15 mg/kg every 12 hours for 5
days.
• Rationale: The patient displays classic symptoms of
scarlet fever caused by Group A Streptococcus. Oral
penicillin or amoxicillin for 10 days remains the first-line
recommendation to achieve eradication and prevent
rheumatic fever. Correct Answer:
4. A 55-year-old female with long-standing Type 2 diabetes
mellitus and hypertension presents with new-onset
laboratory findings showing a serum creatinine of 1.6
mg/dL and an elevated urinary albumin-to-creatinine
ratio (UACR) of 450 mg/g, confirming chronic kidney
disease (Stage 3a, A3). Which class of antihypertensive
medications is strongly indicated as the first-line agent to
slow the progression of her renal disease?
• An Angiotensin-Converting Enzyme (ACE)
inhibitor or Angiotensin Receptor Blocker (ARB).
• A loop diuretic such as furosemide titrated to volume
status.
• A dihydropyridine calcium channel blocker such as
amlodipine.
• A beta-blocker such as metoprolol succinate.
, • Rationale: ACE inhibitors or ARBs are drug-of-choice
therapies in patients with diabetes, hypertension, and
significant albuminuria because they reduce
intraglomerular pressure, directly slowing the
progression of diabetic nephropathy. Correct
Answer:
5. A 68-year-old male with severe chronic obstructive
pulmonary disease (COPD) presents with an acute
exacerbation characterized by increased dyspnea,
increased sputum volume, and sputum purulence. His
oxygen saturation is 89% on room air, and he is initiated
on supplemental oxygen, scheduled short-acting
bronchodilators, and systemic corticosteroids. According
to current guidelines, what is the recommended duration
of antibiotic therapy for an acute, uncomplicated COPD
exacerbation?
• A prolonged 14-day course of high-dose amoxicillin-
clavulanate.
• A short course of 5 days of an appropriate oral
antibiotic such as azithromycin or doxycycline.
• A 10-day course of an intravenous fluoroquinolone such as
levofloxacin.
• Antibiotics should be withheld until a sputum culture
identifies a specific pathogen.
• Rationale: Evidence demonstrates that short courses (5
days) of antibiotics are just as effective as longer
regimens for uncomplicated COPD exacerbations,
minimizing adverse drug effects and antibiotic
resistance. Correct Answer:
6. A 42-year-old healthy female presents with a 4-day history
of productive cough, fever, chills, and pleuritic chest pain.
150 HIGH YIELD SCENARIO Q&AS +
RATIONALES [PASSED]
AAFP Family Medicine Board Examination (High-
Yield 1–50)
1. A 64-year-old male presents with a 4-month history of
progressive difficulty walking, described as a feeling of
"heavy legs," along with worsening clumsiness in both
hands when buttoning his shirt. Physical examination
reveals hyperreflexia in the lower extremities, a positive
Hoffman sign bilaterally, and an upward plantar response
on Babinski testing, combined with decreased
proprioception in the toes. What is the most appropriate
next step in the diagnostic management of this patient?
• Initiate high-dose oral prednisone for suspected acute
transverse myelitis.
• Obtain an urgent magnetic resonance imaging
(MRI) of the cervical spine to evaluate for cervical
spondylotic myelopathy.
• Order an electromyogram and nerve conduction study
(EMG/NCS) to evaluate for amyotrophic lateral sclerosis.
• Perform a lumbar puncture for cerebrospinal fluid analysis
to check for oligoclonal bands.
• Rationale: This patient presents with classic signs of
cervical myelopathy, a critical upper motor neuron
compression condition. An urgent cervical MRI is the
, gold standard diagnostic test to evaluate spinal cord
compression. Correct Answer:
2. A 72-year-old female with a history of permanent atrial
fibrillation and severe chronic kidney disease (estimated
glomerular filtration rate [eGFR] of 24 mL/min/1.73m²)
presents to the clinic for a routine follow-up. She requires
long-term anticoagulation for stroke prevention, but has a
history of poor compliance with international normalized
ratio (INR) monitoring. Which of the following is the most
appropriate anticoagulation strategy for this patient?
• Initiate enoxaparin 1 mg/kg subcutaneously every 12
hours.
• Prescribe apixaban 2.5 mg orally twice daily,
adjusted for her age and renal function.
• Initiate warfarin therapy with a target international
normalized ratio (INR) of 2.0 to 3.0.
• Prescribe dabigatran 150 mg orally twice daily.
• Rationale: Apixaban can be safely used in advanced
chronic kidney disease. Because she meets at least two
dose-reduction criteria (Age ≥ 80, body weight ≤ 60 kg,
or serum creatinine ≥ 1.5 mg/dL), the reduced dose of 2.5
mg twice daily is indicated and avoids the strict
monitoring required by warfarin, which she cannot
comply with. Correct Answer:
3. A 6-year-old male is brought to the clinic by his mother
due to a 2-day history of high fever, sore throat, and a rash
that started on his neck and spread to his trunk and
extremities. Physical examination reveals an erythematous
pharynx with tonsillar exudates, palatal petechiae, a
tongue with a prominent "strawberry" appearance, and a
diffuse, blanching prominence in the skin folds (Pastia
, lines) that feels like sandpaper. What is the first-line
antibiotic treatment of choice for this patient's condition?
• Oral Penicillin V or Amoxicillin for a total
duration of 10 days.
• A single oral dose of azithromycin 10 mg/kg followed by 5
mg/kg daily for 4 days.
• Oral cephalexin 500 mg three times daily for 7 days.
• Intravenous vancomycin 15 mg/kg every 12 hours for 5
days.
• Rationale: The patient displays classic symptoms of
scarlet fever caused by Group A Streptococcus. Oral
penicillin or amoxicillin for 10 days remains the first-line
recommendation to achieve eradication and prevent
rheumatic fever. Correct Answer:
4. A 55-year-old female with long-standing Type 2 diabetes
mellitus and hypertension presents with new-onset
laboratory findings showing a serum creatinine of 1.6
mg/dL and an elevated urinary albumin-to-creatinine
ratio (UACR) of 450 mg/g, confirming chronic kidney
disease (Stage 3a, A3). Which class of antihypertensive
medications is strongly indicated as the first-line agent to
slow the progression of her renal disease?
• An Angiotensin-Converting Enzyme (ACE)
inhibitor or Angiotensin Receptor Blocker (ARB).
• A loop diuretic such as furosemide titrated to volume
status.
• A dihydropyridine calcium channel blocker such as
amlodipine.
• A beta-blocker such as metoprolol succinate.
, • Rationale: ACE inhibitors or ARBs are drug-of-choice
therapies in patients with diabetes, hypertension, and
significant albuminuria because they reduce
intraglomerular pressure, directly slowing the
progression of diabetic nephropathy. Correct
Answer:
5. A 68-year-old male with severe chronic obstructive
pulmonary disease (COPD) presents with an acute
exacerbation characterized by increased dyspnea,
increased sputum volume, and sputum purulence. His
oxygen saturation is 89% on room air, and he is initiated
on supplemental oxygen, scheduled short-acting
bronchodilators, and systemic corticosteroids. According
to current guidelines, what is the recommended duration
of antibiotic therapy for an acute, uncomplicated COPD
exacerbation?
• A prolonged 14-day course of high-dose amoxicillin-
clavulanate.
• A short course of 5 days of an appropriate oral
antibiotic such as azithromycin or doxycycline.
• A 10-day course of an intravenous fluoroquinolone such as
levofloxacin.
• Antibiotics should be withheld until a sputum culture
identifies a specific pathogen.
• Rationale: Evidence demonstrates that short courses (5
days) of antibiotics are just as effective as longer
regimens for uncomplicated COPD exacerbations,
minimizing adverse drug effects and antibiotic
resistance. Correct Answer:
6. A 42-year-old healthy female presents with a 4-day history
of productive cough, fever, chills, and pleuritic chest pain.
