AAFP Family Medicine Board Review Test
Questions with Verified Answers Updated
Question 1
A 55-year-old female with diabetes mellitus, hypertension, and hyperlipidemia
presents to your office for routine follow-up. Her serum creatinine level is 1.5 mg/dL
(estimated creatinine clearance 50 mL/min).
Which diabetes medications would be contraindicated in this patient?
Correct Answer
Metformin (Glucophage)
Metformin is contraindicated in patients with chronic kidney disease. It should be
stopped in females with
a creatinine level ≥1.4 mg/dL and in males with a creatinine level ≥1.5 mg/dL.
Pioglitazone should not be used in patients with hepatic disease. Acarbose should
be avoided in patients with cirrhosis or a creatinine level >2.0 mg/dL. Exenatide is
not recommended in patients with a creatinine clearance <30 mL/min. Insulin
glargine can be used in patients with renal disease at any stage, but the dosage may
need to be decreased.
Page 1 of 313
,Question 2
What is diagnostic for type 2 diabetes mellitus?
Correct Answer
A fasting plasma glucose level ≥126 mg/dL on two separate occasions
The American Diabetes Association (ADA) first published guidelines for the
diagnosis of diabetes mellitus in 1997 and updated its diagnostic criteria in 2010.
With the increasing incidence of obesity, it is estimated that over 5 million
Americans have undiagnosed type 2 diabetes mellitus. Given the long-term risks of
microvascular (renal, ocular) and macrovascular (cardiac) complications, clear
guidelines for screening are critical. The ADA recommends screening for all
asymptomatic adults with a BMI >25.0 kg/m whohave one or more additional risk
factors for diabetes mellitus, and screening for all adults with no risk factors every 3
years beginning at age 45.
Current criteria for the diagnosis of diabetes mellitus include a hemoglobin A 1c
³6.5%, a fasting plasma glucose level ³126 mg/dL, a 2-hour plasma glucose level
³200 mg/dL, or, in a symptomatic patient, a random blood glucose level ³200
mg/dL. In the absence of unequivocal hyperglycemia, results require confirmation
by repeat testing.
Page 2 of 313
,Question 3
A 12-year-old female is brought to your office with an 8-day history of sore throat
and fever, along with migratory aching joint pain. She is otherwise healthy and has no
history of travel, tick exposure, or prior systemic illness. A physical examination is
notable for exudative pharyngitis; a blanching, sharply demarcated macular rash over
her trunk; and a III/VI systolic ejection murmur. Joint and neurologic examinations are
normal. A rapid strep test is positive and her C-reactive protein level is elevated.
Of the following, the most likely diagnosis is:
Correct Answer
acute rheumatic fever
Acute rheumatic fever is very common in developing nations. It was previously rare
in the U.S., but had a resurgence in the mid-1980s. It is most common in children
ages 5-15 years. The diagnosis is based on the Jones criteria. Two major criteria, or
one major criterion and two minor criteria, plus evidence of a preceding
streptococcal infection, indicate a high probability of the disease.
Major criteria include carditis, migratory polyarthritis, erythema marginatum, chorea,
and subcutaneous nodules. Minor criteria include fever, arthralgia, an elevated
erythrocyte sedimentation rate or C-reactive protein (CRP) level, and a prolonged
pulse rate interval on EKG. The differential diagnosis is extensive and there is no
single laboratory test to confirm the diagnosis. This patient meets one major
criterion (erythema marginatum rash) and three minor criteria (fever, elevated CRP
levels, and arthralgia). Echocardiography should be performed if the patient has
cardiac symptoms or an abnormal cardiac examination, to rule out rheumatic
carditis.
Page 3 of 313
, Question 4
What medication most increases insulin sensitivity in an overweight patient with
diabetes mellitus?
A. Metformin (Glucophage)
B. Acarbose (Precose)
C. Glyburide (DiaBeta, Micronase)
D. NPH insulin
Correct Answer
Metformin (Glucophage)
Metformin increases insulin sensitivity much more than sulfonylureas or insulin. This
means lower insulin levels achieve the same level of glycemic control, and may be
one reason that weight changes are less likely to be seen in diabetic patients on
metformin. Acarbose is an α-glucosidase inhibitor that delays glucose absorption.
Question 5
The blood pressure goal for a patient who has uncomplicated diabetes mellitus is
Correct Answer
BP goal: 130/80mmHg
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%
Page 4 of 313
Questions with Verified Answers Updated
Question 1
A 55-year-old female with diabetes mellitus, hypertension, and hyperlipidemia
presents to your office for routine follow-up. Her serum creatinine level is 1.5 mg/dL
(estimated creatinine clearance 50 mL/min).
Which diabetes medications would be contraindicated in this patient?
Correct Answer
Metformin (Glucophage)
Metformin is contraindicated in patients with chronic kidney disease. It should be
stopped in females with
a creatinine level ≥1.4 mg/dL and in males with a creatinine level ≥1.5 mg/dL.
Pioglitazone should not be used in patients with hepatic disease. Acarbose should
be avoided in patients with cirrhosis or a creatinine level >2.0 mg/dL. Exenatide is
not recommended in patients with a creatinine clearance <30 mL/min. Insulin
glargine can be used in patients with renal disease at any stage, but the dosage may
need to be decreased.
Page 1 of 313
,Question 2
What is diagnostic for type 2 diabetes mellitus?
Correct Answer
A fasting plasma glucose level ≥126 mg/dL on two separate occasions
The American Diabetes Association (ADA) first published guidelines for the
diagnosis of diabetes mellitus in 1997 and updated its diagnostic criteria in 2010.
With the increasing incidence of obesity, it is estimated that over 5 million
Americans have undiagnosed type 2 diabetes mellitus. Given the long-term risks of
microvascular (renal, ocular) and macrovascular (cardiac) complications, clear
guidelines for screening are critical. The ADA recommends screening for all
asymptomatic adults with a BMI >25.0 kg/m whohave one or more additional risk
factors for diabetes mellitus, and screening for all adults with no risk factors every 3
years beginning at age 45.
Current criteria for the diagnosis of diabetes mellitus include a hemoglobin A 1c
³6.5%, a fasting plasma glucose level ³126 mg/dL, a 2-hour plasma glucose level
³200 mg/dL, or, in a symptomatic patient, a random blood glucose level ³200
mg/dL. In the absence of unequivocal hyperglycemia, results require confirmation
by repeat testing.
Page 2 of 313
,Question 3
A 12-year-old female is brought to your office with an 8-day history of sore throat
and fever, along with migratory aching joint pain. She is otherwise healthy and has no
history of travel, tick exposure, or prior systemic illness. A physical examination is
notable for exudative pharyngitis; a blanching, sharply demarcated macular rash over
her trunk; and a III/VI systolic ejection murmur. Joint and neurologic examinations are
normal. A rapid strep test is positive and her C-reactive protein level is elevated.
Of the following, the most likely diagnosis is:
Correct Answer
acute rheumatic fever
Acute rheumatic fever is very common in developing nations. It was previously rare
in the U.S., but had a resurgence in the mid-1980s. It is most common in children
ages 5-15 years. The diagnosis is based on the Jones criteria. Two major criteria, or
one major criterion and two minor criteria, plus evidence of a preceding
streptococcal infection, indicate a high probability of the disease.
Major criteria include carditis, migratory polyarthritis, erythema marginatum, chorea,
and subcutaneous nodules. Minor criteria include fever, arthralgia, an elevated
erythrocyte sedimentation rate or C-reactive protein (CRP) level, and a prolonged
pulse rate interval on EKG. The differential diagnosis is extensive and there is no
single laboratory test to confirm the diagnosis. This patient meets one major
criterion (erythema marginatum rash) and three minor criteria (fever, elevated CRP
levels, and arthralgia). Echocardiography should be performed if the patient has
cardiac symptoms or an abnormal cardiac examination, to rule out rheumatic
carditis.
Page 3 of 313
, Question 4
What medication most increases insulin sensitivity in an overweight patient with
diabetes mellitus?
A. Metformin (Glucophage)
B. Acarbose (Precose)
C. Glyburide (DiaBeta, Micronase)
D. NPH insulin
Correct Answer
Metformin (Glucophage)
Metformin increases insulin sensitivity much more than sulfonylureas or insulin. This
means lower insulin levels achieve the same level of glycemic control, and may be
one reason that weight changes are less likely to be seen in diabetic patients on
metformin. Acarbose is an α-glucosidase inhibitor that delays glucose absorption.
Question 5
The blood pressure goal for a patient who has uncomplicated diabetes mellitus is
Correct Answer
BP goal: 130/80mmHg
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%
Page 4 of 313
