Family Medicine (AAFP Questions) WITH
COMPLETE SOLUTIONS
MCC of HTN in children < 6 yrs Correct Answer: renal parenchymal dz (urinalysis, urine
culture, and renal ultrasonography should be ordered for all children presenting with
hypertension)
TZDs should not be used in patients Correct Answer: with New York Heart Association class III
or IV heart failure
next step in management if patient is already on maximum therapy for CHF? Correct Answer:
cardiac resynchronization therapy (look for bundle branch block and EF less than or equal to
30%)
what dietary recommendation has been shown to decrease the rate of a sudden death due to
cardiovascular disease? Correct Answer: Increased intake of omega-3 fax
chest radiograph shows widening of the mediastinum, enlargement of the aortic knob, or tracheal
displacement -> Dx?
Management? Correct Answer: dissecting aortic aneurysm
Acute dissection of the ascending aorta is a surgical emergency, but dissections confined to the
descending aorta are managed medically unless the patient demonstrates progression or
continued hemorrhage into the retroperitoneal space or pleura.
initial medical management aortic dissections confined to the descending aorta? Correct Answer:
reduce the systolic blood pressure to 100-120 mmHg or to the lowest level tolerated (use beta
blockers such as propranolol or labetalol to get the heart rate below 60 beats per minute, if
systolic blood pressure remains over 100 mmHg, IV nitroprusside should be added... but must
have beta-blockade before her nitroprusside because of vasodilation from nitroprusside will
induce reflex activation of the sympathetic nervous system,, causing increased ventricular
contraction and increased shear stress on the aorta)
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can
usually be terminated by the administration of intravenous ___ Correct Answer: verapamil or a
β-blocker. If that fails, intravenous propafenone or flecainide may be necessary. electrical
cardioversion may be necessary if these measures fail to terminate the tachycardia arrhythmia
(also remember to treat contributing causes such as hypovolemia, hypoxia, or electrolyte
disturbances).
monotherapy for hypertension and African American patients is more likely to consist of ___
Correct Answer: diuretics for calcium channel blockers (rather than 8 a blockers or ACE
inhibitors; it has been suggested that hypertension and African American does not as angiotensin
II dependent as it appears to be in Caucasians)
,carvedilol and metoprolol are metabolized by the __ Correct Answer: liver
enoxaparin isn't metabolized by the ___ Correct Answer: kidneys ( requires dosage adjustment
in renal disease)
inpatient with MI, new left bundle branch block suggests ___
What is indicated in this situation? Correct Answer: Occlusion of LAD, placing a significant
portion of LV in jeopardy
Thrombolytic therapy (this would be harmful in a patient with ischemia but no infarction-they
will show ST segment depression only)
isolated systolic hypertension in the elderly responds best to ___ Correct Answer: diuretics (and
beta blockers to a lesser extent)
thiazide diuretics can improve osteoporosis
31 yo F pt found to have thrombus in axillosubclavian vein (only activity she recalls is digging
strenuously to plant a garden the prior day) -> what is Dx? Correct Answer: a compressive
anomaly in the thoracic outlet (these are usually bilateral so there is similar risk on the other
side)
For patients with a first episode of unprovoked deep venous thrombosis, evidence supports
treatment with ___ Correct Answer: warfarin for at least 3 months
profuse perspiration with feeding and a 6 month old suggests? Correct Answer: CHF
you diagnose a patient with aortic stenosis view only complains of dyspnea on exertion (denies
chest pain and syncope), echo shows transvalvular gradient of 55 mmHg and a calculated valve
area of 0.6 cm^2 -> Management? Correct Answer: Valve replacement (patients with
symptomatic aortic stenosis had dismal prognosis without treatment, prompt correction of
mechanical obstruction with aortic valve replacement is indicated)
Contraindications to beta-blocker use include...? Correct Answer: hemodynamic instability,
heart block, bradycardia, and severe asthma.
Beta-blockers may be tried in patients with mild asthma or COPD as long as they are monitored
for potential exacerbations.
how are patients who are capable of moderate activity (greater than 4 METs) without cardiac
symptoms cleared for surgery? Correct Answer: A resting 12-lead EKG is recommended for
males over 45, females over 55, and patients with diabetes, symptoms of chest pain, or a
previous history of cardiac disease. No stress testing or coronary angiography for elective minor
or intermediate-risk operations (even if pt had prior cardiac hx but is now asymptomatic).
,a patient in her third trimester has 2+ pitting edema bilaterally, blood pressure is 118/78 ->
management of edema? Correct Answer: leg swelling requires no further evaluation
what can be used for cardiac prophylaxis both before and after her surgery in patients with
known cardiac disease or cardiac risk factors? Correct Answer: Beta blockers
best initial approach for atrial fibrillation Correct Answer: ventricular RATE control with
calcium channel blocker or beta blocker (digoxin is less effective for rate control and should be
reserved as an add-on for patients not controlled with the beta blocker or calcium channel
blocker, or for patients with significant LV systolic dysfunction) and anti-coagulation with
warfarin
cilostazol (useful for treatment of intermittent claudication) should be avoided in patient's with?
Correct Answer: CHF
patients with long QT syndrome that had sudden arrhythmia death syndrome usually have?
Correct Answer: torsades de pointes or V. fib
Clinical predictors of increased perioperative cardiovascular risk for elderly patients include
major risk factors such as Correct Answer: unstable coronary syndrome (acute or recent
myocardial infarction, unstable angina), decompensated congestive heart failure, significant
arrhythmia (high-grade AV block, symptomatic ventricular arrhythmia, supraventricular
arrhythmias with uncontrolled ventricular rate), and severe valvular disease.
Intermediate clinical predictors of increased perioperative cardiovascular risk for elderly patients
include Correct Answer: mild angina, previous myocardial infarction, compensated congestive
heart failure, diabetes mellitus, and renal insufficiency.
Minor clinical predictors of increased perioperative cardiovascular risk for elderly patients
include Correct Answer: advanced age, an abnormal EKG, left ventricular hypertrophy, left
bundle-branch block, ST and T-wave abnormalities, rhythm other than sinus, low functional
capacity, history of stroke, and uncontrolled hypertension.
Subclinical hypothyroidism (TSH >10 µU/mL) is likely to progress to overt hypothyroidism, and
is associated with increased ___ Correct Answer: LDL cholesterol.
Subclinical hyperthyroidism (TSH <0.1 µU/mL) is associated with the development of ___
Correct Answer: atrial fibrillation, decreased bone density, and cardiac dysfunction.
___ therapy can elevate calcium levels by elevating parathyroid hormone secretion from the
parathyroid gland. This duplicates the laboratory findings seen with mild primary
hyperparathyroidism. Correct Answer: Lithium
, A patient with a recurrent kidney stone and an elevated serum calcium level most likely has ___
Correct Answer: hyperparathyroidism (Elevated PTH is caused by a single parathyroid adenoma
in approximately 80% of cases.)
When evaluating a patient with a solitary thyroid nodule, red flags indicating possible thyroid
cancer include Correct Answer: male gender; age <20 years or >65 years; rapid growth of the
nodule; symptoms of local invasion such as dysphagia, neck pain, and hoarseness; a history of
head or neck radiation; a family history of thyroid cancer; a hard, fixed nodule >4 cm; and
cervical lymphadenopathy.
___, even if well controlled, disqualifies a driver for commercial interstate driving Correct
Answer: Insulin-dependent diabetes
___ may present in one of three ways: as a sudden onset of bilious vomiting and abdominal pain
in a neonate; as a history of feeding problems with bilious vomiting that appears to be a bowel
obstruction; or less commonly, as failure to thrive with severe feeding intolerance. Correct
Answer: Volvulus
The classic finding on abdominal plain films for volvulus is ___ Correct Answer: the double
bubble sign, which shows a paucity of gas (airless abdomen) with two air bubbles, one in the
stomach and one in the duodenum.
___ is the most common congenital abnormality of the small intestine. It is prone to bleeding
because it may contain heterotopic gastric mucosa. Abdominal pain, distention, and vomiting
may develop if obstruction has occurred, and the presentation may mimic appendicitis. Correct
Answer: Meckels diverticulum
Eradication of ___ significantly reduces the risk of ulcer recurrence and rebleeding in patients
with duodenal ulcer, and reduces the risk of peptic ulcer development in patients on chronic
NSAID therapy. Correct Answer: Helicobacter pylori (Eradication has minimal or no effect on
the symptoms of nonulcer dyspepsia and gastroesophageal reflux disease)
Although H. pylori infection is associated with gastric cancer, have trials shown that eradication
of H. pylori purely to prevent gastric cancer is beneficial? Correct Answer: No
What organisms are resistant to chlorine and are important causes of gastroenteritis from
drinking water? Correct Answer: Cryptosporidium oocysts, Giardia cysts, Entamoeba histolytica
and hepatitis A virus
A vaccinated person has been exposed to a known Hep B positive individual. What should be
done? Correct Answer: The exposed person should be tested for hepatitis B antibodies; if
antibody levels are inadequate (<10 IU/L by radioimmunoassay, negative by enzyme
immunoassay) HBIG should be administered immediately, as well as a hepatitis B vaccine
booster dose.
COMPLETE SOLUTIONS
MCC of HTN in children < 6 yrs Correct Answer: renal parenchymal dz (urinalysis, urine
culture, and renal ultrasonography should be ordered for all children presenting with
hypertension)
TZDs should not be used in patients Correct Answer: with New York Heart Association class III
or IV heart failure
next step in management if patient is already on maximum therapy for CHF? Correct Answer:
cardiac resynchronization therapy (look for bundle branch block and EF less than or equal to
30%)
what dietary recommendation has been shown to decrease the rate of a sudden death due to
cardiovascular disease? Correct Answer: Increased intake of omega-3 fax
chest radiograph shows widening of the mediastinum, enlargement of the aortic knob, or tracheal
displacement -> Dx?
Management? Correct Answer: dissecting aortic aneurysm
Acute dissection of the ascending aorta is a surgical emergency, but dissections confined to the
descending aorta are managed medically unless the patient demonstrates progression or
continued hemorrhage into the retroperitoneal space or pleura.
initial medical management aortic dissections confined to the descending aorta? Correct Answer:
reduce the systolic blood pressure to 100-120 mmHg or to the lowest level tolerated (use beta
blockers such as propranolol or labetalol to get the heart rate below 60 beats per minute, if
systolic blood pressure remains over 100 mmHg, IV nitroprusside should be added... but must
have beta-blockade before her nitroprusside because of vasodilation from nitroprusside will
induce reflex activation of the sympathetic nervous system,, causing increased ventricular
contraction and increased shear stress on the aorta)
If supraventricular tachycardia is refractory to adenosine or rapidly recurs, the tachycardia can
usually be terminated by the administration of intravenous ___ Correct Answer: verapamil or a
β-blocker. If that fails, intravenous propafenone or flecainide may be necessary. electrical
cardioversion may be necessary if these measures fail to terminate the tachycardia arrhythmia
(also remember to treat contributing causes such as hypovolemia, hypoxia, or electrolyte
disturbances).
monotherapy for hypertension and African American patients is more likely to consist of ___
Correct Answer: diuretics for calcium channel blockers (rather than 8 a blockers or ACE
inhibitors; it has been suggested that hypertension and African American does not as angiotensin
II dependent as it appears to be in Caucasians)
,carvedilol and metoprolol are metabolized by the __ Correct Answer: liver
enoxaparin isn't metabolized by the ___ Correct Answer: kidneys ( requires dosage adjustment
in renal disease)
inpatient with MI, new left bundle branch block suggests ___
What is indicated in this situation? Correct Answer: Occlusion of LAD, placing a significant
portion of LV in jeopardy
Thrombolytic therapy (this would be harmful in a patient with ischemia but no infarction-they
will show ST segment depression only)
isolated systolic hypertension in the elderly responds best to ___ Correct Answer: diuretics (and
beta blockers to a lesser extent)
thiazide diuretics can improve osteoporosis
31 yo F pt found to have thrombus in axillosubclavian vein (only activity she recalls is digging
strenuously to plant a garden the prior day) -> what is Dx? Correct Answer: a compressive
anomaly in the thoracic outlet (these are usually bilateral so there is similar risk on the other
side)
For patients with a first episode of unprovoked deep venous thrombosis, evidence supports
treatment with ___ Correct Answer: warfarin for at least 3 months
profuse perspiration with feeding and a 6 month old suggests? Correct Answer: CHF
you diagnose a patient with aortic stenosis view only complains of dyspnea on exertion (denies
chest pain and syncope), echo shows transvalvular gradient of 55 mmHg and a calculated valve
area of 0.6 cm^2 -> Management? Correct Answer: Valve replacement (patients with
symptomatic aortic stenosis had dismal prognosis without treatment, prompt correction of
mechanical obstruction with aortic valve replacement is indicated)
Contraindications to beta-blocker use include...? Correct Answer: hemodynamic instability,
heart block, bradycardia, and severe asthma.
Beta-blockers may be tried in patients with mild asthma or COPD as long as they are monitored
for potential exacerbations.
how are patients who are capable of moderate activity (greater than 4 METs) without cardiac
symptoms cleared for surgery? Correct Answer: A resting 12-lead EKG is recommended for
males over 45, females over 55, and patients with diabetes, symptoms of chest pain, or a
previous history of cardiac disease. No stress testing or coronary angiography for elective minor
or intermediate-risk operations (even if pt had prior cardiac hx but is now asymptomatic).
,a patient in her third trimester has 2+ pitting edema bilaterally, blood pressure is 118/78 ->
management of edema? Correct Answer: leg swelling requires no further evaluation
what can be used for cardiac prophylaxis both before and after her surgery in patients with
known cardiac disease or cardiac risk factors? Correct Answer: Beta blockers
best initial approach for atrial fibrillation Correct Answer: ventricular RATE control with
calcium channel blocker or beta blocker (digoxin is less effective for rate control and should be
reserved as an add-on for patients not controlled with the beta blocker or calcium channel
blocker, or for patients with significant LV systolic dysfunction) and anti-coagulation with
warfarin
cilostazol (useful for treatment of intermittent claudication) should be avoided in patient's with?
Correct Answer: CHF
patients with long QT syndrome that had sudden arrhythmia death syndrome usually have?
Correct Answer: torsades de pointes or V. fib
Clinical predictors of increased perioperative cardiovascular risk for elderly patients include
major risk factors such as Correct Answer: unstable coronary syndrome (acute or recent
myocardial infarction, unstable angina), decompensated congestive heart failure, significant
arrhythmia (high-grade AV block, symptomatic ventricular arrhythmia, supraventricular
arrhythmias with uncontrolled ventricular rate), and severe valvular disease.
Intermediate clinical predictors of increased perioperative cardiovascular risk for elderly patients
include Correct Answer: mild angina, previous myocardial infarction, compensated congestive
heart failure, diabetes mellitus, and renal insufficiency.
Minor clinical predictors of increased perioperative cardiovascular risk for elderly patients
include Correct Answer: advanced age, an abnormal EKG, left ventricular hypertrophy, left
bundle-branch block, ST and T-wave abnormalities, rhythm other than sinus, low functional
capacity, history of stroke, and uncontrolled hypertension.
Subclinical hypothyroidism (TSH >10 µU/mL) is likely to progress to overt hypothyroidism, and
is associated with increased ___ Correct Answer: LDL cholesterol.
Subclinical hyperthyroidism (TSH <0.1 µU/mL) is associated with the development of ___
Correct Answer: atrial fibrillation, decreased bone density, and cardiac dysfunction.
___ therapy can elevate calcium levels by elevating parathyroid hormone secretion from the
parathyroid gland. This duplicates the laboratory findings seen with mild primary
hyperparathyroidism. Correct Answer: Lithium
, A patient with a recurrent kidney stone and an elevated serum calcium level most likely has ___
Correct Answer: hyperparathyroidism (Elevated PTH is caused by a single parathyroid adenoma
in approximately 80% of cases.)
When evaluating a patient with a solitary thyroid nodule, red flags indicating possible thyroid
cancer include Correct Answer: male gender; age <20 years or >65 years; rapid growth of the
nodule; symptoms of local invasion such as dysphagia, neck pain, and hoarseness; a history of
head or neck radiation; a family history of thyroid cancer; a hard, fixed nodule >4 cm; and
cervical lymphadenopathy.
___, even if well controlled, disqualifies a driver for commercial interstate driving Correct
Answer: Insulin-dependent diabetes
___ may present in one of three ways: as a sudden onset of bilious vomiting and abdominal pain
in a neonate; as a history of feeding problems with bilious vomiting that appears to be a bowel
obstruction; or less commonly, as failure to thrive with severe feeding intolerance. Correct
Answer: Volvulus
The classic finding on abdominal plain films for volvulus is ___ Correct Answer: the double
bubble sign, which shows a paucity of gas (airless abdomen) with two air bubbles, one in the
stomach and one in the duodenum.
___ is the most common congenital abnormality of the small intestine. It is prone to bleeding
because it may contain heterotopic gastric mucosa. Abdominal pain, distention, and vomiting
may develop if obstruction has occurred, and the presentation may mimic appendicitis. Correct
Answer: Meckels diverticulum
Eradication of ___ significantly reduces the risk of ulcer recurrence and rebleeding in patients
with duodenal ulcer, and reduces the risk of peptic ulcer development in patients on chronic
NSAID therapy. Correct Answer: Helicobacter pylori (Eradication has minimal or no effect on
the symptoms of nonulcer dyspepsia and gastroesophageal reflux disease)
Although H. pylori infection is associated with gastric cancer, have trials shown that eradication
of H. pylori purely to prevent gastric cancer is beneficial? Correct Answer: No
What organisms are resistant to chlorine and are important causes of gastroenteritis from
drinking water? Correct Answer: Cryptosporidium oocysts, Giardia cysts, Entamoeba histolytica
and hepatitis A virus
A vaccinated person has been exposed to a known Hep B positive individual. What should be
done? Correct Answer: The exposed person should be tested for hepatitis B antibodies; if
antibody levels are inadequate (<10 IU/L by radioimmunoassay, negative by enzyme
immunoassay) HBIG should be administered immediately, as well as a hepatitis B vaccine
booster dose.
