AAFP 2026 Board Exam Questions and Answers |
Family Medicine Certification Practice Test Prep |
250 Questions with Detailed Rationales | Latest
Update
,Cardiovascular Acute Presentations
1. A 62-year-old man with hypertension and type 2 diabetes
presents with acute-onset substernal chest pressure radiating to
his left arm, associated with diaphoresis and nausea. ECG shows 2-
mm ST-segment elevations in leads V2–V4. Which of the following
is the most appropriate next step in management?
A. Administer sublingual nitroglycerin and observe for 30 minutes
B. Obtain a chest X-ray and complete blood count
C. Immediate transfer to the emergency department for urgent
reperfusion therapy
D. Start aspirin 81 mg daily and schedule a stress test for tomorrow
Correct Answer: C
This patient has an anterior STEMI. Immediate reperfusion therapy via
PCI or fibrinolysis is indicated. Time is muscle—the goal is door-to-
balloon time less than 90 minutes. Nitroglycerin alone does not treat
the occlusion, and delaying reperfusion for further testing is dangerous.
2. A 55-year-old woman with hypertension presents with sudden,
severe, tearing chest pain radiating to her back. 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 likely diagnosis?
,A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
The classic presentation of aortic dissection includes sudden tearing
chest pain radiating to the back with asymmetric blood pressures
between arms. The interarm blood pressure differential is a key finding.
Acute MI lacks the tearing quality and blood pressure differential.
3. A 68-year-old man with HFrEF presents with worsening dyspnea,
orthopnea, and paroxysmal nocturnal dyspnea over one week.
Which of the following is the most appropriate initial
management?
A. Increase oral furosemide and reassess in one week
B. Admit for intravenous diuresis
C. Start a beta-blocker and reassess in two weeks
D. Obtain an outpatient echocardiogram
Correct Answer: B
, This patient has acute decompensated heart failure with volume
overload. Intravenous diuresis in a monitored setting is indicated. Oral
diuretic adjustment is insufficient for significant decompensation.
4. A 45-year-old man presents with palpitations and a heart rate of
160 bpm. ECG shows a narrow-complex regular tachycardia
without visible P waves. He is hemodynamically stable. Which of
the following is the most appropriate initial intervention?
A. Synchronized cardioversion
B. Adenosine 6 mg IV push
C. Diltiazem 20 mg IV
D. Amiodarone 150 mg IV
Correct Answer: B
Adenosine is the first-line agent for stable narrow-complex regular
tachycardia, typically SVT. It transiently blocks AV nodal conduction and
can terminate the arrhythmia. Cardioversion is reserved for
hemodynamically unstable patients.
5. A 72-year-old woman presents with sudden-onset severe
abdominal pain out of proportion to examination findings. She has
a history of atrial fibrillation and is not anticoagulated. Which of
the following is the most likely diagnosis?
Family Medicine Certification Practice Test Prep |
250 Questions with Detailed Rationales | Latest
Update
,Cardiovascular Acute Presentations
1. A 62-year-old man with hypertension and type 2 diabetes
presents with acute-onset substernal chest pressure radiating to
his left arm, associated with diaphoresis and nausea. ECG shows 2-
mm ST-segment elevations in leads V2–V4. Which of the following
is the most appropriate next step in management?
A. Administer sublingual nitroglycerin and observe for 30 minutes
B. Obtain a chest X-ray and complete blood count
C. Immediate transfer to the emergency department for urgent
reperfusion therapy
D. Start aspirin 81 mg daily and schedule a stress test for tomorrow
Correct Answer: C
This patient has an anterior STEMI. Immediate reperfusion therapy via
PCI or fibrinolysis is indicated. Time is muscle—the goal is door-to-
balloon time less than 90 minutes. Nitroglycerin alone does not treat
the occlusion, and delaying reperfusion for further testing is dangerous.
2. A 55-year-old woman with hypertension presents with sudden,
severe, tearing chest pain radiating to her back. 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 likely diagnosis?
,A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
The classic presentation of aortic dissection includes sudden tearing
chest pain radiating to the back with asymmetric blood pressures
between arms. The interarm blood pressure differential is a key finding.
Acute MI lacks the tearing quality and blood pressure differential.
3. A 68-year-old man with HFrEF presents with worsening dyspnea,
orthopnea, and paroxysmal nocturnal dyspnea over one week.
Which of the following is the most appropriate initial
management?
A. Increase oral furosemide and reassess in one week
B. Admit for intravenous diuresis
C. Start a beta-blocker and reassess in two weeks
D. Obtain an outpatient echocardiogram
Correct Answer: B
, This patient has acute decompensated heart failure with volume
overload. Intravenous diuresis in a monitored setting is indicated. Oral
diuretic adjustment is insufficient for significant decompensation.
4. A 45-year-old man presents with palpitations and a heart rate of
160 bpm. ECG shows a narrow-complex regular tachycardia
without visible P waves. He is hemodynamically stable. Which of
the following is the most appropriate initial intervention?
A. Synchronized cardioversion
B. Adenosine 6 mg IV push
C. Diltiazem 20 mg IV
D. Amiodarone 150 mg IV
Correct Answer: B
Adenosine is the first-line agent for stable narrow-complex regular
tachycardia, typically SVT. It transiently blocks AV nodal conduction and
can terminate the arrhythmia. Cardioversion is reserved for
hemodynamically unstable patients.
5. A 72-year-old woman presents with sudden-onset severe
abdominal pain out of proportion to examination findings. She has
a history of atrial fibrillation and is not anticoagulated. Which of
the following is the most likely diagnosis?
