Family Medicine ITE and Board
AAFP Exam Prep Test Bank 1 with
265 Questions and Correct Answers
with Rationales/ AAFP Family
Medicine Boards and ITE Review
Prep Test Bank
Section 1: Cardiovascular Medicine
1. A 68-year-old male with type 2 diabetes, hypertension, and obstructive sleep
apnea presents for follow-up. He does not use tobacco and drinks two alcoholic
beverages per day. He asks if his family history of atrial fibrillation increases his
own risk. Which one of the following factors would increase the risk of atrial
fibrillation in this patient?
A) Lisinopril treatment
B) Pioglitazone treatment
C) Alcohol use
D) CPAP use
E) Physical stress
Rationale: Alcohol consumption greater than one drink per day has been
associated with an increased risk of atrial fibrillation. While obesity and OSA are
, risk factors, CPAP use would not increase risk. Pioglitazone is not associated with
increased AF risk, and lisinopril is not a risk factor.
2. An 85-year-old female with diabetes mellitus, hypertension, dementia, and
peptic ulcer disease is in a skilled nursing facility for rehabilitation after hip
fracture repair. She develops confusion, shortness of breath, and diaphoresis. BP
172/98 mmHg, HR 122 bpm irregular, RR 22/min. EKG shows atrial fibrillation and
0.2 mV ST-segment elevation. Troponin is elevated. Which of the following is NOT
an absolute contraindication to fibrinolytic therapy?
A) Previous hemorrhagic stroke
B) Ischemic stroke within 3 months
C) Suspected aortic dissection
D) Active bleeding (except menstruation)
E) Age >75 years
Rationale: Age >75 is a relative, not absolute, contraindication to fibrinolytic
therapy. Absolute contraindications include: previous hemorrhagic stroke,
ischemic stroke within 3 months, suspected aortic dissection, active bleeding
(except menstruation), and BP >180/110.
3. A 55-year-old male with a 30-pack-year smoking history presents with
worsening exertional dyspnea. He reports a chronic cough with clear sputum. PFTs
show FEV1/FVC ratio of 0.65, FEV1 55% predicted. Which of the following is the
most appropriate initial pharmacotherapy?
A) Inhaled corticosteroid alone
B) Long-acting bronchodilator (LABA or LAMA)
C) Theophylline
D) Oral corticosteroids
E) Leukotriene receptor antagonist
Rationale: For GOLD Group B (more symptoms, low exacerbation risk), initial
therapy is a long-acting bronchodilator (LABA or LAMA). Inhaled corticosteroids
, alone are not recommended as first-line. ICS/LABA is for Group D (high
exacerbation risk).
4. A 62-year-old female with a history of hypertension and hyperlipidemia
presents with sudden onset of severe, tearing chest pain radiating to her back. BP
190/110 mmHg in the right arm, 140/80 mmHg in the left arm. Which of the
following is the priority diagnostic test?
A) Chest X-ray
B) CT angiography of the chest
C) Transthoracic echocardiogram
D) EKG
E) Cardiac enzymes
Rationale: This presentation with pulse and blood pressure differential is classic
for aortic dissection. CT angiography is the imaging modality of choice for
diagnosis.
5. A 45-year-old male with hypertension is on lisinopril 20 mg daily. He develops a
new dry cough. Which is the most appropriate next step?
A) Add a calcium channel blocker
B) Switch to an angiotensin receptor blocker (ARB)
C) Continue lisinopril and add a beta-blocker
D) Switch to hydrochlorothiazide
E) Add a cough suppressant
Rationale: ACE inhibitors commonly cause a dry cough due to bradykinin
accumulation. Switching to an ARB (which does not affect bradykinin) resolves the
cough while maintaining similar blood pressure control.
6. A 68-year-old male with hypertension and type 2 diabetes presents with new-
onset exertional chest pain. EKG shows normal sinus rhythm with no ST changes.
, Troponin levels are normal. Which of the following is the most appropriate next
test?
A) Exercise stress test
B) Coronary angiography
C) CT coronary angiography
D) Resting echocardiogram
E) Holter monitor
Rationale: In a patient with intermediate pretest probability of coronary artery
disease, an exercise stress test is appropriate to evaluate for ischemia. CT coronary
angiography is also acceptable. Coronary angiography is invasive and generally
reserved for high-risk patients.
7. A 75-year-old female presents with progressive dyspnea, orthopnea, and
peripheral edema. Echocardiogram reveals an ejection fraction of 35%. Which
medication has been shown to reduce mortality in heart failure with reduced
ejection fraction (HFrEF)?
A) Sacubitril/valsartan (Entresto)
B) Diltiazem
C) Digoxin
D) Hydralazine/isosorbide dinitrate alone
E) Metolazone
Rationale: Sacubitril/valsartan, an ARNI, has been shown to reduce mortality and
hospitalizations in HFrEF patients compared to enalapril. Beta-blockers, ACE
inhibitors/ARBs, and aldosterone antagonists are also foundational.
8. A 72-year-old male with a history of hypertension, hyperlipidemia, and
peripheral artery disease is started on a statin. Which LDL-C reduction would be
expected with high-intensity statin therapy?
A) 20-30%
AAFP Exam Prep Test Bank 1 with
265 Questions and Correct Answers
with Rationales/ AAFP Family
Medicine Boards and ITE Review
Prep Test Bank
Section 1: Cardiovascular Medicine
1. A 68-year-old male with type 2 diabetes, hypertension, and obstructive sleep
apnea presents for follow-up. He does not use tobacco and drinks two alcoholic
beverages per day. He asks if his family history of atrial fibrillation increases his
own risk. Which one of the following factors would increase the risk of atrial
fibrillation in this patient?
A) Lisinopril treatment
B) Pioglitazone treatment
C) Alcohol use
D) CPAP use
E) Physical stress
Rationale: Alcohol consumption greater than one drink per day has been
associated with an increased risk of atrial fibrillation. While obesity and OSA are
, risk factors, CPAP use would not increase risk. Pioglitazone is not associated with
increased AF risk, and lisinopril is not a risk factor.
2. An 85-year-old female with diabetes mellitus, hypertension, dementia, and
peptic ulcer disease is in a skilled nursing facility for rehabilitation after hip
fracture repair. She develops confusion, shortness of breath, and diaphoresis. BP
172/98 mmHg, HR 122 bpm irregular, RR 22/min. EKG shows atrial fibrillation and
0.2 mV ST-segment elevation. Troponin is elevated. Which of the following is NOT
an absolute contraindication to fibrinolytic therapy?
A) Previous hemorrhagic stroke
B) Ischemic stroke within 3 months
C) Suspected aortic dissection
D) Active bleeding (except menstruation)
E) Age >75 years
Rationale: Age >75 is a relative, not absolute, contraindication to fibrinolytic
therapy. Absolute contraindications include: previous hemorrhagic stroke,
ischemic stroke within 3 months, suspected aortic dissection, active bleeding
(except menstruation), and BP >180/110.
3. A 55-year-old male with a 30-pack-year smoking history presents with
worsening exertional dyspnea. He reports a chronic cough with clear sputum. PFTs
show FEV1/FVC ratio of 0.65, FEV1 55% predicted. Which of the following is the
most appropriate initial pharmacotherapy?
A) Inhaled corticosteroid alone
B) Long-acting bronchodilator (LABA or LAMA)
C) Theophylline
D) Oral corticosteroids
E) Leukotriene receptor antagonist
Rationale: For GOLD Group B (more symptoms, low exacerbation risk), initial
therapy is a long-acting bronchodilator (LABA or LAMA). Inhaled corticosteroids
, alone are not recommended as first-line. ICS/LABA is for Group D (high
exacerbation risk).
4. A 62-year-old female with a history of hypertension and hyperlipidemia
presents with sudden onset of severe, tearing chest pain radiating to her back. BP
190/110 mmHg in the right arm, 140/80 mmHg in the left arm. Which of the
following is the priority diagnostic test?
A) Chest X-ray
B) CT angiography of the chest
C) Transthoracic echocardiogram
D) EKG
E) Cardiac enzymes
Rationale: This presentation with pulse and blood pressure differential is classic
for aortic dissection. CT angiography is the imaging modality of choice for
diagnosis.
5. A 45-year-old male with hypertension is on lisinopril 20 mg daily. He develops a
new dry cough. Which is the most appropriate next step?
A) Add a calcium channel blocker
B) Switch to an angiotensin receptor blocker (ARB)
C) Continue lisinopril and add a beta-blocker
D) Switch to hydrochlorothiazide
E) Add a cough suppressant
Rationale: ACE inhibitors commonly cause a dry cough due to bradykinin
accumulation. Switching to an ARB (which does not affect bradykinin) resolves the
cough while maintaining similar blood pressure control.
6. A 68-year-old male with hypertension and type 2 diabetes presents with new-
onset exertional chest pain. EKG shows normal sinus rhythm with no ST changes.
, Troponin levels are normal. Which of the following is the most appropriate next
test?
A) Exercise stress test
B) Coronary angiography
C) CT coronary angiography
D) Resting echocardiogram
E) Holter monitor
Rationale: In a patient with intermediate pretest probability of coronary artery
disease, an exercise stress test is appropriate to evaluate for ischemia. CT coronary
angiography is also acceptable. Coronary angiography is invasive and generally
reserved for high-risk patients.
7. A 75-year-old female presents with progressive dyspnea, orthopnea, and
peripheral edema. Echocardiogram reveals an ejection fraction of 35%. Which
medication has been shown to reduce mortality in heart failure with reduced
ejection fraction (HFrEF)?
A) Sacubitril/valsartan (Entresto)
B) Diltiazem
C) Digoxin
D) Hydralazine/isosorbide dinitrate alone
E) Metolazone
Rationale: Sacubitril/valsartan, an ARNI, has been shown to reduce mortality and
hospitalizations in HFrEF patients compared to enalapril. Beta-blockers, ACE
inhibitors/ARBs, and aldosterone antagonists are also foundational.
8. A 72-year-old male with a history of hypertension, hyperlipidemia, and
peripheral artery disease is started on a statin. Which LDL-C reduction would be
expected with high-intensity statin therapy?
A) 20-30%
