AAFP FAMILY MEDICINE BOARD
QUESTIONS 2025-2026 ACTUAL EXAM
TEST WITH QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES
A 57-year-old male with severe renal disease presents with acute
coronary syndrome. Which one of the following would most likely
require a significant dosage adjustment from the standard
protocol?
A. Enoxaparin (Lovenox)
B. Metoprolol (Lopressor, Toprol)
C. Carvedilol (Coreg)
D. Clopidogrel (Plavix)
E. Tissue plasminogen activator (tPA) Correct Answer
Enoxaparin
Enoxaparin is eliminated mostly by the kidneys. When it is
used in patients with severe renal impairment the dosage
must be significantly reduced. For some indications the dose
normally given every 12 hours is given only every 24 hours.
Although some β-blockers require a dosage adjustment,
metoprolol and carvedilol are metabolized by the liver and do
not require dosage adjustment in patients with renal failure.
Clopidogrel is currently recommended at the standard
,dosage for patients with renal failure and acute coronary
syndrome. Thrombolytics like tPA are given at the standard
dosage in renal failure, although hemorrhagic complications
are increased.
A 55-year-old male who has a long history of marginally-controlled
hypertension presents with gradually increasing shortness of
breath and reduced exercise tolerance. His physical examination
is normal except for a blood pressure of 140/90 mm Hg, bilateral
basilar rales, and trace pitting edema. What study would be the
preferred diagnostic tool for evaluating this patient? Correct
Answer 2-dimensional echocardiography with Doppler
The most useful diagnostic tool for evaluating patients with
heart failure is two-dimensional echocardiography with
Doppler to assess left ventricular ejection fraction (LVEF),
left ventricular size, ventricular compliance, wall thickness,
and valve function. The test should be performed during the
initial evaluation. Radionuclide ventriculography can be used
to assess LVEF and volumes, and MRI or CT also may
provide information in selected patients. Chest radiography
(posteroanterior and lateral) and 12-lead electrocardiography
should be performed in all patients presenting with heart
failure, but should not be used as the primary basis for
determining which abnormalities are responsible for the
heart failure.
,A 23-year-old female sees you with a complaint of intermittent
irregular heartbeats that occur once every week or two, but do not
cause her to feel lightheaded or fatigued. They last only a few
seconds and resolve spontaneously. She has never passed out,
had chest pain, or had difficulty with exertion. She is otherwise
healthy, and a physical examination is normal. What cardiac study
should be ordered initially? Correct Answer EKG
The symptom of an increased or abnormal sensation of one's
heartbeat is referred to as palpitations. This condition is
common to primary care, but is often benign. Commonly,
these sensations have their basis in anxiety or panic.
However, about 50% of those who complain of palpitations
will be found to have a diagnosable cardiac condition. It is
recommended to start the evaluation for cardiac causes with
an EKG, which will assess the baseline rhythm and screen
for signs of chamber enlargement, previous myocardial
infarction, conduction disturbances, and a prolonged QT
interval.
What is most appropriate for the initial treatment of claudication?
Correct Answer regular exercise
Claudication is exercise-induced lower-extremity pain that is
caused by ischemia and relieved by rest. It affects 10% of
persons over 70 years of age. However, up to 90% of patients
with peripheral vascular disease are asymptomatic. Initial
treatment should consist of vigorous risk factor modification
, and exercise. Patients who follow an exercise regimen can
increase their walking time by 150%. A supervised program
may produce better results. Risk factors include diabetes
mellitus, hypertension, smoking, and hyperlipidemia.
In a patient who presents with symptoms of acute myocardial
infarction, which one of the following would be an indication for
thrombolytic therapy?
A. New-onset ST-segment depression
B. New-onset left bundle branch block
C. New-onset first degree atrioventricular block
D. New-onset Wenckebach second degree heart block
E. Frequent unifocal ventricular ectopic beats Correct Answer
New-onset left bundle branch block
In patients with ischemic chest pain, the EKG is important for
determining the need for fibrinolytic therapy. Myocardial
infarction is diagnosed by ST elevation ≥1 mm in two or more
limb leads and ≥2 mm in two or more contiguous precordial
leads. In a patient with an MI, new left bundle branch block
suggests occlusion of the left anterior descending artery,
placing a significant portion of the left ventricle in jeopardy.
Thrombolytic therapy could be harmful in patients with
ischemia but not infarction - they will show ST-segment
depression only. Frequent unifocal ventricular ectopy may
warrant antiarrhythmic therapy, but not thrombolytic therapy.
QUESTIONS 2025-2026 ACTUAL EXAM
TEST WITH QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES
A 57-year-old male with severe renal disease presents with acute
coronary syndrome. Which one of the following would most likely
require a significant dosage adjustment from the standard
protocol?
A. Enoxaparin (Lovenox)
B. Metoprolol (Lopressor, Toprol)
C. Carvedilol (Coreg)
D. Clopidogrel (Plavix)
E. Tissue plasminogen activator (tPA) Correct Answer
Enoxaparin
Enoxaparin is eliminated mostly by the kidneys. When it is
used in patients with severe renal impairment the dosage
must be significantly reduced. For some indications the dose
normally given every 12 hours is given only every 24 hours.
Although some β-blockers require a dosage adjustment,
metoprolol and carvedilol are metabolized by the liver and do
not require dosage adjustment in patients with renal failure.
Clopidogrel is currently recommended at the standard
,dosage for patients with renal failure and acute coronary
syndrome. Thrombolytics like tPA are given at the standard
dosage in renal failure, although hemorrhagic complications
are increased.
A 55-year-old male who has a long history of marginally-controlled
hypertension presents with gradually increasing shortness of
breath and reduced exercise tolerance. His physical examination
is normal except for a blood pressure of 140/90 mm Hg, bilateral
basilar rales, and trace pitting edema. What study would be the
preferred diagnostic tool for evaluating this patient? Correct
Answer 2-dimensional echocardiography with Doppler
The most useful diagnostic tool for evaluating patients with
heart failure is two-dimensional echocardiography with
Doppler to assess left ventricular ejection fraction (LVEF),
left ventricular size, ventricular compliance, wall thickness,
and valve function. The test should be performed during the
initial evaluation. Radionuclide ventriculography can be used
to assess LVEF and volumes, and MRI or CT also may
provide information in selected patients. Chest radiography
(posteroanterior and lateral) and 12-lead electrocardiography
should be performed in all patients presenting with heart
failure, but should not be used as the primary basis for
determining which abnormalities are responsible for the
heart failure.
,A 23-year-old female sees you with a complaint of intermittent
irregular heartbeats that occur once every week or two, but do not
cause her to feel lightheaded or fatigued. They last only a few
seconds and resolve spontaneously. She has never passed out,
had chest pain, or had difficulty with exertion. She is otherwise
healthy, and a physical examination is normal. What cardiac study
should be ordered initially? Correct Answer EKG
The symptom of an increased or abnormal sensation of one's
heartbeat is referred to as palpitations. This condition is
common to primary care, but is often benign. Commonly,
these sensations have their basis in anxiety or panic.
However, about 50% of those who complain of palpitations
will be found to have a diagnosable cardiac condition. It is
recommended to start the evaluation for cardiac causes with
an EKG, which will assess the baseline rhythm and screen
for signs of chamber enlargement, previous myocardial
infarction, conduction disturbances, and a prolonged QT
interval.
What is most appropriate for the initial treatment of claudication?
Correct Answer regular exercise
Claudication is exercise-induced lower-extremity pain that is
caused by ischemia and relieved by rest. It affects 10% of
persons over 70 years of age. However, up to 90% of patients
with peripheral vascular disease are asymptomatic. Initial
treatment should consist of vigorous risk factor modification
, and exercise. Patients who follow an exercise regimen can
increase their walking time by 150%. A supervised program
may produce better results. Risk factors include diabetes
mellitus, hypertension, smoking, and hyperlipidemia.
In a patient who presents with symptoms of acute myocardial
infarction, which one of the following would be an indication for
thrombolytic therapy?
A. New-onset ST-segment depression
B. New-onset left bundle branch block
C. New-onset first degree atrioventricular block
D. New-onset Wenckebach second degree heart block
E. Frequent unifocal ventricular ectopic beats Correct Answer
New-onset left bundle branch block
In patients with ischemic chest pain, the EKG is important for
determining the need for fibrinolytic therapy. Myocardial
infarction is diagnosed by ST elevation ≥1 mm in two or more
limb leads and ≥2 mm in two or more contiguous precordial
leads. In a patient with an MI, new left bundle branch block
suggests occlusion of the left anterior descending artery,
placing a significant portion of the left ventricle in jeopardy.
Thrombolytic therapy could be harmful in patients with
ischemia but not infarction - they will show ST-segment
depression only. Frequent unifocal ventricular ectopy may
warrant antiarrhythmic therapy, but not thrombolytic therapy.
