FAMILY MEDICINE BOARD ACTUAL EXAM
WITH ALL CORRECT ANSWERS AND
DETAILED RATIONALES GRADED A+
A 42-year-old female presents to your office to discuss bariatric
surgery and its potential complications. Her BMI is 40 kg/m2 and
she has hypertension, type 2 diabetes, and osteoarthritis of both
knees.
If she opts to have a sleeve gastrectomy, which one of the
following complications is most likely in the first 6 months?
A) Cholelithiasis B) Dumping syndrome C) GERD D) Leaking at
the surgical site E) Small bowel obstruction Correct Answer
ANSWER: C -GERD
Sleeve gastrectomy is currently the most common bariatric
procedure. The most common complication is
development of GERD, which occurs in 20% of patients.
Since this procedure does not produce a
malabsorption component, complications such as
cholelithiasis, dumping syndrome, and small bowel
obstruction are not as likely as with other available
procedures. A postoperative leak develops in <2%
,of cases.
A sleeve gastrectomy involves removing the majority of the
greater curvature of the stomach, which
creates a tubular stomach. Roux-en-Y gastric bypass and
biliopancreatic diversion with duodenal switch
both combine volume restriction and nutrient malabsorption.
An otherwise healthy 58-year-old female presents with several
noduloulcerative lesions ascending up her arm from a lesion on
her index finger. A fungal culture of drainage from one of the
lesions reveals Sporothrix schenckii. Which one of the following
would be the most appropriate initial management strategy?
A) Observation for spontaneous resolution for 1 month B) Local
application of heat C) Oral itraconazole (Onmel) D) Oral saturated
solution of potassium iodide E) Intravenous liposomal
amphotericin B (AmBisome) Correct Answer ANSWER: C
Sporotrichosis is a skin infection caused by the Sporothrix
schenckii fungus. Spontaneous resolution of
sporotrichosis is rare. Uncomplicated small lesions of
cutaneous sporotrichosis sometimes can be treated
with the daily application of local heat for several weeks.
More involved infections, such as this patient's
lymphocutaneous sporotrichosis, require systemic therapy.
The initial treatment strategy is oral
,itraconazole for 3-6 months. Another treatment option is
saturated solution of potassium iodide, but the
regimen is complicated and poorly tolerated. Intravenous
liposomal amphotericin B is required for
treatment of pulmonary, meningeal, and disseminated
sporotrichosis in immunocompromised patients.
Some physicians routinely order spot protein/creatinine ratios
while others order spot albumin/creatinine ratios. When
comparing these two options, one advantage of spot
albumin/creatinine ratios is that they are
A) more convenient for the patient B) unaffected by exercise C)
unaffected by menstruation D) elevated only in patients with
diabetes mellitus E) able to detect lower levels of proteinuria
Correct Answer ANSWER: E
Multiple guidelines recommend screening for proteinuria at least
annually for patients with certain risk
factors.
Urinary protein can be measured through several techniques,
including urinalysis, 24-hour urine collection, a spot urine
protein/creatinine ratio, or a spot urine albumin/creatinine ratio.
, A 24-hour urine collection is cumbersome and prone to error or
delay. Spot ratios have been shown to correlate and provide a
reliable surrogate measurement.
The spot albumin/creatinine ratio is able to detect lower levels of
proteinuria as compared to the spot protein/creatinine ratio.
The albumin/creatinine ratio indicates
proteinuria, which is not specific to diabetes mellitus. Both
protein/creatinine and albumin/creatinine ratios
can be affected by exercise and menstruation.
The spot ________ /creatinine ratio is able to detect lower levels
of proteinuria as compared to the spot _______ /creatinine ratio.
Correct Answer The spot albumin/creatinine ratio is able to detect
lower levels of proteinuria as compared to the spot
protein/creatinine ratio.
A 52-year-old male with known hypertension and hyperlipidemia
comes to your office for a follow-up visit. His last visit was more
than a year ago. He was unemployed for several months and lost
his health insurance. Two months ago he ran out of his
medications, which included amlodipine (Norvasc),
hydrochlorothiazide, and atorvastatin (Lipitor). He says that he
feels fine and has not had any chest pain, changes in vision,
difficulty breathing, or lower extremity edema. He is a nonsmoker,
WITH ALL CORRECT ANSWERS AND
DETAILED RATIONALES GRADED A+
A 42-year-old female presents to your office to discuss bariatric
surgery and its potential complications. Her BMI is 40 kg/m2 and
she has hypertension, type 2 diabetes, and osteoarthritis of both
knees.
If she opts to have a sleeve gastrectomy, which one of the
following complications is most likely in the first 6 months?
A) Cholelithiasis B) Dumping syndrome C) GERD D) Leaking at
the surgical site E) Small bowel obstruction Correct Answer
ANSWER: C -GERD
Sleeve gastrectomy is currently the most common bariatric
procedure. The most common complication is
development of GERD, which occurs in 20% of patients.
Since this procedure does not produce a
malabsorption component, complications such as
cholelithiasis, dumping syndrome, and small bowel
obstruction are not as likely as with other available
procedures. A postoperative leak develops in <2%
,of cases.
A sleeve gastrectomy involves removing the majority of the
greater curvature of the stomach, which
creates a tubular stomach. Roux-en-Y gastric bypass and
biliopancreatic diversion with duodenal switch
both combine volume restriction and nutrient malabsorption.
An otherwise healthy 58-year-old female presents with several
noduloulcerative lesions ascending up her arm from a lesion on
her index finger. A fungal culture of drainage from one of the
lesions reveals Sporothrix schenckii. Which one of the following
would be the most appropriate initial management strategy?
A) Observation for spontaneous resolution for 1 month B) Local
application of heat C) Oral itraconazole (Onmel) D) Oral saturated
solution of potassium iodide E) Intravenous liposomal
amphotericin B (AmBisome) Correct Answer ANSWER: C
Sporotrichosis is a skin infection caused by the Sporothrix
schenckii fungus. Spontaneous resolution of
sporotrichosis is rare. Uncomplicated small lesions of
cutaneous sporotrichosis sometimes can be treated
with the daily application of local heat for several weeks.
More involved infections, such as this patient's
lymphocutaneous sporotrichosis, require systemic therapy.
The initial treatment strategy is oral
,itraconazole for 3-6 months. Another treatment option is
saturated solution of potassium iodide, but the
regimen is complicated and poorly tolerated. Intravenous
liposomal amphotericin B is required for
treatment of pulmonary, meningeal, and disseminated
sporotrichosis in immunocompromised patients.
Some physicians routinely order spot protein/creatinine ratios
while others order spot albumin/creatinine ratios. When
comparing these two options, one advantage of spot
albumin/creatinine ratios is that they are
A) more convenient for the patient B) unaffected by exercise C)
unaffected by menstruation D) elevated only in patients with
diabetes mellitus E) able to detect lower levels of proteinuria
Correct Answer ANSWER: E
Multiple guidelines recommend screening for proteinuria at least
annually for patients with certain risk
factors.
Urinary protein can be measured through several techniques,
including urinalysis, 24-hour urine collection, a spot urine
protein/creatinine ratio, or a spot urine albumin/creatinine ratio.
, A 24-hour urine collection is cumbersome and prone to error or
delay. Spot ratios have been shown to correlate and provide a
reliable surrogate measurement.
The spot albumin/creatinine ratio is able to detect lower levels of
proteinuria as compared to the spot protein/creatinine ratio.
The albumin/creatinine ratio indicates
proteinuria, which is not specific to diabetes mellitus. Both
protein/creatinine and albumin/creatinine ratios
can be affected by exercise and menstruation.
The spot ________ /creatinine ratio is able to detect lower levels
of proteinuria as compared to the spot _______ /creatinine ratio.
Correct Answer The spot albumin/creatinine ratio is able to detect
lower levels of proteinuria as compared to the spot
protein/creatinine ratio.
A 52-year-old male with known hypertension and hyperlipidemia
comes to your office for a follow-up visit. His last visit was more
than a year ago. He was unemployed for several months and lost
his health insurance. Two months ago he ran out of his
medications, which included amlodipine (Norvasc),
hydrochlorothiazide, and atorvastatin (Lipitor). He says that he
feels fine and has not had any chest pain, changes in vision,
difficulty breathing, or lower extremity edema. He is a nonsmoker,
