6 free, board-style Family Medicine End of Rotation questions — each with the correct answer and a complete explanation. No email, no account required.
Mapped to the clinician-reviewed FirstPassPA bank and the 2026 PAEA Family Medicine blueprint. Attempt each one before you reveal the answer.
Question 1CardiovascularEasy
A 58-year-old man with no prior medical history has BP 148/92 mmHg on two separate readings after 3 months of lifestyle modification. He has no diabetes mellitus or chronic kidney disease. Which medication is most appropriate to initiate?
AMetoprolol
BSpironolactone
CAmlodipine
DDoxazosin
Reveal answer & full explanation
Correct answer: C — Amlodipine
AMetoprolol
BSpironolactone
CAmlodipine✓
DDoxazosin
Why Amlodipine is correct
American College of Cardiology/American Heart Association (ACC/AHA) 2017 guidelines recommend thiazide diuretics, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs), or calcium channel blockers (CCBs) as first-line for non-Black patients with stage 2 hypertension (HTN) without compelling indications.
Amlodipine is a CCB and therefore falls within the first-line options.
Why the others are wrong
Metoprolol — beta-blockers are no longer first-line for uncomplicated HTN unless there is a compelling indication such as heart failure (HF), post-myocardial infarction (MI), or angina.
Spironolactone — a fourth-line/resistant-HTN agent, not appropriate for initial therapy.
Doxazosin — alpha-blockers are not first-line for hypertension.
Question 2GastrointestinalEasy
A 45-year-old man presents with 6 weeks of heartburn worse after meals and when lying down. He has no dysphagia, weight loss, or anemia. Which is the most appropriate initial treatment?
AFamotidine 20 mg twice daily for 8 weeks
BOmeprazole 20 mg daily for 8 weeks
CSucralfate 1 g four times daily for 8 weeks
DMetoclopramide 10 mg four times daily for 8 weeks
Reveal answer & full explanation
Correct answer: B — Omeprazole 20 mg daily for 8 weeks
AFamotidine 20 mg twice daily for 8 weeks
BOmeprazole 20 mg daily for 8 weeks✓
CSucralfate 1 g four times daily for 8 weeks
DMetoclopramide 10 mg four times daily for 8 weeks
Why Omeprazole 20 mg daily for 8 weeks is correct
Uncomplicated gastroesophageal reflux disease (GERD) — defined by the absence of alarm symptoms (dysphagia, weight loss, anemia, age over 60 with new onset) — is treated empirically with a proton pump inhibitor (PPI) for 8 weeks.
PPIs are superior to H2 blockers for healing erosive esophagitis.
Why the others are wrong
Famotidine 20 mg twice daily for 8 weeks — famotidine is an H2 blocker and is inferior to PPIs for healing erosive esophagitis.
Sucralfate 1 g four times daily for 8 weeks — provides mucosal coating but is inferior to PPIs for GERD.
Metoclopramide 10 mg four times daily for 8 weeks — a prokinetic with significant CNS side effects; not first-line for GERD.
Additional high-yield points
Endoscopy and antireflux surgery are reserved for alarm symptoms or refractory disease.
Question 3RenalEasy
A 32-year-old woman has 3 days of dysuria, frequency, and suprapubic discomfort. She denies fever or flank pain. Urine dipstick shows nitrites and leukocyte esterase positive. Local Escherichia coli resistance to trimethoprim-sulfamethoxazole exceeds 20%. Which is the most appropriate treatment?
ATrimethoprim-sulfamethoxazole (TMP-SMX) double strength (DS) BID x3 days
BNitrofurantoin 100mg BID x5 days
CCiprofloxacin 500mg BID x7 days
DAmoxicillin 500mg three times daily (TID) x7 days
Reveal answer & full explanation
Correct answer: B — Nitrofurantoin 100mg BID x5 days
ATrimethoprim-sulfamethoxazole (TMP-SMX) double strength (DS) BID x3 days
BNitrofurantoin 100mg BID x5 days✓
CCiprofloxacin 500mg BID x7 days
DAmoxicillin 500mg three times daily (TID) x7 days
Why Nitrofurantoin 100mg BID x5 days is correct
For uncomplicated cystitis, nitrofurantoin macrocrystals 100 mg BID x5 days and TMP-SMX DS BID x3 days are both first-line agents.
Nitrofurantoin is preferred when local TMP-SMX resistance exceeds 20%, as specified in this case.
Why the others are wrong
Trimethoprim-sulfamethoxazole (TMP-SMX) double strength (DS) BID x3 days — TMP-SMX is first-line only when local Escherichia coli resistance is below 20%; local resistance exceeds 20% here, making it an inappropriate choice.
Ciprofloxacin 500mg BID x7 days — a fluoroquinolone reserved for pyelonephritis or complicated urinary tract infection (UTI), not uncomplicated cystitis.
Amoxicillin 500mg three times daily (TID) x7 days — has high E. coli resistance and is not recommended for uncomplicated cystitis.
Question 4PsychiatryMedium
A 28-year-old woman has 2 weeks of low mood, anhedonia, poor sleep, fatigue, and difficulty concentrating. She denies suicidal ideation (SI). Patient Health Questionnaire-9 (PHQ-9) score is 14 (moderate). Which is the most appropriate initial pharmacologic treatment?
ASertraline
BMirtazapine
CBupropion
DAmitriptyline
Reveal answer & full explanation
Correct answer: A — Sertraline
ASertraline✓
BMirtazapine
CBupropion
DAmitriptyline
Why Sertraline is correct
For moderate depression (PHQ-9 score 10–19), first-line pharmacotherapy is a selective serotonin reuptake inhibitor (SSRI) such as sertraline or escitalopram, ideally combined with cognitive behavioral therapy (CBT).
Why the others are wrong
Mirtazapine — an alternative often used when sedation or appetite stimulation is desired, but carries more weight-gain risk; not first-line.
Bupropion — reasonable as monotherapy but generally avoided when anxiety, insomnia, or seizure risk is prominent.
Amitriptyline — a tricyclic antidepressant (TCA); not first-line because of anticholinergic side effects and lethality in overdose.
Question 5PulmonaryEasy
A 55-year-old man with a 30 pack-year history who currently smokes presents for a routine visit. He has no respiratory symptoms. Which lung cancer screening modality is most appropriate?
AAnnual chest radiograph
BSputum cytology
CAnnual MRI of the chest
DAnnual low-dose CT
Reveal answer & full explanation
Correct answer: D — Annual low-dose CT
AAnnual chest radiograph
BSputum cytology
CAnnual MRI of the chest
DAnnual low-dose CT✓
Why Annual low-dose CT is correct
United States Preventive Services Task Force (USPSTF) recommends annual low-dose CT for adults aged 50–80 with a 20+ pack-year history who currently smoke or quit within the past 15 years
This patient meets all criteria
Why the others are wrong
A) Annual chest radiograph — chest radiograph is not effective for lung cancer screening
B) Sputum cytology — sputum cytology has poor positive predictive value for lung cancer screening
Question 6EndocrineMedium
A 44-year-old woman with BMI 34 and Type 2 diabetes mellitus (T2DM) has tried diet and exercise for 12 months without success. Hemoglobin A1c (HbA1c) is 7.8%. Which pharmacologic agent provides the most benefit for both weight loss and glycemic control?
ASemaglutide
BGlipizide
CPioglitazone
DSitagliptin
Reveal answer & full explanation
Correct answer: A — Semaglutide
ASemaglutide✓
BGlipizide
CPioglitazone
DSitagliptin
Why Semaglutide is correct
Glucagon-like peptide-1 (GLP-1) receptor agonists (semaglutide, liraglutide) reduce HbA1c by 1–2% and produce 10–15% body weight reduction
This makes them ideal for patients with T2DM and obesity
Why the others are wrong
B) Glipizide — sulfonylureas (glipizide) lower HbA1c but cause weight gain and hypoglycemia
C) Pioglitazone — pioglitazone lowers HbA1c but causes weight gain and fluid retention
D) Sitagliptin — DPP-4 inhibitors (sitagliptin) are weight-neutral but produce only modest HbA1c reductions (~0.5–0.8%) and do not promote weight loss
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Are these Family Medicine EOR practice questions free?
Yes. Every question here shows the full vignette, the correct answer, and a complete explanation with no email or account required. A free 7-day trial unlocks the full 5,500+ question bank, all seven EOR rotations, flashcards, and an AI tutor.
Are these questions aligned with the 2026 Family Medicine EOR blueprint?
Yes. They are drawn from the clinician-reviewed FirstPassPA bank, mapped to the NCCPA/PAEA blueprint and this rotation's content areas. PAEA's updated End of Rotation exams take effect July 27, 2026; see what changed on the Family Medicine exam on our blueprint-changes page.
How should I use these Family Medicine EOR practice questions?
Attempt each vignette before revealing the answer, then read the full explanation even when you get it right — the reasoning for why the distractors are wrong is where most of the learning is. Then practice focused, blueprint-weighted question blocks in the app as your exam date nears.
Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants.