AAFP - Review of Board Review Questions AND ANSWERS| GRADED A
Absolute contraindications to electroconvulsive therapy (ECT) Correct Answer: There are no
absolute contraindications to ECT
Treatment of community acquired pneumonia in infants and children Correct Answer: -
Diagnosis of *community-acquired pneumonia* is mostly based on the history and physical
examination
- Pneumonia should be suspected in any child with *fever, cyanosis, and any abnormal
respiratory finding* in the history or physical examination
- Outpatient antibiotics are appropriate if the child *does not have a toxic appearance,
hypoxemia, signs of respiratory distress, or dehydration*
- *High-dose amoxicillin* is the drug of choice
Current practice is to introduce solid foods into the diet at what age for normal term infants
Correct Answer: 4-6 months of age as the extrusion reflex disappears by the age of 4 months
Treatment of midshaft posteromedial tibial stress fractures Correct Answer: An air stirrup leg
brace (Aircast)
Most appropriate test to screen for late-onset male hypogonadism Correct Answer: Total
testosterone
Treatment of pediatric HSV-1 infection Correct Answer: Acyclovir suspension
Most accurate maneuver for detecting an ACL tear Correct Answer: - Lachman test (sensitivity
60%-100%, mean 84%),
- Anterior drawer test (sensitivity 9%-93%, mean 62%)
- Pivot shift test (sensitivity 27%-95%, mean 62%)
Diagnosis of multiple myeloma is based on Correct Answer: Evidence of myeloma-related end-
organ impairment (hypercalcemia, renal failure, anemia, skeletal lesions) in the presence of M
protein, monoclonal plasma cells, or both
Findings are typical of femoral neuropathy Correct Answer: - History of weakness of the lower
left leg, giving way of the knee, and discomfort in the anterior thigh
- Femoral neuropathy is a mononeuropathy commonly associated with diabetes mellitus
Women who use low-dose estrogen oral contraceptives have a 50% lower risk of cancer of the:
Correct Answer: Ovary
Clinical hallmarks of polymyalgia rheumatica Correct Answer: - Pain and stiffness in the
shoulder and pelvic girdle
- Dramatic response to corticosteroids
3 subtypes of frontotemporal dementia Correct Answer: - Behavioral variant
,- Semantic dementia
- Progressive nonfluent aphasia
Hallmark biochemical feature of refeeding syndrome Correct Answer: Hypophosphatemia
Methods to reduce risk of oral candidiasis with inhaled corticosteroids for asthma Correct
Answer: - Rinse mouth after each administration
- Use valved holding chamber
When to recommend laryngoscopy for hoarseness Correct Answer: When hoarseness does not
resolve within 3 months or when a serious underlying cause is suspected
Causes of right heart failure Correct Answer: - Left heart failure (most common)
- Myocarditis
- Pulmonic stenosis
- Ventricular septal defects
Metabolites of codeine-containing medications and diazepam Correct Answer: - Morphine for
codeine-containing medications
- Oxazepam for diazepam
Most appropriate initial management of hypercalcemia of malignancy Correct Answer: Normal
saline intravenously
Reason for preference of myomectomy over fibroid embolization in symptomatic patient with
uterine fibroids responsive to medical therapy Correct Answer: Desire for future pregnancy
Hallmarks of melanosis coli Correct Answer: - Brown to black leopard spotting of the colonic
musoca
- Results from abuse of anthraquinone laxatives (cascara, senna, aloe)
What happens to the murmur of mitral valve prolapse with the Valsalva maneuver? Correct
Answer: Becomes longer and louder
Most common hip disorder in 8-15 year-old males & overweight/obese children Correct Answer:
Slipped capital femoral epiphysis
PEG tubes are associated w/ an ↑ use of Correct Answer: Restraints
Highest risk group for colorectal cancer & recommending screening age/interval Correct
Answer: - Patients who have 1 first degree relative diagnosed with colorectal cancer or
adenomatous polyps before age 60, or at least 2 second degree relatives with colorectal cancer
- Start *screening at age 40 or 10 years before the earliest age at which an affected relative was
diagnosed* (whichever comes first) **with rescreening every 5 years*
,Drugs associated with drug-induced pleural disease/lupus pleuritis Correct Answer: -
Hydralazine
- Procainamide, Quinidine, Amiodarone
- Bleomycin, cyclophosphamide, Mitomycin
- Bromocriptine
- Methotrexate
- Minoxidil
Treatment of tachycardia w/ history of Wolff-Parkinson-White syndrome Correct Answer:
Procainamide
Is doxycycline contraindicated in pregnancy? Correct Answer: Yes, in the 2nd and 3rd
trimesters due to permanent discoloration of tooth enamel
Will steady extra caloric intake result in weight gain indefinitely? Correct Answer: No, weight
will increase to a certain point and then become constant
Initial medical management of asthma Correct Answer: Low-dose inhaled corticosteroid daily
w/ SABA as needed
Name some tumor necrosis factor inhibitors & testing required prior to initiation Correct
Answer: - Infliximab, adalimumab, certolizumab pegol, golimumab
- Screen for TB, HBV, HCV
Tests to detect HCV antibody & determine active from past infection Correct Answer: -
Detection: enzyme immunoassay
- Confirmation: recombinant immunoblot assay
- Active/past infection: RNA polymerase chain reaction
Precautions to be initiated for patient with MRSA infection Correct Answer: - All staff, visitors,
and nursing-home residents should observe strict handwashing practices
- Barrier precautions for wounds & medical devices
Procedures for which metformin should be withheld & consequences of not doing so Correct
Answer: - Anything that causes a reduction in kidney function, such as pyelography,
angiography
- Lactic acidosis
Guidelines on combination therapy for nursing-home acquired pneumonia Correct Answer:
Combination therapy consisting of:
1. *Antipseudomonal cephalosporin* (cefepime, ceftazidime) or *Antipseudomonal
carbapenem* (imipenem, meropenem) or *Extended-spectrum ß-lactam/ß-lactamase inhibitor*
(piperacillin/tazobactam)
2. *Antipseudomonal fluoroquinolone* (levofloxacin, ciprofloxacin) or *Aminoglycoside*
(gentamicin, tobramycin, amikacin)
, 3. *Anti-MRSA agent* (vancomycin, linezolid)
SSRI use in pregnancy Correct Answer: No significant risk of congenital anomalies from SSRI
use in pregnancy, *except for paroxetine* (↑ risk of congenital cardiac malformations w/ 1st
trimester exposure)
Classic presentations of the following:
- pyloric stenosis
- choledochal cyst
- Meckel's diverticulum
- intussusception
- intestinal malrotation Correct Answer: - *Pyloric stenosis*: palpable mass that develops b/w 4-
6 weeks of age
- *Choledochal cyst*: classic triad of RUQ pain, jaundice, palpable mass
- *Meckel's diverticulum*: painless lower GI bleeding in infants
- *Intussusception*: paroxysms of colickyl abdominal pain, palpable mass in ~2/3 of patients
- *Intestinal malrotation*: bilious vomiting w/ in first 4 weeks of life
Teriparatide indications Correct Answer: Treatment of severe osteoporosis, for *patients with
multiple osteoporosis risk factors*, or for *patients with failure of bisphosphonate therapy*
Most likely infectious agent for acute dyuria, frequency, pyuria with no associated hematuria,
flank pain, suprapubic pain, or fever, showing no growth/insignificant bacterial growth on
midstream urine culture Correct Answer: Sexually transmitted urethritis caused by:
- C. trachomatis
- N. gonorrhoeae
- HSV
Interpreting "Timed Get Up and Go" test results Correct Answer: - <10 seconds: normal
- >14 seconds: ↑ risk of falls
- >20 seconds: severe gait impairment
Characteristics of the following gait/balance disorders:
- cautious gait
- cerebellar degeneration
- frontal lobe degeneration
- Parkinson's disease
- motor neuropathy Correct Answer: - *Cautious gait*: abducted arms/legs, slow, careful
"walking on ice" movements, wide-based stance and "en bloc" turns associated w/ visual
impairment
- *Cerebellar degeneration*: ataxic gait that is wide-based and staggering
- *Frontal lobe degeneration*: gait apraxia described as "magnetic" with start and turn hesitation
and freezing
Absolute contraindications to electroconvulsive therapy (ECT) Correct Answer: There are no
absolute contraindications to ECT
Treatment of community acquired pneumonia in infants and children Correct Answer: -
Diagnosis of *community-acquired pneumonia* is mostly based on the history and physical
examination
- Pneumonia should be suspected in any child with *fever, cyanosis, and any abnormal
respiratory finding* in the history or physical examination
- Outpatient antibiotics are appropriate if the child *does not have a toxic appearance,
hypoxemia, signs of respiratory distress, or dehydration*
- *High-dose amoxicillin* is the drug of choice
Current practice is to introduce solid foods into the diet at what age for normal term infants
Correct Answer: 4-6 months of age as the extrusion reflex disappears by the age of 4 months
Treatment of midshaft posteromedial tibial stress fractures Correct Answer: An air stirrup leg
brace (Aircast)
Most appropriate test to screen for late-onset male hypogonadism Correct Answer: Total
testosterone
Treatment of pediatric HSV-1 infection Correct Answer: Acyclovir suspension
Most accurate maneuver for detecting an ACL tear Correct Answer: - Lachman test (sensitivity
60%-100%, mean 84%),
- Anterior drawer test (sensitivity 9%-93%, mean 62%)
- Pivot shift test (sensitivity 27%-95%, mean 62%)
Diagnosis of multiple myeloma is based on Correct Answer: Evidence of myeloma-related end-
organ impairment (hypercalcemia, renal failure, anemia, skeletal lesions) in the presence of M
protein, monoclonal plasma cells, or both
Findings are typical of femoral neuropathy Correct Answer: - History of weakness of the lower
left leg, giving way of the knee, and discomfort in the anterior thigh
- Femoral neuropathy is a mononeuropathy commonly associated with diabetes mellitus
Women who use low-dose estrogen oral contraceptives have a 50% lower risk of cancer of the:
Correct Answer: Ovary
Clinical hallmarks of polymyalgia rheumatica Correct Answer: - Pain and stiffness in the
shoulder and pelvic girdle
- Dramatic response to corticosteroids
3 subtypes of frontotemporal dementia Correct Answer: - Behavioral variant
,- Semantic dementia
- Progressive nonfluent aphasia
Hallmark biochemical feature of refeeding syndrome Correct Answer: Hypophosphatemia
Methods to reduce risk of oral candidiasis with inhaled corticosteroids for asthma Correct
Answer: - Rinse mouth after each administration
- Use valved holding chamber
When to recommend laryngoscopy for hoarseness Correct Answer: When hoarseness does not
resolve within 3 months or when a serious underlying cause is suspected
Causes of right heart failure Correct Answer: - Left heart failure (most common)
- Myocarditis
- Pulmonic stenosis
- Ventricular septal defects
Metabolites of codeine-containing medications and diazepam Correct Answer: - Morphine for
codeine-containing medications
- Oxazepam for diazepam
Most appropriate initial management of hypercalcemia of malignancy Correct Answer: Normal
saline intravenously
Reason for preference of myomectomy over fibroid embolization in symptomatic patient with
uterine fibroids responsive to medical therapy Correct Answer: Desire for future pregnancy
Hallmarks of melanosis coli Correct Answer: - Brown to black leopard spotting of the colonic
musoca
- Results from abuse of anthraquinone laxatives (cascara, senna, aloe)
What happens to the murmur of mitral valve prolapse with the Valsalva maneuver? Correct
Answer: Becomes longer and louder
Most common hip disorder in 8-15 year-old males & overweight/obese children Correct Answer:
Slipped capital femoral epiphysis
PEG tubes are associated w/ an ↑ use of Correct Answer: Restraints
Highest risk group for colorectal cancer & recommending screening age/interval Correct
Answer: - Patients who have 1 first degree relative diagnosed with colorectal cancer or
adenomatous polyps before age 60, or at least 2 second degree relatives with colorectal cancer
- Start *screening at age 40 or 10 years before the earliest age at which an affected relative was
diagnosed* (whichever comes first) **with rescreening every 5 years*
,Drugs associated with drug-induced pleural disease/lupus pleuritis Correct Answer: -
Hydralazine
- Procainamide, Quinidine, Amiodarone
- Bleomycin, cyclophosphamide, Mitomycin
- Bromocriptine
- Methotrexate
- Minoxidil
Treatment of tachycardia w/ history of Wolff-Parkinson-White syndrome Correct Answer:
Procainamide
Is doxycycline contraindicated in pregnancy? Correct Answer: Yes, in the 2nd and 3rd
trimesters due to permanent discoloration of tooth enamel
Will steady extra caloric intake result in weight gain indefinitely? Correct Answer: No, weight
will increase to a certain point and then become constant
Initial medical management of asthma Correct Answer: Low-dose inhaled corticosteroid daily
w/ SABA as needed
Name some tumor necrosis factor inhibitors & testing required prior to initiation Correct
Answer: - Infliximab, adalimumab, certolizumab pegol, golimumab
- Screen for TB, HBV, HCV
Tests to detect HCV antibody & determine active from past infection Correct Answer: -
Detection: enzyme immunoassay
- Confirmation: recombinant immunoblot assay
- Active/past infection: RNA polymerase chain reaction
Precautions to be initiated for patient with MRSA infection Correct Answer: - All staff, visitors,
and nursing-home residents should observe strict handwashing practices
- Barrier precautions for wounds & medical devices
Procedures for which metformin should be withheld & consequences of not doing so Correct
Answer: - Anything that causes a reduction in kidney function, such as pyelography,
angiography
- Lactic acidosis
Guidelines on combination therapy for nursing-home acquired pneumonia Correct Answer:
Combination therapy consisting of:
1. *Antipseudomonal cephalosporin* (cefepime, ceftazidime) or *Antipseudomonal
carbapenem* (imipenem, meropenem) or *Extended-spectrum ß-lactam/ß-lactamase inhibitor*
(piperacillin/tazobactam)
2. *Antipseudomonal fluoroquinolone* (levofloxacin, ciprofloxacin) or *Aminoglycoside*
(gentamicin, tobramycin, amikacin)
, 3. *Anti-MRSA agent* (vancomycin, linezolid)
SSRI use in pregnancy Correct Answer: No significant risk of congenital anomalies from SSRI
use in pregnancy, *except for paroxetine* (↑ risk of congenital cardiac malformations w/ 1st
trimester exposure)
Classic presentations of the following:
- pyloric stenosis
- choledochal cyst
- Meckel's diverticulum
- intussusception
- intestinal malrotation Correct Answer: - *Pyloric stenosis*: palpable mass that develops b/w 4-
6 weeks of age
- *Choledochal cyst*: classic triad of RUQ pain, jaundice, palpable mass
- *Meckel's diverticulum*: painless lower GI bleeding in infants
- *Intussusception*: paroxysms of colickyl abdominal pain, palpable mass in ~2/3 of patients
- *Intestinal malrotation*: bilious vomiting w/ in first 4 weeks of life
Teriparatide indications Correct Answer: Treatment of severe osteoporosis, for *patients with
multiple osteoporosis risk factors*, or for *patients with failure of bisphosphonate therapy*
Most likely infectious agent for acute dyuria, frequency, pyuria with no associated hematuria,
flank pain, suprapubic pain, or fever, showing no growth/insignificant bacterial growth on
midstream urine culture Correct Answer: Sexually transmitted urethritis caused by:
- C. trachomatis
- N. gonorrhoeae
- HSV
Interpreting "Timed Get Up and Go" test results Correct Answer: - <10 seconds: normal
- >14 seconds: ↑ risk of falls
- >20 seconds: severe gait impairment
Characteristics of the following gait/balance disorders:
- cautious gait
- cerebellar degeneration
- frontal lobe degeneration
- Parkinson's disease
- motor neuropathy Correct Answer: - *Cautious gait*: abducted arms/legs, slow, careful
"walking on ice" movements, wide-based stance and "en bloc" turns associated w/ visual
impairment
- *Cerebellar degeneration*: ataxic gait that is wide-based and staggering
- *Frontal lobe degeneration*: gait apraxia described as "magnetic" with start and turn hesitation
and freezing
