Family Med Aquifer Questions and answers
2025\2026 A+ Grade
A 34-year-old cisgender female who has no past medical problems and is not currently taking any
medications comes into your office because she noticed a tender lump in her left breast starting
approximately one month ago. She is worried because she has a maternal aunt who had breast cancer
that was BRCA positive, though her mother is BRCA negative. Her periods have been regular since they
started at the age of 13 and occur every 32 days. She is currently menstruating. She has three children,
aged 12, 9, and 4. On exam, her BMI is 32, up from 28 three years ago, and her other vital signs are
stable. On breast exam, you note a mobile rubbery mass approximately 1 x 1cm that has regular borders
and is tender to palpation. You appreciate no axillary adenopathy. The rest of her physical exam is
unremarkable. Of the information provided, which of the following puts this patient at increased risk for
breast cancer?
A. Age
B.
- correct answer E. Weight
A 64-year-old cisgender female who is overweight with well-controlled hypertension comes to your
office with concerns of a lump in her breast that she noticed while showering. She reports having no
pain, tenderness, or skin changes. A pertinent review of systems is negative. Menarche began at the age
of 10. Her first child was born when she was 31 and she had her second and last child at the age of 33.
She experienced menopause at the age of 44. Her mother died of colon cancer when she was 65 and her
father passed away from metastatic prostate cancer at the age of 70. She has no history of tobacco use
ever and occasionally drinks a glass of wine with dinner. Her BMI is 34. Which of the information
provided thus far puts the patient at decreased risk for breast cancer?
A. Age
B. Age at first birth
C. Age at menarche
D. Age at menopause
E. Weight
- correct answer D. Age at menopause
A 63-year old cisgender female comes into your office for her annual preventive exam. She has
hypertension and type 2 diabetes. She is not sexually active. Her blood pressure is 125/80 and her
,physical exam otherwise is within normal limits. You recommend influenza and zoster vaccination. Her
last colonoscopy was eight years ago and her last mammogram one year ago; both were normal. She
has never had an abnormal Pap test. At the age of 45 she had a total hysterectomy for fibroids. Of the
details provided about this patient, which is an appropriate reason to explain why she does not need a
Pap test today?
A. She experienced menopause more than 10 years ago
B. She had a total hysterectomy for fibroids
C. She has never had an abnormal Pap test
D. She is 63 years old
E. She is not sexually active
- correct answer B. She had a total hysterectomy for fibroids
A 47-year-old cisgender female comes into your office for a health care maintenance exam. She has
hypertension and type 2 diabetes. She is not sexually active and has not yet experienced menopause.
There is no family history of cancer. Her blood pressure is 118/78, her BMI is 34, and the remainder of
her physical exam is within normal limits. Her vaccinations are up to date, and she has a Pap test today
and will have labs drawn. According to USPSTF, which of the following is the best recommendation to
give her concerning mammography?
A. Should have started at age 40 and every year thereafter
B. Should have started at age 40 and every two years thereafter
C. Should have started at age 45 and every year thereafter
D. Start at age 50 and every year thereafter
E. Start at age 50 and every two years thereafter
- correct answer E. Start at age 50 and every two years thereafter
A 25-year-old patient presents to the office for follow-up on anxiety and tobacco dependence. She
reports she is doing well on her new medication to help with both her mood and smoking, though she
continues to smoke. She recently started her first sexual relationship with a new female partner. She
received a tetanus vaccine at the age of 18, and she received her flu vaccine this year. Her blood
pressure is 122/70, and her physical exam is within normal limits. You review her recent Pap test, which
was negative. Which of the following indicates the vaccines she should receive today?
Choose the single best answer.
A. HPV vaccine alone
B. HPV vaccine and pneumococcal conjugate vaccine (PCV13)
,C. HPV vaccine and pneumococcal polysaccharide vaccine (PPSV23)
D. HPV vaccine and Zoster vaccine
E. No vaccines are needed
- correct answer C. HPV vaccine and pneumococcal polysaccharide vaccine (PPSV23)
A 55-year-old male with no significant past medical history presents for a routine physical exam. He last
saw a doctor five years ago. Social history is remarkable for a 35-pack-year tobacco history since the age
of 20. He indicates that his wife and children have urged him to quit smoking for the last few months.
When you ask him if he has considered quitting, he replies, "I just don't see what the big deal is!"
Which stage of change best describes this patient at this time?
A. Action
B. Contemplation
C. Maintenance
D. Precontemplation
E. Preparation
- correct answer D. Precontemplation
A 48-year-old male with a past medical history that includes hypertension, chronic obstructive
pulmonary disease (COPD), and hyperlipidemia presents to the clinic as a new patient in October for a
general physical exam. History reveals that he has been smoking a pack of cigarettes daily since age 20.
He drinks two beers daily. He is intermittently nonadherent with his medications. A review of the state
immunization database reveals that the only immunization he has received as an adult was a tetanus
diphtheria shot administered 12 years ago.
Which of the following vaccine combinations would be most appropriate for this patient?
A. Influenza, meningococcal, and zoster
B. Influenza, pneumococcal, and Tdap
C. Influenza, zoster, and Tdap
D. Meningococcal, pneumococcal, and Tdap
E. Meningococcal, pneumococcal, and zoster
- correct answer B. Influenza, pneumococcal, and Tdap
, A 55-year-old male comes to the clinic for a visit. He has read about the dangers of being overweight
and inquires about which category he fits into. He is 177.8 cm (70 in) and weighs 99.8 kgs (220 lbs), BMI
= 31.6.
Which of the following categories most accurately describes the patient based on his BMI?
A. Ideal
B. Morbidly (very severely) obese
C. Obese
D. Overweight
E. Underweight
- correct answer C. Obese
A 55-year-old male with a family history of melanoma presents to the clinic for evaluation of a skin
lesion on his back that appeared three months ago. His wife first alerted him to it, hasn't noticed it
change and he has not noticed any symptoms associated with it. Physical examination reveals a 7 mm
uniformly black macule that is symmetrically round with sharply demarcated borders on his upper back
near the right shoulder.
Which of the following characteristics would most justify it being biopsied today?
A. Borders
B. Color
C. Diameter
D. Location
E. Symmetry
- correct answer C. Diameter
A 55-year-old male with no significant past medical history and generally healthy behaviors presents to
the clinic for a health care maintenance exam. He says, "I'd like to get tested for all types of cancer." He
does not have any family history of cancer. Review of systems is negative for any symptoms of prostate
cancer, such as urinary frequency, urgency, retention, hematuria, weight loss, or back pain. He is a
lifelong non-smoker, and he doesn't drink alcohol or use recreational drugs.
Which of the following screening tests is given either a USPSTF A or B recommendation in favor of its
routine use for patients such as this one?
A. Colon cancer screening
B. ECG screening for coronary artery disease
2025\2026 A+ Grade
A 34-year-old cisgender female who has no past medical problems and is not currently taking any
medications comes into your office because she noticed a tender lump in her left breast starting
approximately one month ago. She is worried because she has a maternal aunt who had breast cancer
that was BRCA positive, though her mother is BRCA negative. Her periods have been regular since they
started at the age of 13 and occur every 32 days. She is currently menstruating. She has three children,
aged 12, 9, and 4. On exam, her BMI is 32, up from 28 three years ago, and her other vital signs are
stable. On breast exam, you note a mobile rubbery mass approximately 1 x 1cm that has regular borders
and is tender to palpation. You appreciate no axillary adenopathy. The rest of her physical exam is
unremarkable. Of the information provided, which of the following puts this patient at increased risk for
breast cancer?
A. Age
B.
- correct answer E. Weight
A 64-year-old cisgender female who is overweight with well-controlled hypertension comes to your
office with concerns of a lump in her breast that she noticed while showering. She reports having no
pain, tenderness, or skin changes. A pertinent review of systems is negative. Menarche began at the age
of 10. Her first child was born when she was 31 and she had her second and last child at the age of 33.
She experienced menopause at the age of 44. Her mother died of colon cancer when she was 65 and her
father passed away from metastatic prostate cancer at the age of 70. She has no history of tobacco use
ever and occasionally drinks a glass of wine with dinner. Her BMI is 34. Which of the information
provided thus far puts the patient at decreased risk for breast cancer?
A. Age
B. Age at first birth
C. Age at menarche
D. Age at menopause
E. Weight
- correct answer D. Age at menopause
A 63-year old cisgender female comes into your office for her annual preventive exam. She has
hypertension and type 2 diabetes. She is not sexually active. Her blood pressure is 125/80 and her
,physical exam otherwise is within normal limits. You recommend influenza and zoster vaccination. Her
last colonoscopy was eight years ago and her last mammogram one year ago; both were normal. She
has never had an abnormal Pap test. At the age of 45 she had a total hysterectomy for fibroids. Of the
details provided about this patient, which is an appropriate reason to explain why she does not need a
Pap test today?
A. She experienced menopause more than 10 years ago
B. She had a total hysterectomy for fibroids
C. She has never had an abnormal Pap test
D. She is 63 years old
E. She is not sexually active
- correct answer B. She had a total hysterectomy for fibroids
A 47-year-old cisgender female comes into your office for a health care maintenance exam. She has
hypertension and type 2 diabetes. She is not sexually active and has not yet experienced menopause.
There is no family history of cancer. Her blood pressure is 118/78, her BMI is 34, and the remainder of
her physical exam is within normal limits. Her vaccinations are up to date, and she has a Pap test today
and will have labs drawn. According to USPSTF, which of the following is the best recommendation to
give her concerning mammography?
A. Should have started at age 40 and every year thereafter
B. Should have started at age 40 and every two years thereafter
C. Should have started at age 45 and every year thereafter
D. Start at age 50 and every year thereafter
E. Start at age 50 and every two years thereafter
- correct answer E. Start at age 50 and every two years thereafter
A 25-year-old patient presents to the office for follow-up on anxiety and tobacco dependence. She
reports she is doing well on her new medication to help with both her mood and smoking, though she
continues to smoke. She recently started her first sexual relationship with a new female partner. She
received a tetanus vaccine at the age of 18, and she received her flu vaccine this year. Her blood
pressure is 122/70, and her physical exam is within normal limits. You review her recent Pap test, which
was negative. Which of the following indicates the vaccines she should receive today?
Choose the single best answer.
A. HPV vaccine alone
B. HPV vaccine and pneumococcal conjugate vaccine (PCV13)
,C. HPV vaccine and pneumococcal polysaccharide vaccine (PPSV23)
D. HPV vaccine and Zoster vaccine
E. No vaccines are needed
- correct answer C. HPV vaccine and pneumococcal polysaccharide vaccine (PPSV23)
A 55-year-old male with no significant past medical history presents for a routine physical exam. He last
saw a doctor five years ago. Social history is remarkable for a 35-pack-year tobacco history since the age
of 20. He indicates that his wife and children have urged him to quit smoking for the last few months.
When you ask him if he has considered quitting, he replies, "I just don't see what the big deal is!"
Which stage of change best describes this patient at this time?
A. Action
B. Contemplation
C. Maintenance
D. Precontemplation
E. Preparation
- correct answer D. Precontemplation
A 48-year-old male with a past medical history that includes hypertension, chronic obstructive
pulmonary disease (COPD), and hyperlipidemia presents to the clinic as a new patient in October for a
general physical exam. History reveals that he has been smoking a pack of cigarettes daily since age 20.
He drinks two beers daily. He is intermittently nonadherent with his medications. A review of the state
immunization database reveals that the only immunization he has received as an adult was a tetanus
diphtheria shot administered 12 years ago.
Which of the following vaccine combinations would be most appropriate for this patient?
A. Influenza, meningococcal, and zoster
B. Influenza, pneumococcal, and Tdap
C. Influenza, zoster, and Tdap
D. Meningococcal, pneumococcal, and Tdap
E. Meningococcal, pneumococcal, and zoster
- correct answer B. Influenza, pneumococcal, and Tdap
, A 55-year-old male comes to the clinic for a visit. He has read about the dangers of being overweight
and inquires about which category he fits into. He is 177.8 cm (70 in) and weighs 99.8 kgs (220 lbs), BMI
= 31.6.
Which of the following categories most accurately describes the patient based on his BMI?
A. Ideal
B. Morbidly (very severely) obese
C. Obese
D. Overweight
E. Underweight
- correct answer C. Obese
A 55-year-old male with a family history of melanoma presents to the clinic for evaluation of a skin
lesion on his back that appeared three months ago. His wife first alerted him to it, hasn't noticed it
change and he has not noticed any symptoms associated with it. Physical examination reveals a 7 mm
uniformly black macule that is symmetrically round with sharply demarcated borders on his upper back
near the right shoulder.
Which of the following characteristics would most justify it being biopsied today?
A. Borders
B. Color
C. Diameter
D. Location
E. Symmetry
- correct answer C. Diameter
A 55-year-old male with no significant past medical history and generally healthy behaviors presents to
the clinic for a health care maintenance exam. He says, "I'd like to get tested for all types of cancer." He
does not have any family history of cancer. Review of systems is negative for any symptoms of prostate
cancer, such as urinary frequency, urgency, retention, hematuria, weight loss, or back pain. He is a
lifelong non-smoker, and he doesn't drink alcohol or use recreational drugs.
Which of the following screening tests is given either a USPSTF A or B recommendation in favor of its
routine use for patients such as this one?
A. Colon cancer screening
B. ECG screening for coronary artery disease
