ABFM Family Medicine Board Certification Exam 2026: Professional
Practice Test — Preventive Care, Chronic Disease Management,
Paediatrics, Women’s Health, Geriatrics & Clinical Decision-Making
— 190 Multiple-Choice Questions with Answers & Detailed
Rationales
Section 1: Cardiovascular and Hematology
Question 1
A 62-year-old male with a history of hypertension and diabetes presents for a routine visit.
He is asymptomatic. His blood pressure is 148/92 mmHg on two separate occasions. He is
currently on lisinopril 20 mg daily. His eGFR is 85 mL/min/1.73m² and potassium is 4.2
mEq/L. According to JNC 8 guidelines, what is the most appropriate next step in
management?
A. Increase lisinopril to 40 mg daily
B. Add a thiazide diuretic
C. Add a beta-blocker
D. Add an angiotensin receptor blocker (ARB)
Correct Answer: B
Explanation: For a patient with diabetes and hypertension not at goal on an ACE inhibitor,
adding a thiazide diuretic or calcium channel blocker is the recommended next step. Adding
an ARB to an ACE inhibitor is contraindicated due to increased risk of hyperkalemia and renal
failure without added benefit.
Question 2
A 34-year-old female presents with palpitations and fatigue. Her ECG shows a narrow-
complex tachycardia at a rate of 160 bpm. She is hemodynamically stable. Vagal maneuvers
have failed. What is the most appropriate next step in management?
,A. Adenosine 6 mg IV push
B. Amiodarone 150 mg IV
C. Synchronized cardioversion
D. Diltiazem 20 mg IV
Correct Answer: A
Explanation: Adenosine is the first-line pharmacologic treatment for stable, narrow-complex
supraventricular tachycardia (SVT) after failed vagal maneuvers. It transiently blocks the AV
node to terminate the reentrant circuit.
Question 3
A 55-year-old male with a history of heart failure with reduced ejection fraction (HFrEF, EF
30%) is started on sacubitril/valsartan. Which of the following medications must be
discontinued prior to initiation?
A. Metoprolol succinate
B. Spironolactone
C. Lisinopril
D. Furosemide
Correct Answer: C
Explanation: ACE inhibitors must be stopped for at least 36 hours before starting
sacubitril/valsartan due to the risk of serious angioedema. The combination of an ACE
inhibitor and a neprilysin inhibitor is contraindicated.
Question 4
,A 28-year-old female presents with a 3-day history of painful, swollen left leg. She is on oral
contraceptives. Doppler ultrasound confirms a deep vein thrombosis (DVT) in the popliteal
vein. She is hemodynamically stable. What is the most appropriate initial anticoagulation
strategy?
A. Warfarin with bridge therapy using low-molecular-weight heparin
B. Aspirin 81 mg daily
C. Rivaroxaban 15 mg twice daily for 21 days
D. Unfractionated heparin infusion
Correct Answer: C
Explanation: Direct oral anticoagulants (DOACs) like rivaroxaban are first-line for provoked
DVT. The standard regimen is 15 mg twice daily for 21 days, followed by 20 mg daily.
Warfarin requires bridging and more monitoring.
Question 5
A 70-year-old male presents with fatigue and exertional dyspnea. Labs reveal hemoglobin of
9.5 g/dL, MCV of 72 fL, and ferritin of 8 ng/mL. He has a history of peptic ulcer disease. What
is the most likely diagnosis?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Vitamin B12 deficiency
D. Thalassemia minor
Correct Answer: B
Explanation: Microcytic anemia with low ferritin is diagnostic of iron deficiency. In an older
male with a history of PUD, occult gastrointestinal blood loss is the most likely etiology and
warrants further investigation.
, Question 6
A 45-year-old male with a BMI of 32 presents for a physical. His blood pressure is 138/88
mmHg. He has no other comorbidities. He has tried lifestyle modifications for 6 months
without success. According to ACC/AHA guidelines, what is the most appropriate
pharmacotherapy?
A. Start lisinopril
B. Start hydrochlorothiazide
C. Start amlodipine
D. Continue lifestyle modifications only
Correct Answer: B
Explanation: For stage 1 hypertension (130-139/80-89) with a BMI >30 but no other
comorbidities, thiazide diuretics are a first-line option. Lifestyle changes are recommended
for all, but pharmacotherapy is indicated if goals are not met.
Question 7
A 68-year-old female on warfarin for atrial fibrillation presents with a mechanical fall and a
head strike. She is asymptomatic. Her INR is 3.5. What is the most appropriate next step?
A. Observation at home
B. CT scan of the head without contrast
C. Administration of vitamin K
D. Reversal with prothrombin complex concentrate
Correct Answer: B
Practice Test — Preventive Care, Chronic Disease Management,
Paediatrics, Women’s Health, Geriatrics & Clinical Decision-Making
— 190 Multiple-Choice Questions with Answers & Detailed
Rationales
Section 1: Cardiovascular and Hematology
Question 1
A 62-year-old male with a history of hypertension and diabetes presents for a routine visit.
He is asymptomatic. His blood pressure is 148/92 mmHg on two separate occasions. He is
currently on lisinopril 20 mg daily. His eGFR is 85 mL/min/1.73m² and potassium is 4.2
mEq/L. According to JNC 8 guidelines, what is the most appropriate next step in
management?
A. Increase lisinopril to 40 mg daily
B. Add a thiazide diuretic
C. Add a beta-blocker
D. Add an angiotensin receptor blocker (ARB)
Correct Answer: B
Explanation: For a patient with diabetes and hypertension not at goal on an ACE inhibitor,
adding a thiazide diuretic or calcium channel blocker is the recommended next step. Adding
an ARB to an ACE inhibitor is contraindicated due to increased risk of hyperkalemia and renal
failure without added benefit.
Question 2
A 34-year-old female presents with palpitations and fatigue. Her ECG shows a narrow-
complex tachycardia at a rate of 160 bpm. She is hemodynamically stable. Vagal maneuvers
have failed. What is the most appropriate next step in management?
,A. Adenosine 6 mg IV push
B. Amiodarone 150 mg IV
C. Synchronized cardioversion
D. Diltiazem 20 mg IV
Correct Answer: A
Explanation: Adenosine is the first-line pharmacologic treatment for stable, narrow-complex
supraventricular tachycardia (SVT) after failed vagal maneuvers. It transiently blocks the AV
node to terminate the reentrant circuit.
Question 3
A 55-year-old male with a history of heart failure with reduced ejection fraction (HFrEF, EF
30%) is started on sacubitril/valsartan. Which of the following medications must be
discontinued prior to initiation?
A. Metoprolol succinate
B. Spironolactone
C. Lisinopril
D. Furosemide
Correct Answer: C
Explanation: ACE inhibitors must be stopped for at least 36 hours before starting
sacubitril/valsartan due to the risk of serious angioedema. The combination of an ACE
inhibitor and a neprilysin inhibitor is contraindicated.
Question 4
,A 28-year-old female presents with a 3-day history of painful, swollen left leg. She is on oral
contraceptives. Doppler ultrasound confirms a deep vein thrombosis (DVT) in the popliteal
vein. She is hemodynamically stable. What is the most appropriate initial anticoagulation
strategy?
A. Warfarin with bridge therapy using low-molecular-weight heparin
B. Aspirin 81 mg daily
C. Rivaroxaban 15 mg twice daily for 21 days
D. Unfractionated heparin infusion
Correct Answer: C
Explanation: Direct oral anticoagulants (DOACs) like rivaroxaban are first-line for provoked
DVT. The standard regimen is 15 mg twice daily for 21 days, followed by 20 mg daily.
Warfarin requires bridging and more monitoring.
Question 5
A 70-year-old male presents with fatigue and exertional dyspnea. Labs reveal hemoglobin of
9.5 g/dL, MCV of 72 fL, and ferritin of 8 ng/mL. He has a history of peptic ulcer disease. What
is the most likely diagnosis?
A. Anemia of chronic disease
B. Iron deficiency anemia
C. Vitamin B12 deficiency
D. Thalassemia minor
Correct Answer: B
Explanation: Microcytic anemia with low ferritin is diagnostic of iron deficiency. In an older
male with a history of PUD, occult gastrointestinal blood loss is the most likely etiology and
warrants further investigation.
, Question 6
A 45-year-old male with a BMI of 32 presents for a physical. His blood pressure is 138/88
mmHg. He has no other comorbidities. He has tried lifestyle modifications for 6 months
without success. According to ACC/AHA guidelines, what is the most appropriate
pharmacotherapy?
A. Start lisinopril
B. Start hydrochlorothiazide
C. Start amlodipine
D. Continue lifestyle modifications only
Correct Answer: B
Explanation: For stage 1 hypertension (130-139/80-89) with a BMI >30 but no other
comorbidities, thiazide diuretics are a first-line option. Lifestyle changes are recommended
for all, but pharmacotherapy is indicated if goals are not met.
Question 7
A 68-year-old female on warfarin for atrial fibrillation presents with a mechanical fall and a
head strike. She is asymptomatic. Her INR is 3.5. What is the most appropriate next step?
A. Observation at home
B. CT scan of the head without contrast
C. Administration of vitamin K
D. Reversal with prothrombin complex concentrate
Correct Answer: B
