AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
A 70yo M with h/o HTN and DM presents with a 2-mo h/o Pioglitzaone
increasing paroxysmal nocturnal dyspnea and SOB with
minimal exertion. An echocardiogram shows an ejection thiazolidinediones (TZDs) are associated with fluid retention, and their use can be
fraction of 25%. Which one of the patients current complicated by the development of heart failure. Caution is necessary when
medications should be discontinued? prescribing TZDs in patients with known heart failure or other heart diseases, those
A. Lisinopril (Zestril) with preexisting edema, and those on concurrent insulin therapy
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL)
What is the most common cause of hypertension in Renal Parenchymal Disease
children under 6 years of age?
The most common cause of hypertension is renal parenchymal disease, and a
urinalysis, urine culture, and renal ultrasonography should be ordered for all
children presenting with hypertension.
A 72-year-old African-American male with New York Heart Refer for cardiac resynchronization therapy (CRT)
Association Class III heart failure sees you for follow-up.
He has shortness of breath with minimal exertion. The Note: he's already on maximum doses of ACEI, loop diuretic, beta-blocker
patient is adherent to his medication regimen. His current
medications include lisinopril (Prinivil, Zestril), 40 mg twice Using a pacemaker-like device, CRT aims to get both ventricles contracting
daily; carvedilol (Coreg), 25 mg twice daily; and simultaneously, overcoming the delayed contraction of the left ventricle caused by
furosemide (Lasix), 80 mg daily. His blood pressure is the left bundle-branch block. These guidelines were refined by an April 2005 AHA
100/60 mm Hg, and his pulse rate is 68 beats/min and Science Advisory, which stated that optimal candidates for CRT have a dilated
regular. Findings include a few scattered bibasilar rales on cardiomyopathy on an ischemic or nonischemic basis, an LVEF ≤0.35, a QRS
examination of the lungs, an S3 gallop on examination of complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV
the heart, and no edema on examination of the legs. An despite maximal medical therapy for heart failure.
EKG reveals a left bundle branch block, and
echocardiography reveals an ejection fraction of 25%, but
no other abnormalities. What's the appropriate next step?
What dietary change recommended for the prevention and increase intake of omega 3 fatty acids
treatment of cardiovascular disease has been shown to
decrease the rate of sudden death? Omega-3 fats contribute to the production of eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA), which inhibit the inflammatory immune response and
platelet aggregation, are mild vasodilators, and may have antiarrhythmic properties.
The American Heart Association guidelines state that omega-3 supplements may be
recommended to patients with preexisting disease, a high risk of disease, or high
triglyceride levels, as well as to patients who do not like or are allergic to fish. The
Italian GISSI study found that the use of 850 mg of EPA and DHA daily resulted in
decreased rates of mortality, nonfatal myocardial infarction, and stroke, with
particular decreases in the rate of sudden death.
A 75-year-old male presents to the emergency department Dx: aortic dissection
with a several-hour history of back pain in the interscapular next step: Intravenous labetalol (Normodyne, Trandate)
region. His medical history includes a previous myocardial
infarction (MI) several years ago, a history of cigarette Initial management should reduce the systolic blood pressure to 100-120 mm Hg or
smoking until the time of the MI, and hypertension that is to the lowest level tolerated. The use of a β-blocker such as propranolol or labetalol
well controlled with hydrochlorothiazide and lisinopril to get the heart rate below 60 beats/min should be first-line therapy. If the systolic
(Prinivil, Zestril). The patient appears anxious, but all blood pressure remains over 100 mm Hg, intravenous nitroprusside should be
pulses are intact. His blood pressure is 170/110 mm Hg added. Without prior beta-blocade, vasodilation from the nitroprusside will induce
and his pulse rate is 110 beats/min. An EKG shows reflex activation of the sympathetic nervous system, causing increased ventricular
evidence of an old inferior wall MI but no acute changes. A contraction and increased shear stress on the aorta.
chest radiograph shows a widened mediastinum and a
normal aortic arch, and CT of the chest shows a dissecting
aneurysm of the descending aorta that is distal to the
proximal abdominal aorta but does not involve the renal
arteries. Which one of the following would be the most
appropriate next step in the management of this patient?
According to the U.S. Preventive Services Task Force, The guideline recommends one-time screening with ultrasonography for AAA in
what are the screening recommendations for an abdominal men 65-75 years of age who have ever smoked. No recommendation was made for
aortic aneurysm? or against screening women. Men with a strong family history of AAA should be
counseled about the risks and benefits of screening as they approach 65 years of
age.
, AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
A 36-year-old white female presents to the emergency verapamil (Calan)
department with palpitations. Her pulse rate is 180
beats/min. An EKG reveals a regular tachycardia with a If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the
narrow complex QRS and no apparent P waves. The tachycardia can usually be terminated by the administration of intravenous
patient fails to respond to carotid massage or to two doses verapamil or a β-blocker. If that fails, intravenous propafenone or flecainide may be
of intravenous adenosine (Adenocard), 6 mg and 12 mg. necessary. It is also important to look for and treat possible contributing causes
The most appropriate next step would be to administer such as hypovolemia, hypoxia, or electrolyte disturbances. Electrical cardioversion
intravenous may be necessary if these measures fail to terminate the tachyarrhythmia.
The blood pressure goal for a patient who has BP goal: 130/80mmHg
uncomplicated diabetes mellitus is
Aggressive control of blood pressure to <135/85 mm Hg in hypertensive patients
and to <130/80 mm Hg in diabetic patients is recommended. Lowering blood
pressure may reduce stroke rates by 40%-52% and cardiovascular morbidity by
18%-20%
A 60-year-old African-American female has a history of Diltiazem (Cardizem)
hypertension that has been well controlled with
hydrochlorothiazide. However, she has developed an Monotherapy for hypertension in African-American patients is more likely to consist
allergy to the medication. Successful monotherapy for her of diuretics or calcium channel blockers than β-blockers or ACE inhibitors. It has
hypertension would be most likely with which one of the been suggested that hypertension in African-Americans is not as angiotensin II-
following? dependent as it appears to be in Caucasians.
A. Lisinopril (Prinivil, Zestril)
B. Hydralazine (Apresoline)
C. Clonidine (Catapres)
D. Atenolol (Tenormin)
E. Diltiazem (Cardizem)
An asymptomatic 3-year-old male presents for a routine Still's murmur
check-up. On examination you notice a systolic heart
murmur. It is heard best in the lower precordium and has a There are several benign murmurs of childhood that have no association with
low, short tone similar to a plucked string or kazoo. It does physiologic or anatomic abnormalities. Of these, Still's murmur best fits the murmur
not radiate to the axillae or the back and seems to described. The cause of Still's murmur is unknown, but it may be due to vibrations
decrease with inspiration. The remainder of the in the chordae tendinae, semilunar valves, or ventricular wall.
examination is normal. What is the most likely diagnosis?
A 57-year-old male with severe renal disease presents with Enoxaparin
acute coronary syndrome. Which one of the following
would most likely require a significant dosage adjustment Enoxaparin is eliminated mostly by the kidneys. When it is used in patients with
from the standard protocol? severe renal impairment the dosage must be significantly reduced. For some
A. Enoxaparin (Lovenox) indications the dose normally given every 12 hours is given only every 24 hours.
B. Metoprolol (Lopressor, Toprol) Although some β-blockers require a dosage adjustment, metoprolol and carvedilol
C. Carvedilol (Coreg) are metabolized by the liver and do not require dosage adjustment in patients with
D. Clopidogrel (Plavix) renal failure. Clopidogrel is currently recommended at the standard dosage for
E. Tissue plasminogen activator (tPA) patients with renal failure and acute coronary syndrome. Thrombolytics like tPA are
given at the standard dosage in renal failure, although hemorrhagic complications
are increased.
A 55-year-old male who has a long history of marginally- 2-dimensional echocardiography with Doppler
controlled hypertension presents with gradually increasing
shortness of breath and reduced exercise tolerance. His The most useful diagnostic tool for evaluating patients with heart failure is two-
physical examination is normal except for a blood pressure dimensional echocardiography with Doppler to assess left ventricular ejection
of 140/90 mm Hg, bilateral basilar rales, and trace pitting fraction (LVEF), left ventricular size, ventricular compliance, wall thickness, and
edema. What study would be the preferred diagnostic tool valve function. The test should be performed during the initial evaluation.
for evaluating this patient? Radionuclide ventriculography can be used to assess LVEF and volumes, and MRI
or CT also may provide information in selected patients. Chest radiography
(posteroanterior and lateral) and 12-lead electrocardiography should be performed
in all patients presenting with heart failure, but should not be used as the primary
basis for determining which abnormalities are responsible for the heart failure.
A 23-year-old female sees you with a complaint of EKG
intermittent irregular heartbeats that occur once every
week or two, but do not cause her to feel lightheaded or The symptom of an increased or abnormal sensation of one's heartbeat is referred
fatigued. They last only a few seconds and resolve to as palpitations. This condition is common to primary care, but is often benign.
spontaneously. She has never passed out, had chest pain, Commonly, these sensations have their basis in anxiety or panic. However, about
or had difficulty with exertion. She is otherwise healthy, 50% of those who complain of palpitations will be found to have a diagnosable
and a physical examination is normal. What cardiac study cardiac condition. It is recommended to start the evaluation for cardiac causes with
should be ordered initially? an EKG, which will assess the baseline rhythm and screen for signs of chamber
enlargement, previous myocardial infarction, conduction disturbances, and a
prolonged QT interval.
, AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
What is most appropriate for the initial treatment of regular exercise
claudication?
Claudication is exercise-induced lower-extremity pain that is caused by ischemia
and relieved by rest. It affects 10% of persons over 70 years of age. However, up to
90% of patients with peripheral vascular disease are asymptomatic. Initial treatment
should consist of vigorous risk factor modification and exercise. Patients who follow
an exercise regimen can increase their walking time by 150%. A supervised
program may produce better results. Risk factors include diabetes mellitus,
hypertension, smoking, and hyperlipidemia.
In a patient who presents with symptoms of acute New-onset left bundle branch block
myocardial infarction, which one of the following would be
an indication for thrombolytic therapy? In patients with ischemic chest pain, the EKG is important for determining the need
A. New-onset ST-segment depression for fibrinolytic therapy. Myocardial infarction is diagnosed by ST elevation ≥1 mm in
B. New-onset left bundle branch block two or more limb leads and ≥2 mm in two or more contiguous precordial leads. In a
C. New-onset first degree atrioventricular block patient with an MI, new left bundle branch block suggests occlusion of the left
D. New-onset Wenckebach second degree heart block anterior descending artery, placing a significant portion of the left ventricle in
E. Frequent unifocal ventricular ectopic beats jeopardy. Thrombolytic therapy could be harmful in patients with ischemia but not
infarction - they will show ST-segment depression only. Frequent unifocal ventricular
ectopy may warrant antiarrhythmic therapy, but not thrombolytic therapy.
A 68-year-old female has an average blood pressure of HCTZ
150/70 mm Hg despite appropriate lifestyle modification
efforts. Her only other medical problems are osteoporosis Randomized, placebo-controlled trials have shown that isolated systolic
and mild depression. The most appropriate treatment at hypertension in the elderly responds best to diuretics and to a lesser extent, β-
this time would be blockers. Diuretics are preferred, although long-acting dihydropyridine calcium
channel blockers may also be used. In the case described, β-blockers or clonidine
A. lisinopril (Prinivil, Zestril) may worsen the depression. Thiazide diuretics may also improve osteoporosis, and
B. clonidine (Catapres) would be the most cost-effective and useful agent in this instance.
C. propranolol (Inderal)
D. amlodipine (Norvasc)
E. hydrochlorothiazide
A 56-year-old white male presents with a 2-week history of Ankle-brachial index (ABI)
intermittent pain in his left leg. The pain usually occurs
while he is walking and is primarily in the calf muscle or The ankle-brachial index (ABI) is an inexpensive, sensitive screening tool and is the
Achilles region. Sometimes he will awaken at night with most appropriate first test for peripheral vascular occlusive disease (PVOD) in this
cramps in the affected leg. He has no known risk factors patient. The ABI is the ratio of systolic blood pressure measured in the ankle to
for atherosclerosis. What would be the best initial test for systolic pressure using the standard brachial measurement. A ratio of 0.9-1.2 is
peripheral vascular occlusive disease? considered normal. Severe disease is defined as a ratio <0.50. More invasive and
expensive testing using Doppler ultrasonography, arteriography, or magnetic
resonance angiography may be useful if the ABI suggests an abnormality. Venous
ultrasonography would not detect PVOD, but it could rule out deep venous
thrombosis, which is another common etiology for calf pain.
A 69-year-old male has a 4-day history of swelling in his 3 months
left leg. He has no history of trauma, recent surgery,
prolonged immobilization, weight loss, or malaise. His For patients with a first episode of unprovoked deep venous thrombosis, evidence
examination is unremarkable except for a diffusely swollen supports treatment with a vitamin K antagonist for at least 3 months (SOR A). The
left leg. A CBC, chemistry profile, prostate-specific antigen American College of Chest Physicians recommends that patients be evaluated at
level, chest radiograph, and EKG are all normal; however, that point for the potential risks and benefits of long-term therapy
compression ultrasonography of the extremity reveals a
clot in the proximal femoral vein. He has no past history of
venous thromboembolic disease. In addition to initiating
therapy with low molecular weight heparin, the American
College of Chest Physicians recommends that warfarin
(Coumadin) be instituted now and continued for how long?
You see a 23-year-old gravida 1 para 0 for her prenatal next step: Admitting the patient to the hospital, treating with parenteral magnesium
checkup at 38 weeks gestation. She complains of severe sulfate, and planning prompt delivery either vaginally or by cesarean section
headaches and epigastric pain. She has had an uneventful
pregnancy to date and had a normal prenatal examination This patient manifests a rapid onset of preeclampsia at term. The symptoms of
2 weeks ago. Her blood pressure is 140/100 mm Hg. A epigastric pain and headache categorize her preeclampsia as severe. These
urinalysis shows 2+ protein; she has gained 5 lb in the last symptoms indicate that the process is well advanced and that convulsions are
week, and has 2+ pitting edema of her legs. The most imminent. Treatment should focus on rapid control of symptoms and delivery of the
appropriate management at this point would be: infant.
, AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
A 67-year-old Hispanic male comes to your office with Celiac and mesenteric arteriography
severe periumbilical abdominal pain, vomiting, and
diarrhea which began suddenly several hours ago. His The sudden onset of severe abdominal pain, vomiting, and diarrhea in a patient with
temperature is 37.0 degrees C (98.6 degrees F), blood a cardiac source of emboli and evidence of a separate embolic event makes
pressure 110/76 mm Hg, and respirations 28/min. His superior mesenteric artery embolization likely. In this case, evidence of a brachial
abdomen is slightly distended, soft, and diffusely tender; artery embolus and a cardiac rhythm indicating atrial fibrillation suggest the
bowel sounds are normal. Other findings include clear diagnosis. Some patients may have a surprisingly normal abdominal examination in
lungs, a rapid and irregularly irregular heartbeat, and a spite of severe pain. Microscopic hematuria and blood in the stool may both occur
pale left forearm and hand with no palpable left brachial with embolization. Severe leukocytosis is present in more than two-thirds of patients
pulse. Right arm and lower extremity pulses are normal. with this problem. Diagnostic confirmation by angiography is recommended.
Urine and stool are both positive for blood on chemical Immediate embolectomy with removal of the propagated clot can then be
testing. His hemoglobin level is 16.4 g/dL (N 13.0-18.0) accomplished and a decision made regarding whether or not the intestine should be
and his WBC count is 25,300/mm3 (N 4300-10,800). The resected. A second procedure may be scheduled to reevaluate intestinal viability.
diagnostic imaging procedure most likely to produce a
specific diagnosis of his abdominal pain is:
A. Intravenous pyelography (IVP)
B. Sonography of the abdominal aorta
C. A barium enema
D. Celiac and mesenteric arteriography
E. Contrast venography
A 49-year-old white female comes to your office Nifedipine (Procardia)
complaining of painful, cold finger tips which turn white
when she is hanging out her laundry. While there is no At present there is no approved treatment for Raynaud's disease. However, patients
approved treatment for this condition at this time, what with this disorder reportedly experience subjective symptomatic improvement with
drug has been shown to be useful? calcium channel antagonists. Nifedipine is the calcium channel blocker of choice in
patients with Raynaud's disease. Beta-blockers can produce arterial insufficiency of
the Raynaud type, so propranolol and atenolol would be contraindicated. Drugs
such as ergotamine preparations and methysergide can produce cold sensitivity,
and should therefore be avoided in patients with Raynaud's disease.
You perform a health maintenance examination on a 2- Referral to a pediatric cardiologist
year-old white male. He is asymptomatic and is meeting all
developmental milestones. The only significant finding is a Children who have a murmur that is diastolic or is greater than 2/6 should be
grade 3/6 diastolic murmur heard at the right upper sternal referred for cardiovascular evaluation, perhaps after an echocardiogram is obtained.
border. Which one of the following would be most Other reasons for referral include cardiac symptoms, abnormal splitting of S2, a
appropriate at this time? murmur that increases on standing, a holosystolic murmur, or ejection clicks.
Digoxin is not indicated at this point in this asymptomatic patient.
For long-term therapy, the most effective control of heart Beta-adrenergic blockers
rate in atrial fibrillation, both at rest and with exercise,
occurs with which class of drugs? For long-term therapy, beta-adrenergic antagonist drugs provide the most effective
control of heart rate in atrial fibrillation, both at rest and during exercise. Although
calcium channel blockers also lower heart rate both at rest and with exercise, they
are not as effective as beta-blockers. Digitalis is primarily effective in controlling the
heart rate at rest, and often does not adequately control heart rate with exercise.
The Class 1 antiarrhythmics are most useful in maintaining sinus rhythm and, in
fact, may paradoxically increase heart rate.
A 75-year-old white female develops deep-vein thrombosis don't need to monitor lovenox with labs, just warfarin!
of the left leg 1 week after hip surgery. The patient is
started on low-molecular-weight heparin (Lovenox). Daily Routine coagulation tests such as prothrombin time and partial thromboplastin time
monitoring while the patient is on low-molecular-weight are insensitive measurements of Lovenox activity. Anti-factor Xa can be measured
heparin should include which lab tests? in patients with renal failure to monitor anticoagulation effects.
Elevated levels of _________ are associated with homocysteine
atherosclerosis?
Multiple prospective and case-control studies have shown that a moderately
elevated plasma homocysteine concentration is an independent risk factor for
atherothrombotic vascular disease.
A 60-year-old African-American male was recently <100 mg/dL
diagnosed with an abdominal aortic aneurysm. A lipid
profile performed a few months ago revealed an LDL level Most physicians realize that the goal LDL level for patients with diabetes mellitus or
of 125 mg/dL. You would now advise him that his goal LDL coronary artery disease is <100 mg/dL. Many may not realize that this goal extends
level is: to people with CAD-equivalent diseases, including peripheral artery disease,
symptomatic carotid artery disease, and abdominal aortic aneurysm.
A 70yo M with h/o HTN and DM presents with a 2-mo h/o Pioglitzaone
increasing paroxysmal nocturnal dyspnea and SOB with
minimal exertion. An echocardiogram shows an ejection thiazolidinediones (TZDs) are associated with fluid retention, and their use can be
fraction of 25%. Which one of the patients current complicated by the development of heart failure. Caution is necessary when
medications should be discontinued? prescribing TZDs in patients with known heart failure or other heart diseases, those
A. Lisinopril (Zestril) with preexisting edema, and those on concurrent insulin therapy
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL)
What is the most common cause of hypertension in Renal Parenchymal Disease
children under 6 years of age?
The most common cause of hypertension is renal parenchymal disease, and a
urinalysis, urine culture, and renal ultrasonography should be ordered for all
children presenting with hypertension.
A 72-year-old African-American male with New York Heart Refer for cardiac resynchronization therapy (CRT)
Association Class III heart failure sees you for follow-up.
He has shortness of breath with minimal exertion. The Note: he's already on maximum doses of ACEI, loop diuretic, beta-blocker
patient is adherent to his medication regimen. His current
medications include lisinopril (Prinivil, Zestril), 40 mg twice Using a pacemaker-like device, CRT aims to get both ventricles contracting
daily; carvedilol (Coreg), 25 mg twice daily; and simultaneously, overcoming the delayed contraction of the left ventricle caused by
furosemide (Lasix), 80 mg daily. His blood pressure is the left bundle-branch block. These guidelines were refined by an April 2005 AHA
100/60 mm Hg, and his pulse rate is 68 beats/min and Science Advisory, which stated that optimal candidates for CRT have a dilated
regular. Findings include a few scattered bibasilar rales on cardiomyopathy on an ischemic or nonischemic basis, an LVEF ≤0.35, a QRS
examination of the lungs, an S3 gallop on examination of complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV
the heart, and no edema on examination of the legs. An despite maximal medical therapy for heart failure.
EKG reveals a left bundle branch block, and
echocardiography reveals an ejection fraction of 25%, but
no other abnormalities. What's the appropriate next step?
What dietary change recommended for the prevention and increase intake of omega 3 fatty acids
treatment of cardiovascular disease has been shown to
decrease the rate of sudden death? Omega-3 fats contribute to the production of eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA), which inhibit the inflammatory immune response and
platelet aggregation, are mild vasodilators, and may have antiarrhythmic properties.
The American Heart Association guidelines state that omega-3 supplements may be
recommended to patients with preexisting disease, a high risk of disease, or high
triglyceride levels, as well as to patients who do not like or are allergic to fish. The
Italian GISSI study found that the use of 850 mg of EPA and DHA daily resulted in
decreased rates of mortality, nonfatal myocardial infarction, and stroke, with
particular decreases in the rate of sudden death.
A 75-year-old male presents to the emergency department Dx: aortic dissection
with a several-hour history of back pain in the interscapular next step: Intravenous labetalol (Normodyne, Trandate)
region. His medical history includes a previous myocardial
infarction (MI) several years ago, a history of cigarette Initial management should reduce the systolic blood pressure to 100-120 mm Hg or
smoking until the time of the MI, and hypertension that is to the lowest level tolerated. The use of a β-blocker such as propranolol or labetalol
well controlled with hydrochlorothiazide and lisinopril to get the heart rate below 60 beats/min should be first-line therapy. If the systolic
(Prinivil, Zestril). The patient appears anxious, but all blood pressure remains over 100 mm Hg, intravenous nitroprusside should be
pulses are intact. His blood pressure is 170/110 mm Hg added. Without prior beta-blocade, vasodilation from the nitroprusside will induce
and his pulse rate is 110 beats/min. An EKG shows reflex activation of the sympathetic nervous system, causing increased ventricular
evidence of an old inferior wall MI but no acute changes. A contraction and increased shear stress on the aorta.
chest radiograph shows a widened mediastinum and a
normal aortic arch, and CT of the chest shows a dissecting
aneurysm of the descending aorta that is distal to the
proximal abdominal aorta but does not involve the renal
arteries. Which one of the following would be the most
appropriate next step in the management of this patient?
According to the U.S. Preventive Services Task Force, The guideline recommends one-time screening with ultrasonography for AAA in
what are the screening recommendations for an abdominal men 65-75 years of age who have ever smoked. No recommendation was made for
aortic aneurysm? or against screening women. Men with a strong family history of AAA should be
counseled about the risks and benefits of screening as they approach 65 years of
age.
, AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
A 36-year-old white female presents to the emergency verapamil (Calan)
department with palpitations. Her pulse rate is 180
beats/min. An EKG reveals a regular tachycardia with a If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the
narrow complex QRS and no apparent P waves. The tachycardia can usually be terminated by the administration of intravenous
patient fails to respond to carotid massage or to two doses verapamil or a β-blocker. If that fails, intravenous propafenone or flecainide may be
of intravenous adenosine (Adenocard), 6 mg and 12 mg. necessary. It is also important to look for and treat possible contributing causes
The most appropriate next step would be to administer such as hypovolemia, hypoxia, or electrolyte disturbances. Electrical cardioversion
intravenous may be necessary if these measures fail to terminate the tachyarrhythmia.
The blood pressure goal for a patient who has BP goal: 130/80mmHg
uncomplicated diabetes mellitus is
Aggressive control of blood pressure to <135/85 mm Hg in hypertensive patients
and to <130/80 mm Hg in diabetic patients is recommended. Lowering blood
pressure may reduce stroke rates by 40%-52% and cardiovascular morbidity by
18%-20%
A 60-year-old African-American female has a history of Diltiazem (Cardizem)
hypertension that has been well controlled with
hydrochlorothiazide. However, she has developed an Monotherapy for hypertension in African-American patients is more likely to consist
allergy to the medication. Successful monotherapy for her of diuretics or calcium channel blockers than β-blockers or ACE inhibitors. It has
hypertension would be most likely with which one of the been suggested that hypertension in African-Americans is not as angiotensin II-
following? dependent as it appears to be in Caucasians.
A. Lisinopril (Prinivil, Zestril)
B. Hydralazine (Apresoline)
C. Clonidine (Catapres)
D. Atenolol (Tenormin)
E. Diltiazem (Cardizem)
An asymptomatic 3-year-old male presents for a routine Still's murmur
check-up. On examination you notice a systolic heart
murmur. It is heard best in the lower precordium and has a There are several benign murmurs of childhood that have no association with
low, short tone similar to a plucked string or kazoo. It does physiologic or anatomic abnormalities. Of these, Still's murmur best fits the murmur
not radiate to the axillae or the back and seems to described. The cause of Still's murmur is unknown, but it may be due to vibrations
decrease with inspiration. The remainder of the in the chordae tendinae, semilunar valves, or ventricular wall.
examination is normal. What is the most likely diagnosis?
A 57-year-old male with severe renal disease presents with Enoxaparin
acute coronary syndrome. Which one of the following
would most likely require a significant dosage adjustment Enoxaparin is eliminated mostly by the kidneys. When it is used in patients with
from the standard protocol? severe renal impairment the dosage must be significantly reduced. For some
A. Enoxaparin (Lovenox) indications the dose normally given every 12 hours is given only every 24 hours.
B. Metoprolol (Lopressor, Toprol) Although some β-blockers require a dosage adjustment, metoprolol and carvedilol
C. Carvedilol (Coreg) are metabolized by the liver and do not require dosage adjustment in patients with
D. Clopidogrel (Plavix) renal failure. Clopidogrel is currently recommended at the standard dosage for
E. Tissue plasminogen activator (tPA) patients with renal failure and acute coronary syndrome. Thrombolytics like tPA are
given at the standard dosage in renal failure, although hemorrhagic complications
are increased.
A 55-year-old male who has a long history of marginally- 2-dimensional echocardiography with Doppler
controlled hypertension presents with gradually increasing
shortness of breath and reduced exercise tolerance. His The most useful diagnostic tool for evaluating patients with heart failure is two-
physical examination is normal except for a blood pressure dimensional echocardiography with Doppler to assess left ventricular ejection
of 140/90 mm Hg, bilateral basilar rales, and trace pitting fraction (LVEF), left ventricular size, ventricular compliance, wall thickness, and
edema. What study would be the preferred diagnostic tool valve function. The test should be performed during the initial evaluation.
for evaluating this patient? Radionuclide ventriculography can be used to assess LVEF and volumes, and MRI
or CT also may provide information in selected patients. Chest radiography
(posteroanterior and lateral) and 12-lead electrocardiography should be performed
in all patients presenting with heart failure, but should not be used as the primary
basis for determining which abnormalities are responsible for the heart failure.
A 23-year-old female sees you with a complaint of EKG
intermittent irregular heartbeats that occur once every
week or two, but do not cause her to feel lightheaded or The symptom of an increased or abnormal sensation of one's heartbeat is referred
fatigued. They last only a few seconds and resolve to as palpitations. This condition is common to primary care, but is often benign.
spontaneously. She has never passed out, had chest pain, Commonly, these sensations have their basis in anxiety or panic. However, about
or had difficulty with exertion. She is otherwise healthy, 50% of those who complain of palpitations will be found to have a diagnosable
and a physical examination is normal. What cardiac study cardiac condition. It is recommended to start the evaluation for cardiac causes with
should be ordered initially? an EKG, which will assess the baseline rhythm and screen for signs of chamber
enlargement, previous myocardial infarction, conduction disturbances, and a
prolonged QT interval.
, AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
What is most appropriate for the initial treatment of regular exercise
claudication?
Claudication is exercise-induced lower-extremity pain that is caused by ischemia
and relieved by rest. It affects 10% of persons over 70 years of age. However, up to
90% of patients with peripheral vascular disease are asymptomatic. Initial treatment
should consist of vigorous risk factor modification and exercise. Patients who follow
an exercise regimen can increase their walking time by 150%. A supervised
program may produce better results. Risk factors include diabetes mellitus,
hypertension, smoking, and hyperlipidemia.
In a patient who presents with symptoms of acute New-onset left bundle branch block
myocardial infarction, which one of the following would be
an indication for thrombolytic therapy? In patients with ischemic chest pain, the EKG is important for determining the need
A. New-onset ST-segment depression for fibrinolytic therapy. Myocardial infarction is diagnosed by ST elevation ≥1 mm in
B. New-onset left bundle branch block two or more limb leads and ≥2 mm in two or more contiguous precordial leads. In a
C. New-onset first degree atrioventricular block patient with an MI, new left bundle branch block suggests occlusion of the left
D. New-onset Wenckebach second degree heart block anterior descending artery, placing a significant portion of the left ventricle in
E. Frequent unifocal ventricular ectopic beats jeopardy. Thrombolytic therapy could be harmful in patients with ischemia but not
infarction - they will show ST-segment depression only. Frequent unifocal ventricular
ectopy may warrant antiarrhythmic therapy, but not thrombolytic therapy.
A 68-year-old female has an average blood pressure of HCTZ
150/70 mm Hg despite appropriate lifestyle modification
efforts. Her only other medical problems are osteoporosis Randomized, placebo-controlled trials have shown that isolated systolic
and mild depression. The most appropriate treatment at hypertension in the elderly responds best to diuretics and to a lesser extent, β-
this time would be blockers. Diuretics are preferred, although long-acting dihydropyridine calcium
channel blockers may also be used. In the case described, β-blockers or clonidine
A. lisinopril (Prinivil, Zestril) may worsen the depression. Thiazide diuretics may also improve osteoporosis, and
B. clonidine (Catapres) would be the most cost-effective and useful agent in this instance.
C. propranolol (Inderal)
D. amlodipine (Norvasc)
E. hydrochlorothiazide
A 56-year-old white male presents with a 2-week history of Ankle-brachial index (ABI)
intermittent pain in his left leg. The pain usually occurs
while he is walking and is primarily in the calf muscle or The ankle-brachial index (ABI) is an inexpensive, sensitive screening tool and is the
Achilles region. Sometimes he will awaken at night with most appropriate first test for peripheral vascular occlusive disease (PVOD) in this
cramps in the affected leg. He has no known risk factors patient. The ABI is the ratio of systolic blood pressure measured in the ankle to
for atherosclerosis. What would be the best initial test for systolic pressure using the standard brachial measurement. A ratio of 0.9-1.2 is
peripheral vascular occlusive disease? considered normal. Severe disease is defined as a ratio <0.50. More invasive and
expensive testing using Doppler ultrasonography, arteriography, or magnetic
resonance angiography may be useful if the ABI suggests an abnormality. Venous
ultrasonography would not detect PVOD, but it could rule out deep venous
thrombosis, which is another common etiology for calf pain.
A 69-year-old male has a 4-day history of swelling in his 3 months
left leg. He has no history of trauma, recent surgery,
prolonged immobilization, weight loss, or malaise. His For patients with a first episode of unprovoked deep venous thrombosis, evidence
examination is unremarkable except for a diffusely swollen supports treatment with a vitamin K antagonist for at least 3 months (SOR A). The
left leg. A CBC, chemistry profile, prostate-specific antigen American College of Chest Physicians recommends that patients be evaluated at
level, chest radiograph, and EKG are all normal; however, that point for the potential risks and benefits of long-term therapy
compression ultrasonography of the extremity reveals a
clot in the proximal femoral vein. He has no past history of
venous thromboembolic disease. In addition to initiating
therapy with low molecular weight heparin, the American
College of Chest Physicians recommends that warfarin
(Coumadin) be instituted now and continued for how long?
You see a 23-year-old gravida 1 para 0 for her prenatal next step: Admitting the patient to the hospital, treating with parenteral magnesium
checkup at 38 weeks gestation. She complains of severe sulfate, and planning prompt delivery either vaginally or by cesarean section
headaches and epigastric pain. She has had an uneventful
pregnancy to date and had a normal prenatal examination This patient manifests a rapid onset of preeclampsia at term. The symptoms of
2 weeks ago. Her blood pressure is 140/100 mm Hg. A epigastric pain and headache categorize her preeclampsia as severe. These
urinalysis shows 2+ protein; she has gained 5 lb in the last symptoms indicate that the process is well advanced and that convulsions are
week, and has 2+ pitting edema of her legs. The most imminent. Treatment should focus on rapid control of symptoms and delivery of the
appropriate management at this point would be: infant.
, AAFP Family Medicine Board Questions and Answers 2026/2027 Exam Prep
A 67-year-old Hispanic male comes to your office with Celiac and mesenteric arteriography
severe periumbilical abdominal pain, vomiting, and
diarrhea which began suddenly several hours ago. His The sudden onset of severe abdominal pain, vomiting, and diarrhea in a patient with
temperature is 37.0 degrees C (98.6 degrees F), blood a cardiac source of emboli and evidence of a separate embolic event makes
pressure 110/76 mm Hg, and respirations 28/min. His superior mesenteric artery embolization likely. In this case, evidence of a brachial
abdomen is slightly distended, soft, and diffusely tender; artery embolus and a cardiac rhythm indicating atrial fibrillation suggest the
bowel sounds are normal. Other findings include clear diagnosis. Some patients may have a surprisingly normal abdominal examination in
lungs, a rapid and irregularly irregular heartbeat, and a spite of severe pain. Microscopic hematuria and blood in the stool may both occur
pale left forearm and hand with no palpable left brachial with embolization. Severe leukocytosis is present in more than two-thirds of patients
pulse. Right arm and lower extremity pulses are normal. with this problem. Diagnostic confirmation by angiography is recommended.
Urine and stool are both positive for blood on chemical Immediate embolectomy with removal of the propagated clot can then be
testing. His hemoglobin level is 16.4 g/dL (N 13.0-18.0) accomplished and a decision made regarding whether or not the intestine should be
and his WBC count is 25,300/mm3 (N 4300-10,800). The resected. A second procedure may be scheduled to reevaluate intestinal viability.
diagnostic imaging procedure most likely to produce a
specific diagnosis of his abdominal pain is:
A. Intravenous pyelography (IVP)
B. Sonography of the abdominal aorta
C. A barium enema
D. Celiac and mesenteric arteriography
E. Contrast venography
A 49-year-old white female comes to your office Nifedipine (Procardia)
complaining of painful, cold finger tips which turn white
when she is hanging out her laundry. While there is no At present there is no approved treatment for Raynaud's disease. However, patients
approved treatment for this condition at this time, what with this disorder reportedly experience subjective symptomatic improvement with
drug has been shown to be useful? calcium channel antagonists. Nifedipine is the calcium channel blocker of choice in
patients with Raynaud's disease. Beta-blockers can produce arterial insufficiency of
the Raynaud type, so propranolol and atenolol would be contraindicated. Drugs
such as ergotamine preparations and methysergide can produce cold sensitivity,
and should therefore be avoided in patients with Raynaud's disease.
You perform a health maintenance examination on a 2- Referral to a pediatric cardiologist
year-old white male. He is asymptomatic and is meeting all
developmental milestones. The only significant finding is a Children who have a murmur that is diastolic or is greater than 2/6 should be
grade 3/6 diastolic murmur heard at the right upper sternal referred for cardiovascular evaluation, perhaps after an echocardiogram is obtained.
border. Which one of the following would be most Other reasons for referral include cardiac symptoms, abnormal splitting of S2, a
appropriate at this time? murmur that increases on standing, a holosystolic murmur, or ejection clicks.
Digoxin is not indicated at this point in this asymptomatic patient.
For long-term therapy, the most effective control of heart Beta-adrenergic blockers
rate in atrial fibrillation, both at rest and with exercise,
occurs with which class of drugs? For long-term therapy, beta-adrenergic antagonist drugs provide the most effective
control of heart rate in atrial fibrillation, both at rest and during exercise. Although
calcium channel blockers also lower heart rate both at rest and with exercise, they
are not as effective as beta-blockers. Digitalis is primarily effective in controlling the
heart rate at rest, and often does not adequately control heart rate with exercise.
The Class 1 antiarrhythmics are most useful in maintaining sinus rhythm and, in
fact, may paradoxically increase heart rate.
A 75-year-old white female develops deep-vein thrombosis don't need to monitor lovenox with labs, just warfarin!
of the left leg 1 week after hip surgery. The patient is
started on low-molecular-weight heparin (Lovenox). Daily Routine coagulation tests such as prothrombin time and partial thromboplastin time
monitoring while the patient is on low-molecular-weight are insensitive measurements of Lovenox activity. Anti-factor Xa can be measured
heparin should include which lab tests? in patients with renal failure to monitor anticoagulation effects.
Elevated levels of _________ are associated with homocysteine
atherosclerosis?
Multiple prospective and case-control studies have shown that a moderately
elevated plasma homocysteine concentration is an independent risk factor for
atherothrombotic vascular disease.
A 60-year-old African-American male was recently <100 mg/dL
diagnosed with an abdominal aortic aneurysm. A lipid
profile performed a few months ago revealed an LDL level Most physicians realize that the goal LDL level for patients with diabetes mellitus or
of 125 mg/dL. You would now advise him that his goal LDL coronary artery disease is <100 mg/dL. Many may not realize that this goal extends
level is: to people with CAD-equivalent diseases, including peripheral artery disease,
symptomatic carotid artery disease, and abdominal aortic aneurysm.
