FAAFP – Fellow of the American Academy of Family
Physicians | Comprehensive Study Guide, Practice
Exam, Questions & Answers, Exam Prep Test Bank,
Family Medicine, Primary Care, Preventive Medicine,
Chronic Disease Management, Clinical Decision-
Making, Evidence-Based Practice, Women's Health,
Pediatrics, Geriatrics, Patient Safety, Detailed
Rationales, Complete Review
Question 1: A 45-year-old male with a 30-pack-year smoking history presents
with a chronic cough and shortness of breath. Pulmonary function testing
reveals a post-bronchodilator FEV1/FVC ratio of 0.65 and an FEV1 of 55% of
predicted. According to the GOLD guidelines, which of the following is the
most appropriate next step in managing this patient's COPD to reduce
mortality?
A. Initiate a long-acting muscarinic antagonist (LAMA)
B. Initiate a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS)
C. Initiate triple therapy with a LAMA, LABA, and ICS
D. Refer for pulmonary rehabilitation
CORRECT ANSWER: C. Initiate triple therapy with a LAMA, LABA, and ICS
Rationale:The patient has GOLD stage 3 (severe) COPD. The GOLD guidelines
recommend triple therapy (LABA/LAMA/ICS) for patients with frequent exacerbations
or those with high symptom burden. Given the significant obstruction, initiating triple
therapy is indicated to reduce exacerbations and improve outcomes.
Question 2: A 60-year-old woman presents with acute onset of severe, tearing
chest pain radiating to her back. She has a history of hypertension. On
examination, her blood pressure is 180/100 mmHg in the right arm and
130/80 mmHg in the left arm. Which of the following is the most appropriate
initial imaging study to confirm the diagnosis?
A. Chest X-ray
B. Computed tomography angiography (CTA)
C. Transesophageal echocardiography (TEE)
D. Magnetic resonance angiography (MRA)
CORRECT ANSWER: B. Computed tomography angiography (CTA)
Rationale:CTA of the chest is the diagnostic test of choice for acute aortic dissection
due to its high sensitivity and specificity, rapid acquisition, and ability to define the
extent of the dissection. In this patient with a pulse deficit, a dissection is highly
suspected.
,Question 3: A 55-year-old man with type 2 diabetes mellitus and hypertension
is being evaluated for chronic kidney disease. His estimated glomerular
filtration rate (eGFR) is 45 mL/min/1.73m², and his urine albumin-to-
creatinine ratio (UACR) is 350 mg/g. Which of the following antihypertensive
classes has been shown to provide the most benefit in slowing the progression
of his diabetic nephropathy?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin-converting enzyme inhibitors (ACE inhibitors)
D. Thiazide diuretics
CORRECT ANSWER: C. Angiotensin-converting enzyme inhibitors (ACE
inhibitors)
Rationale:ACE inhibitors (or ARBs) are the preferred agents for patients with diabetic
nephropathy because they reduce intraglomerular pressure, decrease proteinuria, and
slow the decline in GFR. This patient has stage 3 CKD and significant albuminuria,
making an ACE inhibitor the most appropriate choice.
Question 4: A 70-year-old female presents with a two-week history of
progressive weakness in her proximal muscles, difficulty rising from a chair,
and a purple discoloration on her upper eyelids. Her creatinine kinase (CK)
level is 4,500 U/L. A diagnosis of dermatomyositis is suspected. Which of the
following is the most appropriate initial corticosteroid dosing strategy for this
patient?
A. Topical corticosteroids
B. A moderate-dose oral prednisone taper
C. High-dose oral prednisone (1 mg/kg/day)
D. Intravenous methylprednisolone pulse therapy
CORRECT ANSWER: C. High-dose oral prednisone (1 mg/kg/day)
Rationale:For dermatomyositis with significant muscle weakness, high-dose oral
prednisone (1 mg/kg/day) is the standard initial therapy. This approach rapidly reduces
inflammation and can prevent long-term disability and complications like calcinosis.
Question 5: A 35-year-old man presents with a painful, erythematous, swollen
great toe. He reports a similar episode two years ago. He has a history of
hypertension and chronic kidney disease. Which of the following is the most
appropriate first-line medication to treat this acute gout flare?
A. Allopurinol
B. Febuxostat
,C. Colchicine
D. Probenecid
CORRECT ANSWER: C. Colchicine
Rationale:Colchicine is a first-line agent for acute gout flares. For a patient with an
acute flare, colchicine can be effective if started early. However, given his CKD, the dose
must be adjusted. Allopurinol and febuxostat are urate-lowering therapies for chronic
management and should not be initiated during an acute flare. Probenecid is a
uricosuric agent, also for chronic management.
Question 6: A 25-year-old woman presents with fatigue, joint pain, and a
malar rash. Laboratory tests show anemia, leukopenia, and a positive
antinuclear antibody (ANA) test. Which of the following antibody tests is most
specific for the diagnosis of systemic lupus erythematosus (SLE)?
A. Anti-dsDNA
B. Anti-Sm
C. Anti-Ro (SSA)
D. Rheumatoid factor (RF)
CORRECT ANSWER: B. Anti-Sm
Rationale:Anti-Sm antibodies are highly specific for SLE. While anti-dsDNA is also
specific, it is not considered as specific as anti-Sm. Anti-Ro is associated with Sjögren's
syndrome and SLE but is less specific.
Question 7: A 50-year-old man with a history of chronic alcoholism presents
with confusion and gait ataxia. On examination, he has nystagmus and
ophthalmoplegia. He is admitted for suspected Wernicke's encephalopathy.
Which of the following is the most appropriate initial treatment?
A. Oral thiamine 100 mg daily
B. Intravenous glucose
C. Intravenous thiamine 100 mg
D. Intravenous thiamine 500 mg
CORRECT ANSWER: D. Intravenous thiamine 500 mg
Rationale:Wernicke's encephalopathy is a medical emergency. The recommended
treatment is high-dose intravenous thiamine (500 mg) given before or concurrently with
glucose to prevent precipitation of Wernicke's encephalopathy. This high dose is critical
for rapid replenishment of thiamine in the brain.
, Question 8: A 68-year-old female presents with a one-week history of
progressive dyspnea, orthopnea, and bilateral lower extremity edema. She has
a history of hypertension and coronary artery disease. On examination, she
has jugular venous distension, crackles at the lung bases, and an S3 gallop. An
echocardiogram shows a left ventricular ejection fraction of 30%. Which of the
following is the most appropriate pharmacologic therapy to reduce mortality
in this patient with heart failure with reduced ejection fraction (HFrEF)?
A. Digoxin
B. Furosemide
C. Sacubitril/valsartan
D. Metolazone
CORRECT ANSWER: C. Sacubitril/valsartan
Rationale:Sacubitril/valsartan (Entresto) has been shown to reduce cardiovascular
death and heart failure hospitalizations in patients with HFrEF compared to enalapril.
This patient has symptomatic HFrEF, making this the most appropriate choice to reduce
mortality.
Question 9: A 45-year-old woman presents with a painful, red eye. She reports
a foreign body sensation and photophobia. On examination, there is a corneal
abrasion. Which of the following is the most appropriate initial management to
promote healing and reduce pain?
A. Topical antibiotics and a patch
B. Topical corticosteroids
C. Topical NSAIDs
D. Artificial tears
CORRECT ANSWER: A. Topical antibiotics and a patch
Rationale:For a simple corneal abrasion, the primary treatments are topical antibiotics
to prevent infection and a pressure patch to reduce pain and promote epithelial healing.
Patching is effective in the first 24-48 hours.
Question 10: A 60-year-old man with a history of atrial fibrillation presents
with acute, severe, unilateral leg pain. His leg is pale, cold, and pulseless. A
diagnosis of acute limb ischemia is suspected. Which of the following is the
most appropriate initial step in management?
A. Anticoagulation with heparin and surgical consultation
B. Catheter-directed thrombolysis
C. Percutaneous mechanical thrombectomy
D. Anticoagulation with warfarin
Physicians | Comprehensive Study Guide, Practice
Exam, Questions & Answers, Exam Prep Test Bank,
Family Medicine, Primary Care, Preventive Medicine,
Chronic Disease Management, Clinical Decision-
Making, Evidence-Based Practice, Women's Health,
Pediatrics, Geriatrics, Patient Safety, Detailed
Rationales, Complete Review
Question 1: A 45-year-old male with a 30-pack-year smoking history presents
with a chronic cough and shortness of breath. Pulmonary function testing
reveals a post-bronchodilator FEV1/FVC ratio of 0.65 and an FEV1 of 55% of
predicted. According to the GOLD guidelines, which of the following is the
most appropriate next step in managing this patient's COPD to reduce
mortality?
A. Initiate a long-acting muscarinic antagonist (LAMA)
B. Initiate a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS)
C. Initiate triple therapy with a LAMA, LABA, and ICS
D. Refer for pulmonary rehabilitation
CORRECT ANSWER: C. Initiate triple therapy with a LAMA, LABA, and ICS
Rationale:The patient has GOLD stage 3 (severe) COPD. The GOLD guidelines
recommend triple therapy (LABA/LAMA/ICS) for patients with frequent exacerbations
or those with high symptom burden. Given the significant obstruction, initiating triple
therapy is indicated to reduce exacerbations and improve outcomes.
Question 2: A 60-year-old woman presents with acute onset of severe, tearing
chest pain radiating to her back. She has a history of hypertension. On
examination, her blood pressure is 180/100 mmHg in the right arm and
130/80 mmHg in the left arm. Which of the following is the most appropriate
initial imaging study to confirm the diagnosis?
A. Chest X-ray
B. Computed tomography angiography (CTA)
C. Transesophageal echocardiography (TEE)
D. Magnetic resonance angiography (MRA)
CORRECT ANSWER: B. Computed tomography angiography (CTA)
Rationale:CTA of the chest is the diagnostic test of choice for acute aortic dissection
due to its high sensitivity and specificity, rapid acquisition, and ability to define the
extent of the dissection. In this patient with a pulse deficit, a dissection is highly
suspected.
,Question 3: A 55-year-old man with type 2 diabetes mellitus and hypertension
is being evaluated for chronic kidney disease. His estimated glomerular
filtration rate (eGFR) is 45 mL/min/1.73m², and his urine albumin-to-
creatinine ratio (UACR) is 350 mg/g. Which of the following antihypertensive
classes has been shown to provide the most benefit in slowing the progression
of his diabetic nephropathy?
A. Beta-blockers
B. Calcium channel blockers
C. Angiotensin-converting enzyme inhibitors (ACE inhibitors)
D. Thiazide diuretics
CORRECT ANSWER: C. Angiotensin-converting enzyme inhibitors (ACE
inhibitors)
Rationale:ACE inhibitors (or ARBs) are the preferred agents for patients with diabetic
nephropathy because they reduce intraglomerular pressure, decrease proteinuria, and
slow the decline in GFR. This patient has stage 3 CKD and significant albuminuria,
making an ACE inhibitor the most appropriate choice.
Question 4: A 70-year-old female presents with a two-week history of
progressive weakness in her proximal muscles, difficulty rising from a chair,
and a purple discoloration on her upper eyelids. Her creatinine kinase (CK)
level is 4,500 U/L. A diagnosis of dermatomyositis is suspected. Which of the
following is the most appropriate initial corticosteroid dosing strategy for this
patient?
A. Topical corticosteroids
B. A moderate-dose oral prednisone taper
C. High-dose oral prednisone (1 mg/kg/day)
D. Intravenous methylprednisolone pulse therapy
CORRECT ANSWER: C. High-dose oral prednisone (1 mg/kg/day)
Rationale:For dermatomyositis with significant muscle weakness, high-dose oral
prednisone (1 mg/kg/day) is the standard initial therapy. This approach rapidly reduces
inflammation and can prevent long-term disability and complications like calcinosis.
Question 5: A 35-year-old man presents with a painful, erythematous, swollen
great toe. He reports a similar episode two years ago. He has a history of
hypertension and chronic kidney disease. Which of the following is the most
appropriate first-line medication to treat this acute gout flare?
A. Allopurinol
B. Febuxostat
,C. Colchicine
D. Probenecid
CORRECT ANSWER: C. Colchicine
Rationale:Colchicine is a first-line agent for acute gout flares. For a patient with an
acute flare, colchicine can be effective if started early. However, given his CKD, the dose
must be adjusted. Allopurinol and febuxostat are urate-lowering therapies for chronic
management and should not be initiated during an acute flare. Probenecid is a
uricosuric agent, also for chronic management.
Question 6: A 25-year-old woman presents with fatigue, joint pain, and a
malar rash. Laboratory tests show anemia, leukopenia, and a positive
antinuclear antibody (ANA) test. Which of the following antibody tests is most
specific for the diagnosis of systemic lupus erythematosus (SLE)?
A. Anti-dsDNA
B. Anti-Sm
C. Anti-Ro (SSA)
D. Rheumatoid factor (RF)
CORRECT ANSWER: B. Anti-Sm
Rationale:Anti-Sm antibodies are highly specific for SLE. While anti-dsDNA is also
specific, it is not considered as specific as anti-Sm. Anti-Ro is associated with Sjögren's
syndrome and SLE but is less specific.
Question 7: A 50-year-old man with a history of chronic alcoholism presents
with confusion and gait ataxia. On examination, he has nystagmus and
ophthalmoplegia. He is admitted for suspected Wernicke's encephalopathy.
Which of the following is the most appropriate initial treatment?
A. Oral thiamine 100 mg daily
B. Intravenous glucose
C. Intravenous thiamine 100 mg
D. Intravenous thiamine 500 mg
CORRECT ANSWER: D. Intravenous thiamine 500 mg
Rationale:Wernicke's encephalopathy is a medical emergency. The recommended
treatment is high-dose intravenous thiamine (500 mg) given before or concurrently with
glucose to prevent precipitation of Wernicke's encephalopathy. This high dose is critical
for rapid replenishment of thiamine in the brain.
, Question 8: A 68-year-old female presents with a one-week history of
progressive dyspnea, orthopnea, and bilateral lower extremity edema. She has
a history of hypertension and coronary artery disease. On examination, she
has jugular venous distension, crackles at the lung bases, and an S3 gallop. An
echocardiogram shows a left ventricular ejection fraction of 30%. Which of the
following is the most appropriate pharmacologic therapy to reduce mortality
in this patient with heart failure with reduced ejection fraction (HFrEF)?
A. Digoxin
B. Furosemide
C. Sacubitril/valsartan
D. Metolazone
CORRECT ANSWER: C. Sacubitril/valsartan
Rationale:Sacubitril/valsartan (Entresto) has been shown to reduce cardiovascular
death and heart failure hospitalizations in patients with HFrEF compared to enalapril.
This patient has symptomatic HFrEF, making this the most appropriate choice to reduce
mortality.
Question 9: A 45-year-old woman presents with a painful, red eye. She reports
a foreign body sensation and photophobia. On examination, there is a corneal
abrasion. Which of the following is the most appropriate initial management to
promote healing and reduce pain?
A. Topical antibiotics and a patch
B. Topical corticosteroids
C. Topical NSAIDs
D. Artificial tears
CORRECT ANSWER: A. Topical antibiotics and a patch
Rationale:For a simple corneal abrasion, the primary treatments are topical antibiotics
to prevent infection and a pressure patch to reduce pain and promote epithelial healing.
Patching is effective in the first 24-48 hours.
Question 10: A 60-year-old man with a history of atrial fibrillation presents
with acute, severe, unilateral leg pain. His leg is pale, cold, and pulseless. A
diagnosis of acute limb ischemia is suspected. Which of the following is the
most appropriate initial step in management?
A. Anticoagulation with heparin and surgical consultation
B. Catheter-directed thrombolysis
C. Percutaneous mechanical thrombectomy
D. Anticoagulation with warfarin
