Family Medicine Board Review Questions and Answers
Verified Solution 2024
A 42-year-old Asian male presents for a 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT 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 gonorrhoea 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, leucocytosis, 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 gonorrhoea 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 tube-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 - CORRECT 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
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 - CORRECT ANSWER - 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 oesophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes - CORRECT ANSWER - ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and health care-
associated pneumonia, which is related to gastric overgrowth by gram-negative bacteria. Long-term
treatment of Barrett's oesophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI
therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
, An 87-year-old female comes to your office for an annual health maintenance visit. She appears
cachectic and tells you that for the past 6 months she has had a decreased appetite and generalized
muscle weakness. The patient is alert and oriented to person and place. She has a 10% weight loss,
dry mucous membranes, and tenting of the skin on the extensor surface of her hands. While inflating
the blood pressure cuff on her right arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcaemia
C) Hypokalaemia
D) Hypernatremia
E) Hyponatremia - CORRECT ANSWER - ANSWER: B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the nerves that
control them, is present in up to 94% of patients with hypocalcaemia. Hypercalcemia is more likely to
present with hyperreflexia. Patients with hypokalaemia, hypernatremia, or hyponatremia may present
with weakness and confusion, but tetany is not a common sign of either sodium or potassium
imbalance.
24-year old female presents to your office with a 3-month history of difficulty sleeping. She says that
she struggles to fall asleep and wakes up multiple times at night at least three times a week. She tries
to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an hour in bed
before falling asleep and spends up to 2 hours awake in the middle of the night trying to fall back
asleep. Lately she has been feeling fatigued and having difficulty
concentrating at work. You conduct a full history and physical examination and tell her to return in 2
weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping an average
of 5½ hours per night. Which one of the following would be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for a ho - CORRECT ANSWER - ANSWER: D
This patient presents with symptoms of chronic insomnia. Cognitive-behavioral therapy for insomnia
(CBT-I) and brief behavioral therapy for insomnia (BBT-I) are effective nonpharmacologic treatments
for chronic insomnia. Modified CBT-I and BBT-I can be administered by a primary care physician.
The basic
principles include stimulus control (sleep hygiene) and sleep restriction. Reducing time in bed
increases sleep efficiency. In this case, 6 hours of time in bed would improve the patient's sleep
efficiency and a bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is
accomplished by postponing bedtime rather than getting up earlier. Naps generally do not improve
Verified Solution 2024
A 42-year-old Asian male presents for a 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT 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 gonorrhoea 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, leucocytosis, 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 gonorrhoea 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 tube-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 - CORRECT 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
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 - CORRECT ANSWER - 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 oesophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes - CORRECT ANSWER - ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and health care-
associated pneumonia, which is related to gastric overgrowth by gram-negative bacteria. Long-term
treatment of Barrett's oesophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI
therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
, An 87-year-old female comes to your office for an annual health maintenance visit. She appears
cachectic and tells you that for the past 6 months she has had a decreased appetite and generalized
muscle weakness. The patient is alert and oriented to person and place. She has a 10% weight loss,
dry mucous membranes, and tenting of the skin on the extensor surface of her hands. While inflating
the blood pressure cuff on her right arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcaemia
C) Hypokalaemia
D) Hypernatremia
E) Hyponatremia - CORRECT ANSWER - ANSWER: B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the nerves that
control them, is present in up to 94% of patients with hypocalcaemia. Hypercalcemia is more likely to
present with hyperreflexia. Patients with hypokalaemia, hypernatremia, or hyponatremia may present
with weakness and confusion, but tetany is not a common sign of either sodium or potassium
imbalance.
24-year old female presents to your office with a 3-month history of difficulty sleeping. She says that
she struggles to fall asleep and wakes up multiple times at night at least three times a week. She tries
to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an hour in bed
before falling asleep and spends up to 2 hours awake in the middle of the night trying to fall back
asleep. Lately she has been feeling fatigued and having difficulty
concentrating at work. You conduct a full history and physical examination and tell her to return in 2
weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping an average
of 5½ hours per night. Which one of the following would be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for a ho - CORRECT ANSWER - ANSWER: D
This patient presents with symptoms of chronic insomnia. Cognitive-behavioral therapy for insomnia
(CBT-I) and brief behavioral therapy for insomnia (BBT-I) are effective nonpharmacologic treatments
for chronic insomnia. Modified CBT-I and BBT-I can be administered by a primary care physician.
The basic
principles include stimulus control (sleep hygiene) and sleep restriction. Reducing time in bed
increases sleep efficiency. In this case, 6 hours of time in bed would improve the patient's sleep
efficiency and a bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is
accomplished by postponing bedtime rather than getting up earlier. Naps generally do not improve
