Family Medicine Certification Longitudinal Assessment (FMCLA) — Questions and Answers

Question 1: A 35-year-old presents with well-demarcated, erythematous plaques with silvery scales on the elbows and knees. The most likely diagnosis is:

Pityriasis rosea
Psoriasis vulgaris (Correct answer)
Lichen planus
Nummular eczema

Correct answer: Psoriasis vulgaris

Psoriasis vulgaris classically presents with well-demarcated erythematous plaques covered with silvery-white scales on extensor surfaces such as elbows and knees.

Question 2: A patient presents with suspected deep vein thrombosis. Which scoring system should be applied before ordering imaging?

Ottawa rules
CHADS2 score
CURB-65 score
Wells criteria (Correct answer)

Correct answer: Wells criteria

The Wells criteria stratify pretest probability for DVT and guide the decision to perform D-dimer testing or duplex ultrasound.

Question 3: What is the CHA2DS2-VASc score used to determine in patients with atrial fibrillation?

Appropriate antiarrhythmic drug selection
Risk of stroke and need for anticoagulation (Correct answer)
Rate vs. rhythm control strategy
Need for cardioversion

Correct answer: Risk of stroke and need for anticoagulation

The CHA2DS2-VASc score estimates thromboembolic stroke risk in AF patients and guides the decision to initiate anticoagulation.

Question 4: A 45-year-old woman presents with persistent facial erythema, flushing, and papulopustules on the cheeks and nose. She reports triggers including alcohol and spicy foods. The most likely diagnosis is:

Systemic lupus erythematosus
Seborrheic dermatitis
Acne vulgaris
Rosacea (Correct answer)

Correct answer: Rosacea

Rosacea presents with centrofacial erythema, flushing, and papulopustules without comedones, commonly triggered by alcohol, spicy foods, heat, and sun exposure.

Question 5: Which of the following screening tools is commonly used to assess for anxiety disorders in primary care settings?

CAGE questionnaire
PHQ-9
Beck Depression Inventory
GAD-7 (Correct answer)

Correct answer: GAD-7

The GAD-7 (Generalized Anxiety Disorder 7-item scale) is a widely used and validated screening tool specifically designed to assess for anxiety disorders in primary care settings. It helps clinicians quickly identify and gauge the severity of generalized anxiety symptoms. While other tools like PHQ-9 screen for depression, GAD-7 focuses on anxiety.

Question 6: A 35-year-old female presents with right lower quadrant pain, nausea, and fever. The Alvarado score is 8. What is the next step?

Abdominal X-ray
Urgent surgical consultation (Correct answer)
Repeat exam in 4 hours
Discharge with oral antibiotics

Correct answer: Urgent surgical consultation

An Alvarado score of 7–10 indicates high likelihood of appendicitis and warrants urgent surgical consultation.

Question 7: A 60-year-old male presents with sudden painless vision loss in one eye. Which diagnosis must be ruled out immediately?

Central retinal artery occlusion (Correct answer)
Refractive error
Open-angle glaucoma
Diabetic macular edema

Correct answer: Central retinal artery occlusion

Central retinal artery occlusion is an ophthalmic emergency requiring immediate treatment within hours to restore vision.

Question 8: Which preventive measure is recommended to reduce the risk of cardiovascular disease in adults with a high cardiovascular risk?

Daily multivitamin use
Routine use of antibiotics
Regular physical activity (Correct answer)
Daily sugar consumption

Correct answer: Regular physical activity

Regular physical activity is a cornerstone preventive measure highly recommended to reduce the risk of cardiovascular disease (CVD) in adults with high cardiovascular risk. Engaging in moderate-intensity aerobic activity for at least 150 minutes per week can significantly improve blood pressure, cholesterol levels, and glucose metabolism. These physiological benefits collectively lower the overall risk of heart attacks, strokes, and other CVD events.

Question 9: A 22-year-old presents with scaling, pruritic patches in the groin. KOH preparation reveals hyphae. The most appropriate treatment is:

Topical corticosteroid alone
Topical antibacterial cream
Oral acyclovir
Topical antifungal such as clotrimazole (Correct answer)

Correct answer: Topical antifungal such as clotrimazole

Tinea cruris is a dermatophyte infection confirmed by KOH prep showing hyphae; topical antifungals such as clotrimazole are first-line treatment.

Question 10: A patient presents with acute monoarthritis of the first MTP joint with overlying erythema and severe pain. Synovial fluid shows negatively birefringent crystals. The diagnosis is:

Rheumatoid arthritis
Gout (Correct answer)
Septic arthritis
Pseudogout

Correct answer: Gout

Gout is caused by monosodium urate crystals, which appear needle-shaped and negatively birefringent under polarized light microscopy.

Question 11: First-line treatment for acute uncomplicated low back pain in a 40-year-old without neurological deficits includes:

Lumbar MRI immediately
Opioid analgesics
Bed rest for 2 weeks
NSAIDs and continued activity (Correct answer)

Correct answer: NSAIDs and continued activity

NSAIDs combined with continued physical activity are evidence-based first-line treatments for acute low back pain without red flags.

Question 12: At what age is it recommended to start routine screening for autism spectrum disorder (ASD) in children?

24 months
12 months
36 months
18 months (Correct answer)

Correct answer: 18 months

The American Academy of Pediatrics (AAP) recommends routine screening for autism spectrum disorder (ASD) in children at 18 months and 24 months of age. This universal screening is crucial for early detection, even in the absence of specific concerns. Early identification allows for prompt intervention, which has been shown to significantly improve developmental outcomes for children with ASD.

Question 13: What is the pathophysiology underlying hypoxemia in pulmonary embolism?

Decreased respiratory drive
Airway obstruction
Ventilation-perfusion (V/Q) mismatch (Correct answer)
Alveolar flooding

Correct answer: Ventilation-perfusion (V/Q) mismatch

PE causes dead space ventilation (ventilated but unperfused alveoli), resulting in V/Q mismatch and subsequent hypoxemia.

Question 14: What defines severe preeclampsia apart from hypertension?

Severe-range BP (≥160/110) plus end-organ damage (Correct answer)
Edema of the ankles
Mild proteinuria only
Weight gain of 2 lb/week

Correct answer: Severe-range BP (≥160/110) plus end-organ damage

Severe preeclampsia is defined by BP ≥160/110 mmHg or evidence of end-organ damage (renal, hepatic, neurologic, hematologic).

Question 15: Which medication is recommended for prophylaxis against altitude sickness when ascending rapidly above 8,000 feet?

Acetazolamide (Correct answer)
Dexamethasone
Ibuprofen
Furosemide

Correct answer: Acetazolamide

Acetazolamide (Diamox) accelerates acclimatization and is the first-line prophylactic agent for acute mountain sickness.

Question 16: Which medication is first-line for rate control in a patient with atrial fibrillation with rapid ventricular response?

Amiodarone
Digoxin
Metoprolol (Correct answer)
Flecainide

Correct answer: Metoprolol

Beta-blockers such as metoprolol or calcium channel blockers (diltiazem) are first-line for ventricular rate control in atrial fibrillation.

Question 17: Which electrolyte abnormality is most commonly associated with prolonged QT interval on ECG?

Hyponatremia
Hypernatremia
Hyperkalemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Hypokalemia prolongs the QT interval and increases the risk of life-threatening arrhythmias including torsades de pointes.

Question 18: Which validated tool is most commonly used to screen for cognitive impairment in a primary care setting?

Mini-Cog (Correct answer)
Braden Scale
GAD-7
PHQ-9

Correct answer: Mini-Cog

The Mini-Cog combines a 3-item recall and clock-drawing test, providing a brief and validated dementia screening tool.

Question 19: At what age is it recommended to start colorectal cancer screening for average-risk individuals?

30 years
45 years (Correct answer)
50 years
40 years

Correct answer: 45 years

Current guidelines from organizations like the American Cancer Society and the U.S. Preventive Services Task Force recommend starting colorectal cancer screening for average-risk individuals at age 45. This age was lowered from 50 due to an increasing incidence of colorectal cancer in younger adults. Early screening allows for the detection and removal of precancerous polyps or early-stage cancer, significantly improving treatment outcomes.

Question 20: De Quervain's tenosynovitis affects which tendons?

Abductor pollicis longus and extensor pollicis brevis (Correct answer)
Flexor pollicis longus and brevis
Extensor pollicis longus and brevis
Extensor digitorum communis

Correct answer: Abductor pollicis longus and extensor pollicis brevis

De Quervain's tenosynovitis involves inflammation of the abductor pollicis longus and extensor pollicis brevis tendons in the first dorsal compartment.

Question 21: Which organism is most commonly responsible for bacterial vaginosis?

Trichomonas vaginalis
Gardnerella vaginalis (Correct answer)
Chlamydia trachomatis
Candida albicans

Correct answer: Gardnerella vaginalis

Gardnerella vaginalis drives the disruption of normal vaginal flora that characterizes bacterial vaginosis.

Question 22: What is the recommended calcium intake per day for adults over 70 to support bone health?

1000 mg
800 mg
1500 mg
1200 mg (Correct answer)

Correct answer: 1200 mg

Adults over 70 require 1200 mg of calcium daily to help offset age-related decreases in calcium absorption and bone density.

Question 23: Which assessment tool evaluates gait and balance to predict fall risk in older adults?

MMSE
Mini-Cog
Katz Index
Timed Up and Go (TUG) test (Correct answer)

Correct answer: Timed Up and Go (TUG) test

The Timed Up and Go test measures the time to rise from a chair, walk 3 meters, turn, and return — a validated predictor of fall risk.

Question 24: Which finding distinguishes cardiac asthma from primary asthma in a patient with wheezing and dyspnea?

Elevated BNP and orthopnea (Correct answer)
Response to bronchodilators
Nocturnal symptoms
Eosinophilia on CBC

Correct answer: Elevated BNP and orthopnea

Elevated BNP and orthopnea indicate a cardiac cause of wheezing (pulmonary edema), distinguishing it from primary asthma.

Question 25: A woman presents with cyclic pelvic pain, dysmenorrhea, and dyspareunia. The most likely diagnosis is:

Uterine fibroids
Pelvic inflammatory disease
Endometriosis (Correct answer)
Ovarian torsion

Correct answer: Endometriosis

The triad of dysmenorrhea, dyspareunia, and cyclic pelvic pain is classic for endometriosis, a common gynecologic condition.

Family Medicine Certification Longitudinal Assessment (FMCLA)

The FMCLA is a continuous board recertification assessment administered by the ABFM, delivering 25 open-book clinical questions per quarter that span acute care, chronic disease management, emergent care, and preventive medicine domains.

100

Questions

120 min

Time Limit

70%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

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