Family Medicine Board Review Questions and
Correct Answers
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: C
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: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-confirmed cases
of influenza
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: 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
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: 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 goals for hormonal treatment without the need for additional
gonadotropin suppression from medications such as leuprolide. Clomiphene can increase serum
, testosterone levels, but only in the presence of a functioning testicle. Letrozole is an estrogen
receptor antagonist, but it would not increase serum testosterone levels. Spironolactone has
androgen receptor blocking effects and would not accomplish either of the hormone treatment
goals.
Based on American Cancer Society guidelines for cervical cancer screening, when should HPV
DNA co-testing first be performed along with Papanicolaou testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening, Papanicolaou
(Pap) testing
should begin at age 21 irrespective of sexual activity and should be continued every 3 years until
age 29. The preferred screening strategy beginning at age 30 is Pap testing with HPV co-testing,
which should be continued every 5 years until age 65. Cervical screening may be discontinued at
that time if the patient's last two tests have been negative and the patient was tested within the
previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes
Correct Answers
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: C
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: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-confirmed cases
of influenza
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: 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
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: 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 goals for hormonal treatment without the need for additional
gonadotropin suppression from medications such as leuprolide. Clomiphene can increase serum
, testosterone levels, but only in the presence of a functioning testicle. Letrozole is an estrogen
receptor antagonist, but it would not increase serum testosterone levels. Spironolactone has
androgen receptor blocking effects and would not accomplish either of the hormone treatment
goals.
Based on American Cancer Society guidelines for cervical cancer screening, when should HPV
DNA co-testing first be performed along with Papanicolaou testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening, Papanicolaou
(Pap) testing
should begin at age 21 irrespective of sexual activity and should be continued every 3 years until
age 29. The preferred screening strategy beginning at age 30 is Pap testing with HPV co-testing,
which should be continued every 5 years until age 65. Cervical screening may be discontinued at
that time if the patient's last two tests have been negative and the patient was tested within the
previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes
