FAMILY MEDICINE BOARD REVIEW
EXAM | QUESTIONS & ANSWERS
(VERIFIED) | LATEST UPDATE | GRADED
A+
PR
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no
additional chronic medical problems and is otherwise asymptomatic. An examination is
significant for a blood pressure of 162/95 mm Hg but is otherwise unremarkable.
O
Laboratory Findings unremarkable
FD
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association 2017
guidelines, which one of the following would be the most appropriate medication to
O
initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
C
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily
Correct Answer: ANSWER: C
This patient has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Association 2017 guidelines, antihypertensive treatment
1
,should be initiated. For the general non-African-American population, monotherapy with
an ACE inhibitor, an angiotensin receptor blocker, a calcium channel blocker, or a
thiazide diuretic would be appropriate for initial management. It is also appropriate to
initiate combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin receptor blocker
simultaneously. Studies have shown that blood pressure control is achieved faster with
the initiation of combination therapy compared to monotherapy, without an increase in
morbidity. Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. -
PR
Blockers, vasodilators, -blockers, and potassium-sparing diuretics are not
recommended as initial choices for the treatment of hypertension.
O
During rounds at the nursing home, you are informed that there are two residents on the
FD
unit with laboratory-confirmed influenza. According to CDC guidelines, who should
receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
O
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
C
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
Correct Answer: ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-confirmed
cases of influenza
2
,within 72 hours in patients on the same unit. The CDC recommends chemoprophylaxis
for all asymptomatic residents of the affected unit. Any resident exhibiting symptoms of
influenza should be treated for influenza and not given chemoprophylaxis dosing.
Chemoprophylaxis is not recommended for residents of other units unless there are two
laboratory-confirmed cases in those units. Facility staff of the affected unit can be
considered for chemoprophylaxis if they have not been vaccinated or if they had a
recent vaccination, but chemoprophylaxis is not recommended for all staff in the entire
facility.
PR
A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She
has had two male sex partners in the last 6 months and uses oral contraceptives and
O
sometimes condoms.
FD
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical
motion and uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal
microscopy shows only WBCs.
O
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
C
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
Correct Answer: ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be
administered at the time of diagnosis and not delayed until the results of the nucleic acid
3
, amplification testing (NAAT) for gonorrhea and Chlamydia are returned. The clinical
diagnosis is based on an at-risk woman presenting with lower abdominal or pelvic pain,
accompanied by cervical motion, uterine, or adnexal tenderness that can range from
mild to severe. There is often a mucopurulent discharge or WBCs on saline microscopy.
Acute phase indicators such as fever, leukocytosis, or an elevated C-reactive protein
level may be helpful but are neither sensitive nor specific. A positive NAAT is not
required for diagnosis and treatment because an upper tract infection may be present,
or the causative agent may not be gonorrhea or Chlamydia. PID should be considered a
PR
polymicrobial infection. Pelvic ultrasonography may be used if there is a concern about
other pathology such as a tubo-ovarian abscess.
O
A 24-year-old patient wants to start the process of transitioning from female to male. He
FD
has been working with a psychiatrist who has confirmed the diagnosis of gender
dysphoria. Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
O
B) Letrozole (Femara)
C) Leuprolide (Eligard)
C
D) Spironolactone (Aldactone)
E) Testosterone
Correct Answer: ANSWER: E
For patients with gender dysphoria or gender incongruence who desire hormone
treatment, the treatment goal is to suppress endogenous sex hormone production and
maintain sex hormone levels in the normal range for their affirmed gender. For a
4
EXAM | QUESTIONS & ANSWERS
(VERIFIED) | LATEST UPDATE | GRADED
A+
PR
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no
additional chronic medical problems and is otherwise asymptomatic. An examination is
significant for a blood pressure of 162/95 mm Hg but is otherwise unremarkable.
O
Laboratory Findings unremarkable
FD
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association 2017
guidelines, which one of the following would be the most appropriate medication to
O
initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
C
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily
Correct Answer: ANSWER: C
This patient has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Association 2017 guidelines, antihypertensive treatment
1
,should be initiated. For the general non-African-American population, monotherapy with
an ACE inhibitor, an angiotensin receptor blocker, a calcium channel blocker, or a
thiazide diuretic would be appropriate for initial management. It is also appropriate to
initiate combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin receptor blocker
simultaneously. Studies have shown that blood pressure control is achieved faster with
the initiation of combination therapy compared to monotherapy, without an increase in
morbidity. Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. -
PR
Blockers, vasodilators, -blockers, and potassium-sparing diuretics are not
recommended as initial choices for the treatment of hypertension.
O
During rounds at the nursing home, you are informed that there are two residents on the
FD
unit with laboratory-confirmed influenza. According to CDC guidelines, who should
receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
O
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
C
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
Correct Answer: ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-confirmed
cases of influenza
2
,within 72 hours in patients on the same unit. The CDC recommends chemoprophylaxis
for all asymptomatic residents of the affected unit. Any resident exhibiting symptoms of
influenza should be treated for influenza and not given chemoprophylaxis dosing.
Chemoprophylaxis is not recommended for residents of other units unless there are two
laboratory-confirmed cases in those units. Facility staff of the affected unit can be
considered for chemoprophylaxis if they have not been vaccinated or if they had a
recent vaccination, but chemoprophylaxis is not recommended for all staff in the entire
facility.
PR
A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She
has had two male sex partners in the last 6 months and uses oral contraceptives and
O
sometimes condoms.
FD
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical
motion and uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal
microscopy shows only WBCs.
O
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
C
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
Correct Answer: ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be
administered at the time of diagnosis and not delayed until the results of the nucleic acid
3
, amplification testing (NAAT) for gonorrhea and Chlamydia are returned. The clinical
diagnosis is based on an at-risk woman presenting with lower abdominal or pelvic pain,
accompanied by cervical motion, uterine, or adnexal tenderness that can range from
mild to severe. There is often a mucopurulent discharge or WBCs on saline microscopy.
Acute phase indicators such as fever, leukocytosis, or an elevated C-reactive protein
level may be helpful but are neither sensitive nor specific. A positive NAAT is not
required for diagnosis and treatment because an upper tract infection may be present,
or the causative agent may not be gonorrhea or Chlamydia. PID should be considered a
PR
polymicrobial infection. Pelvic ultrasonography may be used if there is a concern about
other pathology such as a tubo-ovarian abscess.
O
A 24-year-old patient wants to start the process of transitioning from female to male. He
FD
has been working with a psychiatrist who has confirmed the diagnosis of gender
dysphoria. Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
O
B) Letrozole (Femara)
C) Leuprolide (Eligard)
C
D) Spironolactone (Aldactone)
E) Testosterone
Correct Answer: ANSWER: E
For patients with gender dysphoria or gender incongruence who desire hormone
treatment, the treatment goal is to suppress endogenous sex hormone production and
maintain sex hormone levels in the normal range for their affirmed gender. For a
4
