FAAFP – Fellow of the American Academy of Family
Physicians | Comprehensive Study Guide, Practice
Exam, Questions & Answers, Exam Prep Test Bank,
Family Medicine, Preventive Care, Chronic Disease
Management, Primary Care, Clinical Decision-
Making, Evidence-Based Practice, Patient Safety,
Detailed Rationales, Complete Review
Question 1: A 65-year-old male with a 40-pack-year smoking history presents
with a new onset of dyspnea on exertion and a non-productive cough.
Pulmonary function testing reveals a reduced FEV1 and a decreased
FEV1/FVC ratio. Which of the following is the most appropriate next step in
confirming the diagnosis of COPD?
A. High-resolution computed tomography (HRCT) of the chest
B. Bronchodilator reversibility testing
C. Arterial blood gas analysis
D. Diffusing capacity of the lungs for carbon monoxide (DLCO)
CORRECT ANSWER: B. Bronchodilator reversibility testing
Rationale:The diagnosis of COPD is confirmed by spirometry showing airflow
obstruction that is not fully reversible. A post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. While HRCT, ABG, and
DLCO can provide additional information, bronchodilator reversibility testing is the
immediate standard diagnostic step to confirm the diagnosis and assess the fixed nature
of the obstruction.
Question 2: A 45-year-old woman presents with fatigue, weight gain, and cold
intolerance. Laboratory studies show an elevated TSH and a low free T4. She is
started on levothyroxine. After 6 weeks of therapy, she returns with persistent
symptoms. Which of the following is the most common reason for treatment
failure in this scenario?
A. Non-adherence to medication
B. Concurrent use of calcium supplements
C. Incorrect dosing based on weight
D. Presence of anti-thyroid antibodies
CORRECT ANSWER: A. Non-adherence to medication
Rationale:Non-adherence is the most common cause of persistently elevated TSH in
patients on levothyroxine therapy. While factors like concurrent medications (calcium,
iron), malabsorption, and incorrect dosing can also cause treatment failure, they are less
common than simple non-adherence to the daily medication regimen.
Question 3: A 55-year-old male with a history of hypertension and type 2
diabetes presents for a routine follow-up. His blood pressure is 138/86 mm Hg,
and his estimated glomerular filtration rate (eGFR) is 52 mL/min/1.73m². His
,current medications include lisinopril and metformin. Which of the following
is the most appropriate addition to his antihypertensive regimen to achieve the
recommended blood pressure target?
A. Amlodipine
B. Hydrochlorothiazide
C. Carvedilol
D. Clonidine
CORRECT ANSWER: A. Amlodipine
Rationale:For patients with hypertension and chronic kidney disease (CKD), the
recommended blood pressure target is <130/80 mm Hg. The patient is already on an
ACE inhibitor (lisinopril). Adding a dihydropyridine calcium channel blocker (CCB) like
amlodipine is the preferred next step in a two-drug regimen for patients with CKD due
to its efficacy and renal protective effects.
Question 4: A 28-year-old woman presents with a chief complaint of
"spinning" dizziness that began suddenly this morning. The episodes are brief,
lasting less than a minute, and are triggered by turning her head to the left
while lying down. She has no hearing loss or tinnitus. The Dix-Hallpike
maneuver elicits nystagmus and vertigo. Which of the following is the most
appropriate initial management?
A. Prescribe meclizine for symptom control
B. Order a head CT to rule out stroke
C. Perform the Epley maneuver
D. Refer to ENT for a surgical evaluation
CORRECT ANSWER: C. Perform the Epley maneuver
Rationale:The patient's presentation is classic for benign paroxysmal positional vertigo
(BPPV). The Dix-Hallpike test is the diagnostic maneuver. The Epley maneuver (canalith
repositioning procedure) is the first-line treatment for posterior canal BPPV and is highly
effective in resolving symptoms. Meclizine may be used for more persistent symptoms,
but the Epley maneuver addresses the underlying cause.
Question 5: A 72-year-old male with a history of coronary artery disease and
heart failure with reduced ejection fraction (HFrEF) presents with increasing
dyspnea and bilateral leg edema. His blood pressure is 110/70 mm Hg, heart
rate is 68 bpm, and oxygen saturation is 92% on room air. He is currently on
lisinopril, carvedilol, and furosemide. Which of the following medications, if
initiated, has been shown to provide the most significant mortality benefit in
this patient's condition?
A. Spironolactone
B. Digoxin
C. Sacubitril/valsartan
D. Hydralazine/isosorbide dinitrate
,CORRECT ANSWER: C. Sacubitril/valsartan
Rationale:Sacubitril/valsartan (an ARNI) has been shown to reduce cardiovascular
death and heart failure hospitalization more effectively than enalapril in patients with
HFrEF. It is now a cornerstone of therapy and is preferred over an ACE inhibitor or ARB.
While spironolactone also provides a mortality benefit, the question specifies the most
significant benefit, which is associated with sacubitril/valsartan.
Question 6: A 34-year-old G2P1 woman at 28 weeks gestation presents with a
3-day history of headache, blurred vision, and epigastric pain. Her blood
pressure is 155/98 mm Hg, and she has 2+ proteinuria on a urine dipstick.
Which of the following is the most appropriate initial management for this
patient's condition?
A. Administer magnesium sulfate
B. Initiate labetalol for blood pressure control
C. Administer betamethasone for fetal lung maturity
D. Perform an emergency cesarean section
CORRECT ANSWER: A. Administer magnesium sulfate
Rationale:This patient is presenting with preeclampsia with severe features (headache,
visual changes, epigastric pain, severe hypertension, and proteinuria). The most
important initial step is to prevent eclampsia by administering magnesium sulfate. While
blood pressure control (labetalol) and corticosteroid administration are also important,
magnesium sulfate is the priority to prevent seizures and is a medical emergency.
Question 7: A 6-month-old infant is brought to the clinic for a well-child visit.
The mother reports that the infant has been irritable and has been drooling
excessively. On examination, you notice white, adherent plaques on the buccal
mucosa that cannot be wiped away. The infant is afebrile and feeding well.
Which of the following is the most appropriate treatment?
A. Nystatin oral suspension
B. Oral acyclovir
C. Amoxicillin
D. Observation with reassurance
CORRECT ANSWER: A. Nystatin oral suspension
Rationale:The presentation is classic for oral candidiasis (thrush) in an infant. Nystatin
oral suspension is the first-line treatment. It is applied topically to the affected areas
several times a day. The infant is otherwise healthy, so systemic antifungals are not
typically required.
Question 8: A 60-year-old female presents with a 6-week history of pain and
stiffness in her shoulders, neck, and hips. The stiffness is worse in the morning
and lasts for over an hour. She also reports a low-grade fever, malaise, and a 5-
, lb weight loss. Her erythrocyte sedimentation rate (ESR) is 95 mm/hr. Which
of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Polymyalgia rheumatica
C. Osteoarthritis
D. Fibromyalgia
CORRECT ANSWER: B. Polymyalgia rheumatica
Rationale:Polymyalgia rheumatica (PMR) classically presents in older adults with
bilateral aching and morning stiffness in the shoulder and hip girdles. The stiffness lasts
>45 minutes. The presence of a markedly elevated ESR and systemic symptoms further
supports the diagnosis. Rheumatoid arthritis typically affects smaller joints,
osteoarthritis does not cause such significant morning stiffness or systemic symptoms,
and fibromyalgia is characterized by widespread pain without elevated inflammatory
markers.
Question 9: A 45-year-old male with a history of alcohol use disorder presents
with jaundice, ascites, and confusion. Laboratory studies reveal an elevated
INR, low albumin, and a platelet count of 80,000/µL. Which of the following is
the most appropriate initial treatment for his ascites?
A. Large-volume paracentesis
B. Initiation of spironolactone
C. Restriction of dietary sodium
D. Administration of intravenous albumin
CORRECT ANSWER: C. Restriction of dietary sodium
Rationale:The patient has decompensated cirrhosis with ascites. The first-line
treatment for ascites is sodium restriction (often < 2000 mg/day) and diuretics
(spironolactone +/- furosemide). While paracentesis may be needed for diagnostic
purposes or for tense, refractory ascites, dietary sodium restriction is a fundamental
initial step in management.
Question 10: A 22-year-old college student presents with a 2-day history of
fever, sore throat, and fatigue. On examination, he has pharyngeal erythema,
tonsillar exudates, and tender anterior cervical lymphadenopathy. A rapid
strep test is positive. Which of the following is the recommended antibiotic
regimen?
A. Penicillin VK for 10 days
B. Azithromycin for 5 days
C. Amoxicillin for 10 days
D. Cephalexin for 7 days
CORRECT ANSWER: A. Penicillin VK for 10 days
Physicians | Comprehensive Study Guide, Practice
Exam, Questions & Answers, Exam Prep Test Bank,
Family Medicine, Preventive Care, Chronic Disease
Management, Primary Care, Clinical Decision-
Making, Evidence-Based Practice, Patient Safety,
Detailed Rationales, Complete Review
Question 1: A 65-year-old male with a 40-pack-year smoking history presents
with a new onset of dyspnea on exertion and a non-productive cough.
Pulmonary function testing reveals a reduced FEV1 and a decreased
FEV1/FVC ratio. Which of the following is the most appropriate next step in
confirming the diagnosis of COPD?
A. High-resolution computed tomography (HRCT) of the chest
B. Bronchodilator reversibility testing
C. Arterial blood gas analysis
D. Diffusing capacity of the lungs for carbon monoxide (DLCO)
CORRECT ANSWER: B. Bronchodilator reversibility testing
Rationale:The diagnosis of COPD is confirmed by spirometry showing airflow
obstruction that is not fully reversible. A post-bronchodilator FEV1/FVC ratio of less
than 0.70 confirms the presence of persistent airflow limitation. While HRCT, ABG, and
DLCO can provide additional information, bronchodilator reversibility testing is the
immediate standard diagnostic step to confirm the diagnosis and assess the fixed nature
of the obstruction.
Question 2: A 45-year-old woman presents with fatigue, weight gain, and cold
intolerance. Laboratory studies show an elevated TSH and a low free T4. She is
started on levothyroxine. After 6 weeks of therapy, she returns with persistent
symptoms. Which of the following is the most common reason for treatment
failure in this scenario?
A. Non-adherence to medication
B. Concurrent use of calcium supplements
C. Incorrect dosing based on weight
D. Presence of anti-thyroid antibodies
CORRECT ANSWER: A. Non-adherence to medication
Rationale:Non-adherence is the most common cause of persistently elevated TSH in
patients on levothyroxine therapy. While factors like concurrent medications (calcium,
iron), malabsorption, and incorrect dosing can also cause treatment failure, they are less
common than simple non-adherence to the daily medication regimen.
Question 3: A 55-year-old male with a history of hypertension and type 2
diabetes presents for a routine follow-up. His blood pressure is 138/86 mm Hg,
and his estimated glomerular filtration rate (eGFR) is 52 mL/min/1.73m². His
,current medications include lisinopril and metformin. Which of the following
is the most appropriate addition to his antihypertensive regimen to achieve the
recommended blood pressure target?
A. Amlodipine
B. Hydrochlorothiazide
C. Carvedilol
D. Clonidine
CORRECT ANSWER: A. Amlodipine
Rationale:For patients with hypertension and chronic kidney disease (CKD), the
recommended blood pressure target is <130/80 mm Hg. The patient is already on an
ACE inhibitor (lisinopril). Adding a dihydropyridine calcium channel blocker (CCB) like
amlodipine is the preferred next step in a two-drug regimen for patients with CKD due
to its efficacy and renal protective effects.
Question 4: A 28-year-old woman presents with a chief complaint of
"spinning" dizziness that began suddenly this morning. The episodes are brief,
lasting less than a minute, and are triggered by turning her head to the left
while lying down. She has no hearing loss or tinnitus. The Dix-Hallpike
maneuver elicits nystagmus and vertigo. Which of the following is the most
appropriate initial management?
A. Prescribe meclizine for symptom control
B. Order a head CT to rule out stroke
C. Perform the Epley maneuver
D. Refer to ENT for a surgical evaluation
CORRECT ANSWER: C. Perform the Epley maneuver
Rationale:The patient's presentation is classic for benign paroxysmal positional vertigo
(BPPV). The Dix-Hallpike test is the diagnostic maneuver. The Epley maneuver (canalith
repositioning procedure) is the first-line treatment for posterior canal BPPV and is highly
effective in resolving symptoms. Meclizine may be used for more persistent symptoms,
but the Epley maneuver addresses the underlying cause.
Question 5: A 72-year-old male with a history of coronary artery disease and
heart failure with reduced ejection fraction (HFrEF) presents with increasing
dyspnea and bilateral leg edema. His blood pressure is 110/70 mm Hg, heart
rate is 68 bpm, and oxygen saturation is 92% on room air. He is currently on
lisinopril, carvedilol, and furosemide. Which of the following medications, if
initiated, has been shown to provide the most significant mortality benefit in
this patient's condition?
A. Spironolactone
B. Digoxin
C. Sacubitril/valsartan
D. Hydralazine/isosorbide dinitrate
,CORRECT ANSWER: C. Sacubitril/valsartan
Rationale:Sacubitril/valsartan (an ARNI) has been shown to reduce cardiovascular
death and heart failure hospitalization more effectively than enalapril in patients with
HFrEF. It is now a cornerstone of therapy and is preferred over an ACE inhibitor or ARB.
While spironolactone also provides a mortality benefit, the question specifies the most
significant benefit, which is associated with sacubitril/valsartan.
Question 6: A 34-year-old G2P1 woman at 28 weeks gestation presents with a
3-day history of headache, blurred vision, and epigastric pain. Her blood
pressure is 155/98 mm Hg, and she has 2+ proteinuria on a urine dipstick.
Which of the following is the most appropriate initial management for this
patient's condition?
A. Administer magnesium sulfate
B. Initiate labetalol for blood pressure control
C. Administer betamethasone for fetal lung maturity
D. Perform an emergency cesarean section
CORRECT ANSWER: A. Administer magnesium sulfate
Rationale:This patient is presenting with preeclampsia with severe features (headache,
visual changes, epigastric pain, severe hypertension, and proteinuria). The most
important initial step is to prevent eclampsia by administering magnesium sulfate. While
blood pressure control (labetalol) and corticosteroid administration are also important,
magnesium sulfate is the priority to prevent seizures and is a medical emergency.
Question 7: A 6-month-old infant is brought to the clinic for a well-child visit.
The mother reports that the infant has been irritable and has been drooling
excessively. On examination, you notice white, adherent plaques on the buccal
mucosa that cannot be wiped away. The infant is afebrile and feeding well.
Which of the following is the most appropriate treatment?
A. Nystatin oral suspension
B. Oral acyclovir
C. Amoxicillin
D. Observation with reassurance
CORRECT ANSWER: A. Nystatin oral suspension
Rationale:The presentation is classic for oral candidiasis (thrush) in an infant. Nystatin
oral suspension is the first-line treatment. It is applied topically to the affected areas
several times a day. The infant is otherwise healthy, so systemic antifungals are not
typically required.
Question 8: A 60-year-old female presents with a 6-week history of pain and
stiffness in her shoulders, neck, and hips. The stiffness is worse in the morning
and lasts for over an hour. She also reports a low-grade fever, malaise, and a 5-
, lb weight loss. Her erythrocyte sedimentation rate (ESR) is 95 mm/hr. Which
of the following is the most likely diagnosis?
A. Rheumatoid arthritis
B. Polymyalgia rheumatica
C. Osteoarthritis
D. Fibromyalgia
CORRECT ANSWER: B. Polymyalgia rheumatica
Rationale:Polymyalgia rheumatica (PMR) classically presents in older adults with
bilateral aching and morning stiffness in the shoulder and hip girdles. The stiffness lasts
>45 minutes. The presence of a markedly elevated ESR and systemic symptoms further
supports the diagnosis. Rheumatoid arthritis typically affects smaller joints,
osteoarthritis does not cause such significant morning stiffness or systemic symptoms,
and fibromyalgia is characterized by widespread pain without elevated inflammatory
markers.
Question 9: A 45-year-old male with a history of alcohol use disorder presents
with jaundice, ascites, and confusion. Laboratory studies reveal an elevated
INR, low albumin, and a platelet count of 80,000/µL. Which of the following is
the most appropriate initial treatment for his ascites?
A. Large-volume paracentesis
B. Initiation of spironolactone
C. Restriction of dietary sodium
D. Administration of intravenous albumin
CORRECT ANSWER: C. Restriction of dietary sodium
Rationale:The patient has decompensated cirrhosis with ascites. The first-line
treatment for ascites is sodium restriction (often < 2000 mg/day) and diuretics
(spironolactone +/- furosemide). While paracentesis may be needed for diagnostic
purposes or for tense, refractory ascites, dietary sodium restriction is a fundamental
initial step in management.
Question 10: A 22-year-old college student presents with a 2-day history of
fever, sore throat, and fatigue. On examination, he has pharyngeal erythema,
tonsillar exudates, and tender anterior cervical lymphadenopathy. A rapid
strep test is positive. Which of the following is the recommended antibiotic
regimen?
A. Penicillin VK for 10 days
B. Azithromycin for 5 days
C. Amoxicillin for 10 days
D. Cephalexin for 7 days
CORRECT ANSWER: A. Penicillin VK for 10 days
