AAFP Board Practice Questions (Part 1)
A 69 yo M with T2DM, obesity, and CAD sees you for f/u of DM. His A1c has increased
to 8.7% despite therapy with metformin, 1000 mg BID, and insulin glargine (Lantus).
Which one of the following additional medications would be the most effective for
reducing his blood glucose level and lowering his risk of cardiovascular events?
A. Exenatide (Byetta)
B. Glipizide (Glucotrol)
C. Liraglutide (Victoza)
D. Rosiglitazone (Avandia)
E. Sitagliptin (Januvia) - Answers -C. Liraglutide (Victoza)
A 28 yo F presents with 3 mo hx of fatigue and postural lightheadedness. On exam she
is diffusely hyperpigmented, especially her skin creases and areolae. A CBC and BMP
are normal minus elevated K. You order corticotropin stimulation test. Prior to the
corticotropin injection, you order which one of the following tests to confirm that this
patient has a primary insufficiency and not a secondary (pituitary) disorder?
A. ACTH
B. Aldosterone
C. Melanocyte-stimulating hormone
D. Renin
E. TSH - Answers -A. ACTH
Adrenal disease will be primary dysfunction, leading to elevated ACTH
If it was a pituitary dysfunction, there would be low ACTH (secondary dysfunction)
A 62 yo F who is a new patient requests a thyroid evaluation because she has a hx of
abnormal thyroid test results. You obtain a copy of her records, which include TSH level
of 0.2 (N 0.4-4.2) and a free T4 level of 2.0 (N 0.8-2.7) from 3 years ago. She reports
feeling well and has no other health conditions. She does not take any medications.
A PE reveals normal vitals, BMI of 23, no neck masses, a normal thyroid size, and
normal heart sounds. Lab studies reveal TSH of 0.1, free T4 of 2.5, and free T3 of 3.1
(N2.3-4.2).
Treatment for this condition would be indicated if patient has an abnormal...
A. Calcium level
B. DXA scan
C. glucose level
,D. Lipid level
E. Thyroid u/s study - Answers -B. DXA scan
Subclinical hypothyroidism
Which of the following is the most appropriate first-line therapy for primary
dysmenorrhea?
A. Combined monophasic oral contraceptives
B. Combined multiphasic oral contraceptives
C. Subdermal etonogestrel (Nexplanon)
D. IM medroxyprogesterone (Depo-Provera)
E. NSAIDs - Answers -E. NSAIDs
A 30 yo F with anovulatory uterine bleeding asks about treatment options. An
examination is normal and blood testing is negative. She is unmarried and is undecided
about having children.
Which one of the following would be most appropriate treatment for this patient?
A. Oral progestin during the luteal phase
B. A levonorgestrel releasing IUD
C. Endometrial ablation
D. Hysterectomy - Answers -B. The IUD
A 42 yo F presents for f/u after being treated for recurrent respiratory problems at an
urgent care. She is feeling a little better after a short course of oral prednisone and use
of an albuterol inhaler. She has had a gradual increase in SOB, a chronic cough, and
decrease in her usual activity level over the past year. She has brought a copy of a
recent CXR for your review that described panlobular basal emphysema. She does not
have a hx of smoking, secondhand smoke exposure, or occupational exposures.
Spirometry in the office reveals an FEV1/FVC ratio of 0.67 with no change after
bronchodilator administration.
Which one of the following underlying conditions is the most likely cause for this clinical
presentation?
A. alpha-1 antitrypsin deficiency
B. Bronchiectasis
C. Diffuse panbronchiolitis
D. Interstitial lung disease
E. Left heart failure - Answers -A. alpha 1 antitrypsin
A 55 yo F presents with new onset palpitations. An underlying cardiac cause should be
suspected if the patient's palpitations:
,A. affect her sleep
B. are associated with dry mouth
C. are worse in public places
D. last less than 5 minutes - Answers -A. affect her sleep
A 69 yo F presents with scaling, redness, and irritation under her breasts for the past
several months. She has tried several OTC antifungal creams without any improvement.
On examination you note erythematous, well demarcated patches with some scale
under both breasts. You examine the rash with a Wood's lamp to confirm your
suspected diagnosis. This rash is most likely to fluoresce...
A. bright yellow
B. coral pink
C. lime green
D. pale blue
E. totally white - Answers -B. coral pink
this is corynebacterium mintissimum
A 52-year-old male presents with moderate symptoms of prostatism. A prostate
examination is normal. His post-void residual volume is 90 mL. His PSA level is 0.75
ng/mL (N 0.0-4.0). He says his nocturia has become troublesome and you decide to
initiate therapy. This patient does NOT meet the criteria for use of which one of the
following?
A. Doxazosin (Cardura)
B. Finasteride (Proscar)
C. Tadalafil (Cialis)
D. Tamsulosin (Flomax)
E. Silodosin (Rapaflo) - Answers -B. Finasteride
5-alpha reductase inhibitors are only beneficial for BPH treatment if the PSA is >1.5
Tadalafil is a phosphodiesterase inhibitor, the others are alpha blockers
An otherwise healthy 57-year-old male presents with mild fatigue, decreased libido, and
erectile dysfunction. A subsequent evaluation of serum testosterone reveals
hypogonadism. Which one of the following would you recommend at this time?
A. No further diagnostic testing
B. A prolactin level
C. A serum iron level and total iron binding capacity
D. FSH and LH levels
E. Karyotyping - Answers -D. FSH and LH levels
Need to determine if primary or secondary hypogonadism, so check these levels.
, If FSH and LH are low or normal, then consider secondary cause. At this point, you
would get a prolactin and iron to look for those causes.
Functional constipation treatment - Answers -Miralax
Patients being treated with amiodarone (Cordarone) should be monitored periodically
with serum levels of... - Answers -TSH, can cause hyper or hypothyroidism
A patient who uses intravenous drugs and has a fever without a clear source must be
evaluated for... - Answers -infective endocarditis, get the blood cultures
Rotator cuff muscle actions - Answers -supraspinatus- abduction of the arm
Infraspinatus-external rotation and stability.
teres minor- external rotation
subscapularis- internal rotation
A 69-year-old male with type 2 diabetes mellitus, obesity, and a history of coronary
artery disease sees you for follow-up of his diabetes. His hemoglobin A1c has increased
to 8.7% despite therapy with metformin (Glucophage), 1000 mg twice daily, and insulin
glargine (Lantus).Which one of the following additional medications would be most
effective for reducing his blood glucose level and lowering his risk of cardiovascular
events?
A. Exenatide (Byetta)
B. Glipizide (Glucotrol)
C. Liraglutide (Victoza)
D. Rosiglitazone (Avandia)
E. Sitagliptin (Januvia) - Answers -C. Liraglutide (Victoza)
Only GLP-1 to reduce risk of cardiovascular events
A 75 yo M presents to the clinic with dizziness. He reports no head trauma or
weakness. He feels his hearing has been worse in his R ear since the dizziness started.
VS WNL, L-beating horizontal nystagmus observed. Which of the following is most likely
diagnosis?
A. BPPV
B. Labyrinthitis
C. Orthostatic hypotension
D. Vestibular migraine - Answers -B. labyrinthitis
A 28 yo M w/ shoulder pain presents to clinic. He reports he works as a mechanic, and
he was trying to lift an engine with a coworker when he suddenly lost his grip. Now he
has difficulty raising his L arm above his head, and the pain keeps him awake at night.
A 69 yo M with T2DM, obesity, and CAD sees you for f/u of DM. His A1c has increased
to 8.7% despite therapy with metformin, 1000 mg BID, and insulin glargine (Lantus).
Which one of the following additional medications would be the most effective for
reducing his blood glucose level and lowering his risk of cardiovascular events?
A. Exenatide (Byetta)
B. Glipizide (Glucotrol)
C. Liraglutide (Victoza)
D. Rosiglitazone (Avandia)
E. Sitagliptin (Januvia) - Answers -C. Liraglutide (Victoza)
A 28 yo F presents with 3 mo hx of fatigue and postural lightheadedness. On exam she
is diffusely hyperpigmented, especially her skin creases and areolae. A CBC and BMP
are normal minus elevated K. You order corticotropin stimulation test. Prior to the
corticotropin injection, you order which one of the following tests to confirm that this
patient has a primary insufficiency and not a secondary (pituitary) disorder?
A. ACTH
B. Aldosterone
C. Melanocyte-stimulating hormone
D. Renin
E. TSH - Answers -A. ACTH
Adrenal disease will be primary dysfunction, leading to elevated ACTH
If it was a pituitary dysfunction, there would be low ACTH (secondary dysfunction)
A 62 yo F who is a new patient requests a thyroid evaluation because she has a hx of
abnormal thyroid test results. You obtain a copy of her records, which include TSH level
of 0.2 (N 0.4-4.2) and a free T4 level of 2.0 (N 0.8-2.7) from 3 years ago. She reports
feeling well and has no other health conditions. She does not take any medications.
A PE reveals normal vitals, BMI of 23, no neck masses, a normal thyroid size, and
normal heart sounds. Lab studies reveal TSH of 0.1, free T4 of 2.5, and free T3 of 3.1
(N2.3-4.2).
Treatment for this condition would be indicated if patient has an abnormal...
A. Calcium level
B. DXA scan
C. glucose level
,D. Lipid level
E. Thyroid u/s study - Answers -B. DXA scan
Subclinical hypothyroidism
Which of the following is the most appropriate first-line therapy for primary
dysmenorrhea?
A. Combined monophasic oral contraceptives
B. Combined multiphasic oral contraceptives
C. Subdermal etonogestrel (Nexplanon)
D. IM medroxyprogesterone (Depo-Provera)
E. NSAIDs - Answers -E. NSAIDs
A 30 yo F with anovulatory uterine bleeding asks about treatment options. An
examination is normal and blood testing is negative. She is unmarried and is undecided
about having children.
Which one of the following would be most appropriate treatment for this patient?
A. Oral progestin during the luteal phase
B. A levonorgestrel releasing IUD
C. Endometrial ablation
D. Hysterectomy - Answers -B. The IUD
A 42 yo F presents for f/u after being treated for recurrent respiratory problems at an
urgent care. She is feeling a little better after a short course of oral prednisone and use
of an albuterol inhaler. She has had a gradual increase in SOB, a chronic cough, and
decrease in her usual activity level over the past year. She has brought a copy of a
recent CXR for your review that described panlobular basal emphysema. She does not
have a hx of smoking, secondhand smoke exposure, or occupational exposures.
Spirometry in the office reveals an FEV1/FVC ratio of 0.67 with no change after
bronchodilator administration.
Which one of the following underlying conditions is the most likely cause for this clinical
presentation?
A. alpha-1 antitrypsin deficiency
B. Bronchiectasis
C. Diffuse panbronchiolitis
D. Interstitial lung disease
E. Left heart failure - Answers -A. alpha 1 antitrypsin
A 55 yo F presents with new onset palpitations. An underlying cardiac cause should be
suspected if the patient's palpitations:
,A. affect her sleep
B. are associated with dry mouth
C. are worse in public places
D. last less than 5 minutes - Answers -A. affect her sleep
A 69 yo F presents with scaling, redness, and irritation under her breasts for the past
several months. She has tried several OTC antifungal creams without any improvement.
On examination you note erythematous, well demarcated patches with some scale
under both breasts. You examine the rash with a Wood's lamp to confirm your
suspected diagnosis. This rash is most likely to fluoresce...
A. bright yellow
B. coral pink
C. lime green
D. pale blue
E. totally white - Answers -B. coral pink
this is corynebacterium mintissimum
A 52-year-old male presents with moderate symptoms of prostatism. A prostate
examination is normal. His post-void residual volume is 90 mL. His PSA level is 0.75
ng/mL (N 0.0-4.0). He says his nocturia has become troublesome and you decide to
initiate therapy. This patient does NOT meet the criteria for use of which one of the
following?
A. Doxazosin (Cardura)
B. Finasteride (Proscar)
C. Tadalafil (Cialis)
D. Tamsulosin (Flomax)
E. Silodosin (Rapaflo) - Answers -B. Finasteride
5-alpha reductase inhibitors are only beneficial for BPH treatment if the PSA is >1.5
Tadalafil is a phosphodiesterase inhibitor, the others are alpha blockers
An otherwise healthy 57-year-old male presents with mild fatigue, decreased libido, and
erectile dysfunction. A subsequent evaluation of serum testosterone reveals
hypogonadism. Which one of the following would you recommend at this time?
A. No further diagnostic testing
B. A prolactin level
C. A serum iron level and total iron binding capacity
D. FSH and LH levels
E. Karyotyping - Answers -D. FSH and LH levels
Need to determine if primary or secondary hypogonadism, so check these levels.
, If FSH and LH are low or normal, then consider secondary cause. At this point, you
would get a prolactin and iron to look for those causes.
Functional constipation treatment - Answers -Miralax
Patients being treated with amiodarone (Cordarone) should be monitored periodically
with serum levels of... - Answers -TSH, can cause hyper or hypothyroidism
A patient who uses intravenous drugs and has a fever without a clear source must be
evaluated for... - Answers -infective endocarditis, get the blood cultures
Rotator cuff muscle actions - Answers -supraspinatus- abduction of the arm
Infraspinatus-external rotation and stability.
teres minor- external rotation
subscapularis- internal rotation
A 69-year-old male with type 2 diabetes mellitus, obesity, and a history of coronary
artery disease sees you for follow-up of his diabetes. His hemoglobin A1c has increased
to 8.7% despite therapy with metformin (Glucophage), 1000 mg twice daily, and insulin
glargine (Lantus).Which one of the following additional medications would be most
effective for reducing his blood glucose level and lowering his risk of cardiovascular
events?
A. Exenatide (Byetta)
B. Glipizide (Glucotrol)
C. Liraglutide (Victoza)
D. Rosiglitazone (Avandia)
E. Sitagliptin (Januvia) - Answers -C. Liraglutide (Victoza)
Only GLP-1 to reduce risk of cardiovascular events
A 75 yo M presents to the clinic with dizziness. He reports no head trauma or
weakness. He feels his hearing has been worse in his R ear since the dizziness started.
VS WNL, L-beating horizontal nystagmus observed. Which of the following is most likely
diagnosis?
A. BPPV
B. Labyrinthitis
C. Orthostatic hypotension
D. Vestibular migraine - Answers -B. labyrinthitis
A 28 yo M w/ shoulder pain presents to clinic. He reports he works as a mechanic, and
he was trying to lift an engine with a coworker when he suddenly lost his grip. Now he
has difficulty raising his L arm above his head, and the pain keeps him awake at night.
