Page 1 of 100
AAFP 2026 BOARD EXAM FAMILY MEDICINE CERTIFICATION
EXAM QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
AAFP 2026 BOARD EXAM FAMILY MEDICINE CERTIFICATION
EXAM COVERAGE
Acute outpatient diagnosis, initial management, and clinical decision-making across
common family medicine presentations.
Chronic disease management involving cardiovascular, pulmonary, endocrine, renal,
gastrointestinal, neurologic, and rheumatologic disorders.
Emergency and urgent evaluation of potentially life-threatening cardiovascular,
respiratory, neurologic, infectious, traumatic, and metabolic conditions.
Preventive care, screening, immunization, counseling, risk reduction, and health
maintenance across the lifespan.
Adult medicine including hypertension, diabetes, dyslipidemia, obesity, common
infections, and multisystem disease.
Pediatrics and adolescents including developmental assessment, immunization, common
childhood illnesses, behavioral conditions, and acute presentations.
Obstetrics and gynecology including prenatal care, contraception, abnormal uterine
bleeding, menopause, pregnancy complications, and women's preventive health.
Behavioral health including depression, anxiety, substance use disorders, psychosis,
bipolar disorder, suicide risk, and common psychiatric treatments.
Geriatric medicine, polypharmacy, cognitive impairment, falls, frailty, functional
assessment, and age-associated disease.
Foundations of family medicine including evidence-based medicine, statistics, ethics,
health equity, quality improvement, legal principles, and population health.
1. A 58-year-old man presents with crushing substernal chest pain radiating to his left arm for 45
minutes, and an ECG shows ST elevations in leads II, III, and aVF. What is the most appropriate
immediate management?
A. Administer aspirin and activate urgent reperfusion treatment
B. Schedule an outpatient stress test
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C. Begin oral proton-pump inhibitor therapy
D. Obtain a routine echocardiogram before treatment
Answer: A
Rationale: Acute ST-elevation myocardial infarction requires immediate antiplatelet therapy and
urgent reperfusion rather than outpatient evaluation.
2. Which finding in a patient with acute abdominal pain most strongly suggests a surgical
abdomen requiring urgent evaluation?
A. Mild nausea after eating
B. Diffuse abdominal tenderness without guarding
C. Involuntary guarding with rebound tenderness
D. Intermittent bloating relieved by defecation
Answer: C
Rationale: Involuntary guarding and rebound tenderness indicate peritoneal irritation and raise
concern for an acute surgical process.
3. A 67-year-old woman with atrial fibrillation develops sudden right-sided weakness and
aphasia 50 minutes before arrival. What should occur first?
A. Start aspirin without imaging
B. Obtain emergent brain imaging to evaluate for hemorrhage
C. Perform outpatient carotid ultrasonography
D. Administer a benzodiazepine
Answer: B
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Rationale: Emergent neuroimaging is required before thrombolytic therapy to exclude
intracranial hemorrhage.
4. A 34-year-old woman has dysuria, urinary frequency, and suprapubic discomfort without
fever or flank pain. Which diagnosis is most likely?
A. Acute pyelonephritis
B. Nephrolithiasis
C. Acute cystitis
D. Pelvic inflammatory disease
Answer: C
Rationale: Dysuria, frequency, and suprapubic discomfort without systemic illness are classic for
uncomplicated cystitis.
5. Which laboratory pattern is most consistent with primary hypothyroidism?
A. High TSH with low free T4
B. Low TSH with high free T4
C. Low TSH with low free T4
D. High TSH with high free T4
Answer: A
Rationale: Primary thyroid failure reduces circulating thyroid hormone, causing compensatory
elevation of TSH.
6. A 72-year-old patient with chronic kidney disease develops weakness and an ECG showing
peaked T waves. Which abnormality requires immediate treatment?
, Page 4 of 100
A. Mild hypocalcemia
B. Hyperkalemia
C. Mild hyperphosphatemia
D. Elevated creatinine
Answer: B
Rationale: Hyperkalemia with ECG changes can rapidly cause fatal cardiac arrhythmias and
requires emergency treatment.
7. A 45-year-old woman has episodic unilateral throbbing headaches associated with nausea
and photophobia. Which diagnosis best explains these symptoms?
A. Tension headache
B. Cluster headache
C. Migraine
D. Temporal arteritis
Answer: C
Rationale: Unilateral pulsatile headache with nausea and photophobia is characteristic of
migraine.
8. A patient with suspected bacterial meningitis arrives with fever, severe headache, neck
stiffness, and altered mental status. What is the priority?
A. Delay antibiotics until all cultures are finalized
B. Initiate empiric antimicrobial treatment promptly
C. Schedule outpatient lumbar puncture
D. Treat only with acetaminophen
AAFP 2026 BOARD EXAM FAMILY MEDICINE CERTIFICATION
EXAM QUESTIONS AND CORRECT VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR – JUST RELEASED
AAFP 2026 BOARD EXAM FAMILY MEDICINE CERTIFICATION
EXAM COVERAGE
Acute outpatient diagnosis, initial management, and clinical decision-making across
common family medicine presentations.
Chronic disease management involving cardiovascular, pulmonary, endocrine, renal,
gastrointestinal, neurologic, and rheumatologic disorders.
Emergency and urgent evaluation of potentially life-threatening cardiovascular,
respiratory, neurologic, infectious, traumatic, and metabolic conditions.
Preventive care, screening, immunization, counseling, risk reduction, and health
maintenance across the lifespan.
Adult medicine including hypertension, diabetes, dyslipidemia, obesity, common
infections, and multisystem disease.
Pediatrics and adolescents including developmental assessment, immunization, common
childhood illnesses, behavioral conditions, and acute presentations.
Obstetrics and gynecology including prenatal care, contraception, abnormal uterine
bleeding, menopause, pregnancy complications, and women's preventive health.
Behavioral health including depression, anxiety, substance use disorders, psychosis,
bipolar disorder, suicide risk, and common psychiatric treatments.
Geriatric medicine, polypharmacy, cognitive impairment, falls, frailty, functional
assessment, and age-associated disease.
Foundations of family medicine including evidence-based medicine, statistics, ethics,
health equity, quality improvement, legal principles, and population health.
1. A 58-year-old man presents with crushing substernal chest pain radiating to his left arm for 45
minutes, and an ECG shows ST elevations in leads II, III, and aVF. What is the most appropriate
immediate management?
A. Administer aspirin and activate urgent reperfusion treatment
B. Schedule an outpatient stress test
, Page 2 of 100
C. Begin oral proton-pump inhibitor therapy
D. Obtain a routine echocardiogram before treatment
Answer: A
Rationale: Acute ST-elevation myocardial infarction requires immediate antiplatelet therapy and
urgent reperfusion rather than outpatient evaluation.
2. Which finding in a patient with acute abdominal pain most strongly suggests a surgical
abdomen requiring urgent evaluation?
A. Mild nausea after eating
B. Diffuse abdominal tenderness without guarding
C. Involuntary guarding with rebound tenderness
D. Intermittent bloating relieved by defecation
Answer: C
Rationale: Involuntary guarding and rebound tenderness indicate peritoneal irritation and raise
concern for an acute surgical process.
3. A 67-year-old woman with atrial fibrillation develops sudden right-sided weakness and
aphasia 50 minutes before arrival. What should occur first?
A. Start aspirin without imaging
B. Obtain emergent brain imaging to evaluate for hemorrhage
C. Perform outpatient carotid ultrasonography
D. Administer a benzodiazepine
Answer: B
, Page 3 of 100
Rationale: Emergent neuroimaging is required before thrombolytic therapy to exclude
intracranial hemorrhage.
4. A 34-year-old woman has dysuria, urinary frequency, and suprapubic discomfort without
fever or flank pain. Which diagnosis is most likely?
A. Acute pyelonephritis
B. Nephrolithiasis
C. Acute cystitis
D. Pelvic inflammatory disease
Answer: C
Rationale: Dysuria, frequency, and suprapubic discomfort without systemic illness are classic for
uncomplicated cystitis.
5. Which laboratory pattern is most consistent with primary hypothyroidism?
A. High TSH with low free T4
B. Low TSH with high free T4
C. Low TSH with low free T4
D. High TSH with high free T4
Answer: A
Rationale: Primary thyroid failure reduces circulating thyroid hormone, causing compensatory
elevation of TSH.
6. A 72-year-old patient with chronic kidney disease develops weakness and an ECG showing
peaked T waves. Which abnormality requires immediate treatment?
, Page 4 of 100
A. Mild hypocalcemia
B. Hyperkalemia
C. Mild hyperphosphatemia
D. Elevated creatinine
Answer: B
Rationale: Hyperkalemia with ECG changes can rapidly cause fatal cardiac arrhythmias and
requires emergency treatment.
7. A 45-year-old woman has episodic unilateral throbbing headaches associated with nausea
and photophobia. Which diagnosis best explains these symptoms?
A. Tension headache
B. Cluster headache
C. Migraine
D. Temporal arteritis
Answer: C
Rationale: Unilateral pulsatile headache with nausea and photophobia is characteristic of
migraine.
8. A patient with suspected bacterial meningitis arrives with fever, severe headache, neck
stiffness, and altered mental status. What is the priority?
A. Delay antibiotics until all cultures are finalized
B. Initiate empiric antimicrobial treatment promptly
C. Schedule outpatient lumbar puncture
D. Treat only with acetaminophen
