AAFP Board Review Questions Solved 2024
"growing pains" - ANSWER-benign nocturnal limb pains of childhood
crampy pains in thigh, calf, or shin
kids 4-6 yo; can occur up to 19 yo
tx: supportive care and OTC analgesics if necessary
1 cm nodule in left lobe of thyroid; confirmed by US
next step in evaluation? - ANSWER-TSH level
followed w/ radionuclide thyroid scan if results abnormal
1st line tx for primary dysmenorrhea - ANSWER-NSAIDs
started at onset of menses and cont for first 1-2 days
1st line tx for pts w/ HoTN in septic shock - ANSWER-fluid resuscitation
1st line tx in previously healthy infants and school-age kids w/ mild-mod CAP -
ANSWER-amoxicillin
MC bug for CAP in this age group: Strep pneumo
1st step in evaluating nonmassive hemoptysis - ANSWER-CXR
if normal but still high risk of malignancy - order chest CT
2 day old infant has flesh-colored papules w/ erythematous base
on face and trunk
contain eosinophils
dx? tx? - ANSWER-erythema toxic neonatorum
happens usually first 2 wks of life
no tx necessary
5 yo w/ in-toeing due to excessive femoral anteversion
mobility unimpaired
what to do? - ANSWER-observation
shoe wedges, torque heels, and twister cable splints - not effective
5-HT syndrome - ANSWER-autonomic hyperactivity, neuromuscular abnormality, and
mental status changes
MC meds that cause this: SSRIs
occurs first 24 hrs of tx
PE: slow, horizontal mvnt of eyes
tx: IV benzo; if doesn't respond - cryptoheptadine
72 yo female - recent HAs
pain generalized all over her head - persisting over past several months
feels more achy and fatigued - dec appetite and unintentional weight loss (4 lbs in 2
months)
,acetaminophen - minimally helpful
denies sinus congestion, N/V, N/T, weakness, or vision changes
100.2 F
PE: normal CNs, fundo gucci, no tenderness on head palpation; mildly tender to
palpation of shoulders/upper arms
labs: ESR 88 mm/hr
what should you get to confirm dx? - ANSWER-temporal artery biopsy
homegirl has giant cell arteritis (aka temporal arteritis)
can lead to blindness
MC in elderly (esp women)
temporal artery can be thickened, tender, or lacking pulsation
classic lab: inc ESR
tx: high-dose corticosteroids
AB ppx to prevent bacterial endocarditis in dental, GI, or GU procedures - ANSWER-
now only indicated in high risk pts
> prosthetic valves
> previous hx of endoarditis
> unrepaired cyanotic congenital heart dz
> CHD repaired w prosthetic material
> cardiac transplant recipients who develop valvular dz
recommendations exclude mitral valve prolapse and acquired valvular dz
AB therapy during AOM in kids - ANSWER-> 6 months w/ severe signs/symptoms
(mod-severe otalgia or otalgia > 48 hrs; 102 F) - AB tx
< 24 months w/o severe symptoms - AB tx for BL AOM
older kids or those w/ UL AOM - observation + f/u
tx: amoxicillin; add B-lactamase coverage (like clavulanate) if kid had amoxicillin w/in
past 30 days
abd pain
bloody diarrhea
CV risk factors - hx of vascular dementia, peripheral artery dz, HTN, and HLD
nasogastric aspirate neg for bleeding (r/o PUD)
most likely cause of bleeding? - ANSWER-ischemic colitis
also associated w/ fever
acute parotitis - ANSWER-commonly caused by dehydration
tx: B-lactamase inhibitor (like Augmentin); sialagogues (like lemon drops) and parotid
gland massage also helpful; I&D necessary if abscess
acute, sharp chest pain relieved by leaning forward
pericardial friction rub
EKG: diffuse ST elections
echo: small pericardial effusion
dx? tx? - ANSWER-acute pericarditis
, colchicine and/or NSAIDs
glucocorticoids used in severe/refractory cases or in cases caused by CT dz,
autoreactivity, or uremia
akathisia - ANSWER-syndrome marked
by motor restlessness
possible SE of antipsychotics
anti-epileptic med that has the SE of SJS - ANSWER-lamotrigine
should start at 25 mg qd and titrated q2 wks until goal dosage is reached
antidepressant tx for kids and adolescents - ANSWER-1st line: fluoxetine (Prozac)
citalopram and sertraline - not as effective
all antidepressants carry black box warning about inc risk of suicide in younger pts
any child < 29 days old w/ fever and any child who appears toxic regardless of age -
needs to ??? - ANSWER-needs to undergo complete sepsis workup and be admitted to
hospital for observation until cx results are known or source of fever is found/tx
if bet 29-90 days w/ neg screening lab studies (CBC + UA) - sent home w/ f/u in 24 hrs
app anatomic location for steroid injection:
A. rotator cuff tendinitis
B. severe shoulder OA
C. AC arthritis - ANSWER-A. subacromial space
B. intra-articular shoulder joint under fluoroscopy
C. AC joint
asplenic pts - ANSWER-if develop fever > give ABs immediately
pneumo vaccines are both recommended
ppx PCN bid in kids < 5 yo
consider lifelong daily ABs after post-splenectomy sepsis
asymptotic microscopic hematuria measurement? - ANSWER->3 RBCs/hpf
Bartonella quintana - ANSWER-causes trench fever
vector: lice
tx: AB (doxy and gentamicin)
before initiating OCP, you should check? - ANSWER-BP
best for making dx of fibromyalgia? - ANSWER-structured symptom hx
bug and tx for the following situations:
A. hospitalized for AB tx
B. travelers to less developed countries
"growing pains" - ANSWER-benign nocturnal limb pains of childhood
crampy pains in thigh, calf, or shin
kids 4-6 yo; can occur up to 19 yo
tx: supportive care and OTC analgesics if necessary
1 cm nodule in left lobe of thyroid; confirmed by US
next step in evaluation? - ANSWER-TSH level
followed w/ radionuclide thyroid scan if results abnormal
1st line tx for primary dysmenorrhea - ANSWER-NSAIDs
started at onset of menses and cont for first 1-2 days
1st line tx for pts w/ HoTN in septic shock - ANSWER-fluid resuscitation
1st line tx in previously healthy infants and school-age kids w/ mild-mod CAP -
ANSWER-amoxicillin
MC bug for CAP in this age group: Strep pneumo
1st step in evaluating nonmassive hemoptysis - ANSWER-CXR
if normal but still high risk of malignancy - order chest CT
2 day old infant has flesh-colored papules w/ erythematous base
on face and trunk
contain eosinophils
dx? tx? - ANSWER-erythema toxic neonatorum
happens usually first 2 wks of life
no tx necessary
5 yo w/ in-toeing due to excessive femoral anteversion
mobility unimpaired
what to do? - ANSWER-observation
shoe wedges, torque heels, and twister cable splints - not effective
5-HT syndrome - ANSWER-autonomic hyperactivity, neuromuscular abnormality, and
mental status changes
MC meds that cause this: SSRIs
occurs first 24 hrs of tx
PE: slow, horizontal mvnt of eyes
tx: IV benzo; if doesn't respond - cryptoheptadine
72 yo female - recent HAs
pain generalized all over her head - persisting over past several months
feels more achy and fatigued - dec appetite and unintentional weight loss (4 lbs in 2
months)
,acetaminophen - minimally helpful
denies sinus congestion, N/V, N/T, weakness, or vision changes
100.2 F
PE: normal CNs, fundo gucci, no tenderness on head palpation; mildly tender to
palpation of shoulders/upper arms
labs: ESR 88 mm/hr
what should you get to confirm dx? - ANSWER-temporal artery biopsy
homegirl has giant cell arteritis (aka temporal arteritis)
can lead to blindness
MC in elderly (esp women)
temporal artery can be thickened, tender, or lacking pulsation
classic lab: inc ESR
tx: high-dose corticosteroids
AB ppx to prevent bacterial endocarditis in dental, GI, or GU procedures - ANSWER-
now only indicated in high risk pts
> prosthetic valves
> previous hx of endoarditis
> unrepaired cyanotic congenital heart dz
> CHD repaired w prosthetic material
> cardiac transplant recipients who develop valvular dz
recommendations exclude mitral valve prolapse and acquired valvular dz
AB therapy during AOM in kids - ANSWER-> 6 months w/ severe signs/symptoms
(mod-severe otalgia or otalgia > 48 hrs; 102 F) - AB tx
< 24 months w/o severe symptoms - AB tx for BL AOM
older kids or those w/ UL AOM - observation + f/u
tx: amoxicillin; add B-lactamase coverage (like clavulanate) if kid had amoxicillin w/in
past 30 days
abd pain
bloody diarrhea
CV risk factors - hx of vascular dementia, peripheral artery dz, HTN, and HLD
nasogastric aspirate neg for bleeding (r/o PUD)
most likely cause of bleeding? - ANSWER-ischemic colitis
also associated w/ fever
acute parotitis - ANSWER-commonly caused by dehydration
tx: B-lactamase inhibitor (like Augmentin); sialagogues (like lemon drops) and parotid
gland massage also helpful; I&D necessary if abscess
acute, sharp chest pain relieved by leaning forward
pericardial friction rub
EKG: diffuse ST elections
echo: small pericardial effusion
dx? tx? - ANSWER-acute pericarditis
, colchicine and/or NSAIDs
glucocorticoids used in severe/refractory cases or in cases caused by CT dz,
autoreactivity, or uremia
akathisia - ANSWER-syndrome marked
by motor restlessness
possible SE of antipsychotics
anti-epileptic med that has the SE of SJS - ANSWER-lamotrigine
should start at 25 mg qd and titrated q2 wks until goal dosage is reached
antidepressant tx for kids and adolescents - ANSWER-1st line: fluoxetine (Prozac)
citalopram and sertraline - not as effective
all antidepressants carry black box warning about inc risk of suicide in younger pts
any child < 29 days old w/ fever and any child who appears toxic regardless of age -
needs to ??? - ANSWER-needs to undergo complete sepsis workup and be admitted to
hospital for observation until cx results are known or source of fever is found/tx
if bet 29-90 days w/ neg screening lab studies (CBC + UA) - sent home w/ f/u in 24 hrs
app anatomic location for steroid injection:
A. rotator cuff tendinitis
B. severe shoulder OA
C. AC arthritis - ANSWER-A. subacromial space
B. intra-articular shoulder joint under fluoroscopy
C. AC joint
asplenic pts - ANSWER-if develop fever > give ABs immediately
pneumo vaccines are both recommended
ppx PCN bid in kids < 5 yo
consider lifelong daily ABs after post-splenectomy sepsis
asymptotic microscopic hematuria measurement? - ANSWER->3 RBCs/hpf
Bartonella quintana - ANSWER-causes trench fever
vector: lice
tx: AB (doxy and gentamicin)
before initiating OCP, you should check? - ANSWER-BP
best for making dx of fibromyalgia? - ANSWER-structured symptom hx
bug and tx for the following situations:
A. hospitalized for AB tx
B. travelers to less developed countries
