AAFP FAMILY MEDICINE (FM) NEWEST
QUESTIONBANK ACTUAL EXAM
QUESTIONS AND DETAILED CORRECT
ANSWERS WITH RATIONALES | 2025
A 60-year-old African-American female has a history of
hypertension that has been well controlled with
hydrochlorothiazide. However, she has developed an allergy to
the medication. Successful monotherapy for her hypertension
would be most likely with which one of the following?
A. Lisinopril (Prinivil, Zestril)
B. Hydralazine (Apresoline)
C. Clonidine (Catapres)
D. Atenolol (Tenormin)
E. Diltiazem (Cardizem) Correct Answer Diltiazem (Cardizem)
Monotherapy for hypertension in African-American patients
is more likely to consist of diuretics or calcium channel
blockers than β-blockers or ACE inhibitors. It has been
suggested that hypertension in African-Americans is not as
angiotensin II-dependent as it appears to be in Caucasians.
A 67-year-old Hispanic male comes to your office with severe
periumbilical abdominal pain, vomiting, and diarrhea which began
suddenly several hours ago. His temperature is 37.0 degrees C
(98.6 degrees F), blood pressure 110/76 mm Hg, and respirations
28/min. His abdomen is slightly distended, soft, and diffusely
tender; bowel sounds are normal. Other findings include clear
lungs, a rapid and irregularly irregular heartbeat, and a pale left
forearm and hand with no palpable left brachial pulse. Right arm
and lower extremity pulses are normal. Urine and stool are both
,positive for blood on chemical testing. His hemoglobin level is
16.4 g/dL (N 13.0-18.0) and his WBC count is 25,300/mm3 (N
4300-10,800). The diagnostic imaging procedure most likely to
produce a specific diagnosis of his abdominal pain is:
A. Intravenous pyelography (IVP)
B. Sonography of the abdominal aorta
C. A barium enema
D. Celiac and mesent Correct Answer Celiac and mesenteric
arteriography
The sudden onset of severe abdominal pain, vomiting, and
diarrhea in a patient with a cardiac source of emboli and
evidence of a separate embolic event makes superior
mesenteric artery embolization likely. In this case, evidence
of a brachial artery embolus and a cardiac rhythm indicating
atrial fibrillation suggest the diagnosis. Some patients may
have a surprisingly normal abdominal examination in spite of
severe pain. Microscopic hematuria and blood in the stool
may both occur with embolization. Severe leukocytosis is
present in more than two-thirds of patients with this problem.
Diagnostic confirmation by angiography is recommended.
Immediate embolectomy with removal of the propagated clot
can then be accomplished and a decision made regarding
whether or not the intestine should be resected. A second
procedure may be scheduled to reevaluate intestinal viability.
An asymptomatic 3-year-old male presents for a routine check-up.
On examination you notice a systolic heart murmur. It is heard
best in the lower precordium and has a low, short tone similar to a
plucked string or kazoo. It does not radiate to the axillae or the
back and seems to decrease with inspiration. The remainder of
the examination is normal. What is the most likely diagnosis?
Correct Answer Still's murmur
,There are several benign murmurs of childhood that have no
association with physiologic or anatomic abnormalities. Of
these, Still's murmur best fits the murmur described. The
cause of Still's murmur is unknown, but it may be due to
vibrations in the chordae tendinae, semilunar valves, or
ventricular wall.
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.
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.
A 68-year-old female has an average blood pressure of 150/70
mm Hg despite appropriate lifestyle modification efforts. Her only
other medical problems are osteoporosis and mild depression.
The most appropriate treatment at this time would be
A. lisinopril (Prinivil, Zestril)
B. clonidine (Catapres)
C. propranolol (Inderal)
D. amlodipine (Norvasc)
E. hydrochlorothiazide Correct Answer HCTZ
Randomized, placebo-controlled trials have shown that
isolated systolic hypertension in the elderly responds best to
diuretics and to a lesser extent, β-blockers. Diuretics are
preferred, although long-acting dihydropyridine calcium
channel blockers may also be used. In the case described, β-
blockers or clonidine may worsen the depression. Thiazide
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