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iHUMAN WEEK 9 FAMILY
MEDICINE BOARD REVIEW
iHUMAN WEEK 9 FAMILY
MEDICINE BOARD REVIEW 2025/
2026 – CLINICAL CASES & EXAM
PREP GUIDE LATEST UPDATE
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.
Laboratory Findings unremarkable
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 initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
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
- ............ANSWER..........ANSWER: C
,2 | Page
This patient has hypertension and according to both JNC 8 and
American College of Cardiology/American Heart Association 2017
guidelines, antihypertensive treatment 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. -Blockers, vasodilators, -blockers, and
potassium-sparing diuretics are not recommended as initial choices for
the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to
CDC guidelines, who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
- ............ANSWER..........ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two
laboratory-confirmed cases of influenza
,3 | Page
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.
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 sometimes condoms.
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.
The initiation of antibiotics for treatment of pelvic inflammatory disease
in this patient
A) is appropriate at this time
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
- ............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 amplification testing (NAAT) for gonorrhea
and Chlamydia are returned. The clinical diagnosis is based on an at-risk
, 4 | Page
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 polymicrobial infection. Pelvic ultrasonography may be
used if there is a concern about other pathology such as a tubo-ovarian
abscess.
A 24-year-old patient wants to start the process of transitioning from
female to male. He 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
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
- ............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 female-to-male transgender patient
this is most easily accomplished with testosterone. When testosterone
levels are maintained in the normal genetic male range, gonadotropins
and ovarian hormone production is suppressed, which accomplishes both
iHUMAN WEEK 9 FAMILY
MEDICINE BOARD REVIEW
iHUMAN WEEK 9 FAMILY
MEDICINE BOARD REVIEW 2025/
2026 – CLINICAL CASES & EXAM
PREP GUIDE LATEST UPDATE
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.
Laboratory Findings unremarkable
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 initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
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
- ............ANSWER..........ANSWER: C
,2 | Page
This patient has hypertension and according to both JNC 8 and
American College of Cardiology/American Heart Association 2017
guidelines, antihypertensive treatment 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. -Blockers, vasodilators, -blockers, and
potassium-sparing diuretics are not recommended as initial choices for
the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to
CDC guidelines, who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
- ............ANSWER..........ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two
laboratory-confirmed cases of influenza
,3 | Page
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.
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 sometimes condoms.
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.
The initiation of antibiotics for treatment of pelvic inflammatory disease
in this patient
A) is appropriate at this time
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
- ............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 amplification testing (NAAT) for gonorrhea
and Chlamydia are returned. The clinical diagnosis is based on an at-risk
, 4 | Page
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 polymicrobial infection. Pelvic ultrasonography may be
used if there is a concern about other pathology such as a tubo-ovarian
abscess.
A 24-year-old patient wants to start the process of transitioning from
female to male. He 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
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
- ............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 female-to-male transgender patient
this is most easily accomplished with testosterone. When testosterone
levels are maintained in the normal genetic male range, gonadotropins
and ovarian hormone production is suppressed, which accomplishes both
