Family Medicine Question Bank

Read the Family Medicine Question Bank sample questions

1. 1.According to ACC/AHA blood pressure thresholds, stage 2 hypertension is defined as an office blood pressure of at least which value?

   • A.130/80 mm Hg
   • B.120/80 mm Hg
   • C.140/90 mm HgCorrect
   • D.160/100 mm Hg

   Why: Stage 2 hypertension is defined as systolic 140 mm Hg or higher or diastolic 90 mm Hg or higher. Stage 1 is 130-139/80-89, and elevated BP is 120-129 with diastolic under 80. Diagnosis should rest on the average of multiple properly measured readings.

2. 2.A 55-year-old Black man has uncomplicated stage 2 hypertension and no other comorbidities. Which is the most appropriate initial antihypertensive?

   • A.Thiazide-type diuretic (chlorthalidone)Correct
   • B.Lisinopril
   • C.Metoprolol
   • D.Doxazosin

   Why: For Black patients without heart failure or CKD, initial therapy with a thiazide-type diuretic or calcium channel blocker is preferred because these classes produce greater BP lowering in this group. Beta blockers and alpha blockers are not first-line for uncomplicated hypertension.

3. 3.A 60-year-old with type 2 diabetes has a blood pressure of 145/90 mm Hg and moderately increased albuminuria. Which is the best initial antihypertensive?

   • A.Amlodipine
   • B.Hydrochlorothiazide
   • C.Metoprolol
   • D.LisinoprilCorrect

   Why: In patients with diabetes and albuminuria, an ACE inhibitor or ARB is preferred because it reduces albuminuria and slows progression of diabetic kidney disease. These agents provide organ protection beyond blood pressure lowering alone.

4. 4.A patient's blood pressure remains above goal despite maximally dosed lisinopril, amlodipine, and chlorthalidone taken correctly. Which add-on agent is preferred for resistant hypertension?

   • A.Clonidine
   • B.SpironolactoneCorrect
   • C.Hydralazine
   • D.Terazosin

   Why: When BP is uncontrolled on three agents including a diuretic, adding a mineralocorticoid receptor antagonist such as spironolactone is the preferred fourth-line step. Occult aldosterone excess commonly contributes to resistant hypertension, so this class is particularly effective.

5. 5.A patient has repeatedly elevated office blood pressure readings but reports normal readings at home. Which is the best way to confirm the diagnosis?

   • A.Ambulatory blood pressure monitoringCorrect
   • B.Immediately start an ACE inhibitor
   • C.Order an echocardiogram
   • D.Order renal artery ultrasound

   Why: Ambulatory or validated home blood pressure monitoring distinguishes true hypertension from white-coat hypertension and is recommended before committing to lifelong therapy. Confirming out-of-office readings prevents overtreatment.

6. 6.An asymptomatic patient has a blood pressure of 210/120 mm Hg with no evidence of acute target-organ damage. Which is the most appropriate management?

   • A.Intravenous nitroprusside infusion
   • B.Immediate ICU admission
   • C.Intravenous labetalol boluses
   • D.Oral antihypertensive therapy with close outpatient follow-upCorrect

   Why: Severe asymptomatic hypertension (hypertensive urgency) without acute organ damage is managed with gradual blood pressure reduction using oral agents and close follow-up, not rapid intravenous lowering. Precipitous reduction can cause ischemic complications.

7. 7.A patient with resistant hypertension is found to have spontaneous, unprovoked hypokalemia. Which is the most likely secondary cause?

   • A.Pheochromocytoma
   • B.Primary hyperaldosteronismCorrect
   • C.Renal artery stenosis
   • D.Cushing syndrome

   Why: The combination of resistant hypertension and spontaneous hypokalemia strongly suggests primary hyperaldosteronism. Screening is performed with a plasma aldosterone-to-renin ratio.

8. 8.A pregnant woman with chronic hypertension needs pharmacologic treatment. Which agent is contraindicated?

   • A.Labetalol
   • B.Nifedipine
   • C.LisinoprilCorrect
   • D.Methyldopa

   Why: ACE inhibitors and ARBs are contraindicated in pregnancy because of fetal renal and developmental toxicity. Labetalol, nifedipine, and methyldopa are considered safe first-line options.

9. 9.A 30-year-old woman has resistant hypertension and an abdominal bruit. Which is the most likely underlying cause?

   • A.Primary aldosteronism
   • B.Coarctation of the aorta
   • C.Pheochromocytoma
   • D.Fibromuscular dysplasia causing renal artery stenosisCorrect

   Why: In a young woman, renovascular hypertension from fibromuscular dysplasia is a classic cause of secondary hypertension and may produce an abdominal bruit. Imaging of the renal arteries confirms the diagnosis.

10. 10.What is the general blood pressure target for most adults with hypertension to reduce cardiovascular risk?

    • A.Less than 150/90 mm Hg
    • B.Less than 130/80 mm HgCorrect
    • C.Less than 120/70 mm Hg
    • D.Less than 140/90 mm Hg

    Why: Current guidelines recommend a target below 130/80 mm Hg for most adults, including those with diabetes or established cardiovascular disease, when it can be achieved safely. Individualization is appropriate for frail elderly patients.