AAFP Family Medicine Board Questions 2025/2026

AAFP Family Medicine Board Exam Questions

1. A 70yo M with h/o HTN and DM presents with a 2-mo h/o increasing parox- ysmal nocturnal dyspnea and SOB with minimal exertion. An echocardiogram shows an ejection fraction of 25%. Which one of the patients current medications should be discontinued? A. Lisinopril (Zestril) B. Pioglitazone (Actos) C. Glipizide (Glucotrol) D. Metoprolol (Toprol-XL): Pioglitzaone thiazolidinediones (TZDs) are associated with fluid retention, and their use can be complicated by the development of heart failure. Caution is necessary when prescribing TZDs in patients with known heart failure or other heart diseases, those with preexisting edema, and those on concurrent insulin therapy 2. What is the most common cause of hypertension in children under 6 years of age?: Renal Parenchymal Disease The most common cause of hypertension is renal parenchymal disease, and a urinalysis, urine culture, and renal ultrasonography should be ordered for all children presenting with hypertension. 3. A 72-year-old African-American male with NewYork Heart Association Class III heart failure sees you for follow-up. He has shortness of breath with min- imal exertion.The patient is adherent to his medication regimen. His current medications include lisinopril (Prinivil, Zestril), 40 mg twice daily; carvedilol (Coreg), 25 mg twice daily; and furosemide (Lasix), 80 mg daily. His blood pressure is 100/60 mm Hg, and his pulse rate is 68 beats/min and regular. Findings include a few scattered bibasilar rales on examination of the lungs, an S3 gallop on examination of the heart, and no edema on examination of the legs. An EKG reveals a left bundle branch block, and echocardiography reveals an ejection fraction of 25%, but no other abnormalities. What's the appropriate next step?: Refer for cardiac resynchronization therapy (CRT) Note: he's already on maximum doses of ACEI, loop diuretic, beta-blocker Using a pacemaker-like device, CRT aims to get both ventricles contracting simul- taneously, overcoming the delayed contraction of the left ventricle caused by the left bundle-branch block. These guidelines were refined by an April 2005 AHA Science Advisory, which stated that optimal candidates for CRT have a dilated cardiomyopa- thy on an ischemic or nonischemic basis, an LVEF d0.35, a QRS complex e120 msec and sinus rhythm, and are NYHA functional class III or IV despite maximal medical therapy for heart failure. 4. What dietary change recommended for the prevention and treatment of cardiovascular disease has been shown to decrease the rate of sudden death?: increase intake of omega 3 fatty acids Omega-3 fats contribute to the production of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which inhibit the inflammatory immune response and platelet aggregation, are mild vasodilators, and may have antiarrhythmic properties. The American Heart Association guidelines state that omega-3 supplements may be recommended to patients with preexisting disease, a high risk of disease, or high triglyceride levels, as well as to patients who do not like or are allergic to fish. The Italian GISSI study found that the use of 850 mg of EPA and DHA daily resulted in decreased rates of mortality, nonfatal myocardial infarction, and stroke, with particular decreases in the rate of sudden death.