Family Medicine Board Exam 2024
Questions & Answers Graded A+
A 30-year-old male comes to your office for evaluation of hand weakness. On
examination you
Detect weakness when he tries to bring his thumb and index finger together. For
confirmation
You ask him to try to hold on to a piece of paper between his thumb and index finger
while you
Try to pull it away. He is unable to resist when you pull on the paper.
The most likely explanation for these findings is an injury to the - Answer - e - ulnar
nerve
Initial general neurovascular assessment of an upper extremity injury includes
evaluating for radial pulse
And digit movement and sensation. Weakness of the thumb and index finger pincer
mechanism is indicative
Of an ulnar nerve injury. Weakness in the shoulder or upper arm would indicate a
potential brachial plexus
Injury. Symptoms related to the median nerve generally include paresthesia of the
thumb, index finger,
And long finger. Weakness of supination of the forearm would indicate a potential
musculocutaneous nerve
Injury. Weakness of active wrist extension would indicate a potential radial nerve injury.
Weakness of the thumb and index finger pincer mechanism is indicative
,Of an _________ nerve injury. - Answer - Weakness of the thumb and index finger
pincer mechanism is indicative
Of an *ulnar* nerve injury.
Symptoms related to the __________ nerve generally include paresthesia of the thumb,
index finger, and long finger. - Answer - Symptoms related to the *median* nerve
generally include paresthesia of the thumb, index finger,
And long finger.
Weakness of supination of the forearm would indicate a potential ________ nerve
Injury. - Answer - Weakness of supination of the forearm would indicate a potential *
musculocutaneous* nerve
Injury.
Weakness of active wrist extension would indicate a potential ________ nerve injury. -
Answer - Weakness of active wrist extension would indicate a potential *radial* nerve
injury.
A 30-year-old male is diagnosed with hereditary hemochromatosis. Periodic therapeutic
phlebotomy may be appropriate to prevent
A) chronic liver disease B) chronic renal disease C) encephalopathy D) myelofibrosis E)
Wilson disease - Answer - A) chronic liver disease
Hereditary hemochromatosis is a common inherited disorder of iron metabolism. Iron
deposits in the liver
may lead to chronic liver disease and hepatocellular cancer. Screening for hereditary
hemochromatosis
includes serum ferritin levels, a family history, and genetic testing. Chronic renal
disease, encephalopathy,
myelofibrosis, and Wilson disease (disorder of copper transport) do not result from iron
overload.
A 70-year-old female sees you for a Medicare annual wellness visit. Her past medical
history includes hypertension treated with enalapril (Vasotec). She states that she
"couldn't be better" and says that she has no new symptoms or health concerns. She
has a blood pressure of 159/90 mm Hg, a temperature of 36.7°C (98.1°F), a heart rate
of 76 beats/min, a respiratory rate of 17/min, and an oxygen saturation of 98% on room
air. On examination you note a new harsh systolic murmur that is heard best at the
second right intercostal space and can also be heard over the right carotid artery. A
transthoracic echocardiogram reveals severe aortic stenosis. Which one of the following
should you recommend for this patient? A) Antibiotic prophylaxis for dental procedures
B) Transesophageal echocardiography C) Repeat echocardiography in 6 months D)
Referral for aortic valve replacement - Answer - ANSWER: C
This patient has severe aortic stenosis that is asymptomatic. Watchful waiting is
recommended for most
,asymptomatic patients. In asymptomatic patients with severe aortic stenosis, monitoring
with serial
echocardiography is recommended every 6-12 months. Antibiotic prophylaxis is not
indicated unless the
patient has undergone aortic valve replacement or has a history of endocarditis.
Transesophageal
echocardiography is not indicated in this situation. Aortic valve replacement is indicated
to decrease
mortality in patients with symptomatic aortic stenosis.
After a thorough history and examination you determine that a 30-year-old male has an
upper respiratory infection with a persistent cough. He is afebrile and is otherwise
healthy. The best treatment for symptomatic relief of his persistent cough would be
intranasal A) antibiotics B) antihistamines C) corticosteroids D) ipratropium (Atrovent) E)
saline - Answer - ANSWER: D - ipratropium (Atrovent)
Upper respiratory tract infections are the most common acute illness in the United
States. Symptoms are
self-limited and can include nasal congestion, rhinorrhea, sore throat, cough, general
malaise, and a
low-grade fever. According to a Cochrane review of 10 trials without a meta-analysis,
antitussives and
expectorants are no more effective than placebo for cough.
Intranasal ipratropium is the only medication
that improves persistent cough related to upper respiratory infection in adults.
Intranasal antibiotics,
antihistamines, corticosteroids, and saline would not improve this patient's cough.
A 30-year-old female presents for evaluation of chronic abdominal bloating, cramping,
diarrhea, and recent weight loss. An abdominal examination is unremarkable, and stool
guaiac testing is negative. She requests testing for celiac disease. Which one of the
following would be most likely to cause a false-negative result on serologic testing for
celiac disease? A) A recent increase in dietary wheat consumption B) Recent use of
loperamide (Imodium A-D) C) A skin rash consistent with dermatitis herpetiformis D) IgA
deficiency E) Iron deficiency anemia - Answer - ANSWER: D - IgA deficiency
Celiac disease is a chronic malabsorptive disorder with an estimated worldwide
prevalence of 1.4%. The
preferred initial diagnostic test includes a serum IgA transglutaminase-2 (TG2) antibody
level, which has
a 98% sensitivity and 98% specificity for the diagnosis of celiac disease. False-negative
serologic results
may occur in patients with an IgA deficiency, which includes up to 3% of patients with
celiac disease.
Therefore, when a diagnosis of celiac disease is strongly suspected despite a negative
IgA TG2 antibody
, test, a total IgA level should be obtained. Diagnostic confirmation for patients with
positive serologic
testing is accomplished with endoscopic mucosal biopsy.
Dietary elimination of gluten, not an increase in gluten intake, prior to serologic testing
may lead to
false-negative results. Recent use of medications, including loperamide, would not be
expected to interfere
with the accuracy of serologic testing for celiac disease. Dermatitis herpetiformis is a
widespread pruritic
papulovesicular rash that occurs in less than 10% of patients with celiac disease,
although is essentially
pathognomonic for the condition, as nearly all patients with this rash have evidence of
celiac disease on
an intestinal biopsy. Iron deficiency anemia often occurs in patients with celiac disease
due to poor iron
absorption, although the presence of iron deficiency anemia does not decrease the
sensitivity of serologic
testing.
A 20-year-old male presents with a painful second finger after his right hand was
stepped on 3 days ago while he was playing basketball. He has marked pain as well as
numbness of the distal finger. There are no open wounds and the skin color and nail
appear normal other than moderate edema of the fingertip. A radiograph reveals a distal
phalanx fracture. Which one of the following would be the most appropriate next step?
A) Treat symptomatically with ice and an anti-inflammatory medication B) Tape the first
and second digits together until symptoms resolve C) Splint the affected digit for 2-4
weeks D) Remove the nail to evaluate for a nail bed injury E) Refer to a hand surgeon -
Answer - Tuft fractures are the most common type of distal phalanx fracture. They rarely
require orthopedic referral
but often result in up to 6 months of hyperesthesia, pain, and numbness. Treatment
involves splinting the
affected digit for 2-4 weeks, followed by range of motion and strengthening exercises.
Symptomatic
treatment may also be involved, but splinting is needed. Taping digits would likely not
provide enough
stability for the second digit distal phalanx, which extends beyond the first digit. Patients
with distal finger
injuries need careful physical examination to evaluate for a nail bed injury, but in this
case there is no
evidence of nail bed damage or laceration.
A 72-year-old female with a history of type 2 diabetes and hypertension presents to your
clinic because of fatigue and depression for the last 5-6 months. She has gained about
7 kg (15 lb) and now has a BMI of 32 kg/m2 . A physical examination is otherwise
unremarkable. Laboratory studies reveal a TSH level of 8.2 U/mL (N 0.4-4.0). A repeat
Questions & Answers Graded A+
A 30-year-old male comes to your office for evaluation of hand weakness. On
examination you
Detect weakness when he tries to bring his thumb and index finger together. For
confirmation
You ask him to try to hold on to a piece of paper between his thumb and index finger
while you
Try to pull it away. He is unable to resist when you pull on the paper.
The most likely explanation for these findings is an injury to the - Answer - e - ulnar
nerve
Initial general neurovascular assessment of an upper extremity injury includes
evaluating for radial pulse
And digit movement and sensation. Weakness of the thumb and index finger pincer
mechanism is indicative
Of an ulnar nerve injury. Weakness in the shoulder or upper arm would indicate a
potential brachial plexus
Injury. Symptoms related to the median nerve generally include paresthesia of the
thumb, index finger,
And long finger. Weakness of supination of the forearm would indicate a potential
musculocutaneous nerve
Injury. Weakness of active wrist extension would indicate a potential radial nerve injury.
Weakness of the thumb and index finger pincer mechanism is indicative
,Of an _________ nerve injury. - Answer - Weakness of the thumb and index finger
pincer mechanism is indicative
Of an *ulnar* nerve injury.
Symptoms related to the __________ nerve generally include paresthesia of the thumb,
index finger, and long finger. - Answer - Symptoms related to the *median* nerve
generally include paresthesia of the thumb, index finger,
And long finger.
Weakness of supination of the forearm would indicate a potential ________ nerve
Injury. - Answer - Weakness of supination of the forearm would indicate a potential *
musculocutaneous* nerve
Injury.
Weakness of active wrist extension would indicate a potential ________ nerve injury. -
Answer - Weakness of active wrist extension would indicate a potential *radial* nerve
injury.
A 30-year-old male is diagnosed with hereditary hemochromatosis. Periodic therapeutic
phlebotomy may be appropriate to prevent
A) chronic liver disease B) chronic renal disease C) encephalopathy D) myelofibrosis E)
Wilson disease - Answer - A) chronic liver disease
Hereditary hemochromatosis is a common inherited disorder of iron metabolism. Iron
deposits in the liver
may lead to chronic liver disease and hepatocellular cancer. Screening for hereditary
hemochromatosis
includes serum ferritin levels, a family history, and genetic testing. Chronic renal
disease, encephalopathy,
myelofibrosis, and Wilson disease (disorder of copper transport) do not result from iron
overload.
A 70-year-old female sees you for a Medicare annual wellness visit. Her past medical
history includes hypertension treated with enalapril (Vasotec). She states that she
"couldn't be better" and says that she has no new symptoms or health concerns. She
has a blood pressure of 159/90 mm Hg, a temperature of 36.7°C (98.1°F), a heart rate
of 76 beats/min, a respiratory rate of 17/min, and an oxygen saturation of 98% on room
air. On examination you note a new harsh systolic murmur that is heard best at the
second right intercostal space and can also be heard over the right carotid artery. A
transthoracic echocardiogram reveals severe aortic stenosis. Which one of the following
should you recommend for this patient? A) Antibiotic prophylaxis for dental procedures
B) Transesophageal echocardiography C) Repeat echocardiography in 6 months D)
Referral for aortic valve replacement - Answer - ANSWER: C
This patient has severe aortic stenosis that is asymptomatic. Watchful waiting is
recommended for most
,asymptomatic patients. In asymptomatic patients with severe aortic stenosis, monitoring
with serial
echocardiography is recommended every 6-12 months. Antibiotic prophylaxis is not
indicated unless the
patient has undergone aortic valve replacement or has a history of endocarditis.
Transesophageal
echocardiography is not indicated in this situation. Aortic valve replacement is indicated
to decrease
mortality in patients with symptomatic aortic stenosis.
After a thorough history and examination you determine that a 30-year-old male has an
upper respiratory infection with a persistent cough. He is afebrile and is otherwise
healthy. The best treatment for symptomatic relief of his persistent cough would be
intranasal A) antibiotics B) antihistamines C) corticosteroids D) ipratropium (Atrovent) E)
saline - Answer - ANSWER: D - ipratropium (Atrovent)
Upper respiratory tract infections are the most common acute illness in the United
States. Symptoms are
self-limited and can include nasal congestion, rhinorrhea, sore throat, cough, general
malaise, and a
low-grade fever. According to a Cochrane review of 10 trials without a meta-analysis,
antitussives and
expectorants are no more effective than placebo for cough.
Intranasal ipratropium is the only medication
that improves persistent cough related to upper respiratory infection in adults.
Intranasal antibiotics,
antihistamines, corticosteroids, and saline would not improve this patient's cough.
A 30-year-old female presents for evaluation of chronic abdominal bloating, cramping,
diarrhea, and recent weight loss. An abdominal examination is unremarkable, and stool
guaiac testing is negative. She requests testing for celiac disease. Which one of the
following would be most likely to cause a false-negative result on serologic testing for
celiac disease? A) A recent increase in dietary wheat consumption B) Recent use of
loperamide (Imodium A-D) C) A skin rash consistent with dermatitis herpetiformis D) IgA
deficiency E) Iron deficiency anemia - Answer - ANSWER: D - IgA deficiency
Celiac disease is a chronic malabsorptive disorder with an estimated worldwide
prevalence of 1.4%. The
preferred initial diagnostic test includes a serum IgA transglutaminase-2 (TG2) antibody
level, which has
a 98% sensitivity and 98% specificity for the diagnosis of celiac disease. False-negative
serologic results
may occur in patients with an IgA deficiency, which includes up to 3% of patients with
celiac disease.
Therefore, when a diagnosis of celiac disease is strongly suspected despite a negative
IgA TG2 antibody
, test, a total IgA level should be obtained. Diagnostic confirmation for patients with
positive serologic
testing is accomplished with endoscopic mucosal biopsy.
Dietary elimination of gluten, not an increase in gluten intake, prior to serologic testing
may lead to
false-negative results. Recent use of medications, including loperamide, would not be
expected to interfere
with the accuracy of serologic testing for celiac disease. Dermatitis herpetiformis is a
widespread pruritic
papulovesicular rash that occurs in less than 10% of patients with celiac disease,
although is essentially
pathognomonic for the condition, as nearly all patients with this rash have evidence of
celiac disease on
an intestinal biopsy. Iron deficiency anemia often occurs in patients with celiac disease
due to poor iron
absorption, although the presence of iron deficiency anemia does not decrease the
sensitivity of serologic
testing.
A 20-year-old male presents with a painful second finger after his right hand was
stepped on 3 days ago while he was playing basketball. He has marked pain as well as
numbness of the distal finger. There are no open wounds and the skin color and nail
appear normal other than moderate edema of the fingertip. A radiograph reveals a distal
phalanx fracture. Which one of the following would be the most appropriate next step?
A) Treat symptomatically with ice and an anti-inflammatory medication B) Tape the first
and second digits together until symptoms resolve C) Splint the affected digit for 2-4
weeks D) Remove the nail to evaluate for a nail bed injury E) Refer to a hand surgeon -
Answer - Tuft fractures are the most common type of distal phalanx fracture. They rarely
require orthopedic referral
but often result in up to 6 months of hyperesthesia, pain, and numbness. Treatment
involves splinting the
affected digit for 2-4 weeks, followed by range of motion and strengthening exercises.
Symptomatic
treatment may also be involved, but splinting is needed. Taping digits would likely not
provide enough
stability for the second digit distal phalanx, which extends beyond the first digit. Patients
with distal finger
injuries need careful physical examination to evaluate for a nail bed injury, but in this
case there is no
evidence of nail bed damage or laceration.
A 72-year-old female with a history of type 2 diabetes and hypertension presents to your
clinic because of fatigue and depression for the last 5-6 months. She has gained about
7 kg (15 lb) and now has a BMI of 32 kg/m2 . A physical examination is otherwise
unremarkable. Laboratory studies reveal a TSH level of 8.2 U/mL (N 0.4-4.0). A repeat
