AAFP Board Review Part 3 Exam Questions And
Answers 100% Pass
A 54-year-old male with cervical disc disease, generalized anxiety disorder, and opioid
use disorder on maintenance therapy presents with a 5-day history of pain and
numbness in both hands and feet. He mentions that he had a COVID-19 booster
vaccination 6 weeks ago. On the review of systems, he reports increased urinary
frequency and feeling less steady on his feet. A neurologic examination is notable for a
slightly wide-based gait, decreased sensation in the upper extremities to the forearms
and lower extremities to the calves, and brisk Achilles reflexes with clonus. His muscle
strength is normal in both the upper and lower extremities, and there is no spinal
tenderness. The remainder of the examination, including vital signs, is normal. Which
one of the following diagnoses is most consistent with this presentation?
A) Cervical myelopathy
B) Epidural abscess
C) Guillain-Barré syndrome
D) Multiple sclerosis - ANSWER A- cervical myelopathy
Findings suggest cord compression.
If cord compression in cervical spine have loss of sensation in all 4 extremities,
hyperreflexia, gait instability--> can lead to extreme weakness and bladder/bowel
dysfunction
Epidural abscess- IV drug use, localized tenderness, systemic inflammation like fever
Guillan-Barre- ascending numbness and weakness WITH associated loss of reflexes
An otherwise healthy 70-year-old male presents with a 6-month history of hives
recurring every week or so. A causative factor is not identified through the history and
physical examination. Which one of the following is recommended as the first-line
treatment for this patient's chronic urticaria?
A) A first-generation H1-antihistamine
B) A second-generation H1-antihistamine
,C) An H2-antihistamine
D) Omalizumab (Xolair)
E) Prednisone - ANSWER B- second generation H1 antihistamine
Chronic urticaria of unknown cause treatment:
Step 1- second-gen H1 antihistamine (can increase up to 4x the approved dosage), aka
claritin, zyrtec etc
If not controlled, add H2 antihistamine (H2 blockers) or antileukotriene agent
(montelukast)
Systemic corticosteroids can be used for short-term control of severe acute episodes,
but long-term use should be avoided.
First-generation H1-antihistamines (benadryl, promethazine and the like) can be used if
control cannot be achieved at step two, but they should be used cautiously, as sedation
and confusion may occur, especially in the elderly.
The options available in the third step of treatment are omalizumab and cyclosporine.
A 20-year-old college football player becomes disoriented and weak during an afternoon
practice in the heat. On the field, he is sweaty and tachycardic, with a core (rectal)
temperature of 40.9°C (105.6°F). In this patient with exertional heatstroke, which one of
the following would be the most important initial step to reduce his core body
temperature?
A) Administering acetaminophen
B) Administering aspirin
C) Immersing him in cold water
D) Initiating intravenous fluids
E) Transporting him to an emergency facility for treatment - ANSWER C- immersing in
cold water
,Start treatment right away on the field- immerse in cold water or if not an option pour
copious amounts of water on patient with fanning
Infusion of cold fluids would be one of the treatments of choice in elderly patients with
classic heatstroke.
USPSTF recommendation on ocular prophylaxis in newborns for gonococcal ophthalmia
neonatorum - ANSWER Grade A- do this right after birth regardless of gestational age
For patients with terminal pancreatic cancer, lung cancer, or metastatic melanoma,
which one of the following is the potential increase in life expectancy from receiving
hospice care?
A) No increase
B) 3 months
C) 6 months
D) 9 months
E) 12 months - ANSWER B- 3 months
A parent brings their 2-month-old infant to your office for a routine well check. The
infant, who was born at full term, is formula fed and the parent is concerned about
vomiting that occurs after every feeding. After taking a history and examining the infant
you diagnose uncomplicated reflux. The next appropriate intervention would be
A) prone positioning for sleep
B) celiac testing
C) a trial of thickened feeds
D) a trial of an acid suppressor
E) abdominal ultrasonography - ANSWER C- a trial of thickened feeds
I know you love a good acid suppressor.
, For uncomplicated reflux, a trial of thickened feeds and/or switching to a soy formula
would be appropriate, as a milk protein allergy can present similarly.
A trial of an acid suppressor should take place if symptoms are not improved after
omitting cow's milk formula and thickening feeds.
USPSTF recommendation on screening for unhealthy alcohol use in adults 18+ -
ANSWER *pregnant included*
Grade B, use an appropriate questionnaire and counsel if hazardous behavior
USPSTF recommendation on screening for unhealthy alcohol use in ages 12-17 -
ANSWER insufficient evidence
USPSTF recommendation on screening for intimate partner violence - ANSWER Grade B
recommendation for women of reproductive age (adolescent through 40s)
USPSTF recommendation on screening for elder abuse/neglect - ANSWER insufficient
evidence
USPSTF recommendation on behavioral interventions for weight loss to prevent
obesity-related morbidity and mortality in adults - ANSWER Grade B recommendation
If BMI 30 or higher and 18+ years, recommend intensive, multicomponent behavioral
interventions
USPSTF recommendation on screening for syphilis in pregnant women - ANSWER
Grade A, screen at initial visit aka asap
If higher risk community should do third trimester and at delivery, but otherwise only
Answers 100% Pass
A 54-year-old male with cervical disc disease, generalized anxiety disorder, and opioid
use disorder on maintenance therapy presents with a 5-day history of pain and
numbness in both hands and feet. He mentions that he had a COVID-19 booster
vaccination 6 weeks ago. On the review of systems, he reports increased urinary
frequency and feeling less steady on his feet. A neurologic examination is notable for a
slightly wide-based gait, decreased sensation in the upper extremities to the forearms
and lower extremities to the calves, and brisk Achilles reflexes with clonus. His muscle
strength is normal in both the upper and lower extremities, and there is no spinal
tenderness. The remainder of the examination, including vital signs, is normal. Which
one of the following diagnoses is most consistent with this presentation?
A) Cervical myelopathy
B) Epidural abscess
C) Guillain-Barré syndrome
D) Multiple sclerosis - ANSWER A- cervical myelopathy
Findings suggest cord compression.
If cord compression in cervical spine have loss of sensation in all 4 extremities,
hyperreflexia, gait instability--> can lead to extreme weakness and bladder/bowel
dysfunction
Epidural abscess- IV drug use, localized tenderness, systemic inflammation like fever
Guillan-Barre- ascending numbness and weakness WITH associated loss of reflexes
An otherwise healthy 70-year-old male presents with a 6-month history of hives
recurring every week or so. A causative factor is not identified through the history and
physical examination. Which one of the following is recommended as the first-line
treatment for this patient's chronic urticaria?
A) A first-generation H1-antihistamine
B) A second-generation H1-antihistamine
,C) An H2-antihistamine
D) Omalizumab (Xolair)
E) Prednisone - ANSWER B- second generation H1 antihistamine
Chronic urticaria of unknown cause treatment:
Step 1- second-gen H1 antihistamine (can increase up to 4x the approved dosage), aka
claritin, zyrtec etc
If not controlled, add H2 antihistamine (H2 blockers) or antileukotriene agent
(montelukast)
Systemic corticosteroids can be used for short-term control of severe acute episodes,
but long-term use should be avoided.
First-generation H1-antihistamines (benadryl, promethazine and the like) can be used if
control cannot be achieved at step two, but they should be used cautiously, as sedation
and confusion may occur, especially in the elderly.
The options available in the third step of treatment are omalizumab and cyclosporine.
A 20-year-old college football player becomes disoriented and weak during an afternoon
practice in the heat. On the field, he is sweaty and tachycardic, with a core (rectal)
temperature of 40.9°C (105.6°F). In this patient with exertional heatstroke, which one of
the following would be the most important initial step to reduce his core body
temperature?
A) Administering acetaminophen
B) Administering aspirin
C) Immersing him in cold water
D) Initiating intravenous fluids
E) Transporting him to an emergency facility for treatment - ANSWER C- immersing in
cold water
,Start treatment right away on the field- immerse in cold water or if not an option pour
copious amounts of water on patient with fanning
Infusion of cold fluids would be one of the treatments of choice in elderly patients with
classic heatstroke.
USPSTF recommendation on ocular prophylaxis in newborns for gonococcal ophthalmia
neonatorum - ANSWER Grade A- do this right after birth regardless of gestational age
For patients with terminal pancreatic cancer, lung cancer, or metastatic melanoma,
which one of the following is the potential increase in life expectancy from receiving
hospice care?
A) No increase
B) 3 months
C) 6 months
D) 9 months
E) 12 months - ANSWER B- 3 months
A parent brings their 2-month-old infant to your office for a routine well check. The
infant, who was born at full term, is formula fed and the parent is concerned about
vomiting that occurs after every feeding. After taking a history and examining the infant
you diagnose uncomplicated reflux. The next appropriate intervention would be
A) prone positioning for sleep
B) celiac testing
C) a trial of thickened feeds
D) a trial of an acid suppressor
E) abdominal ultrasonography - ANSWER C- a trial of thickened feeds
I know you love a good acid suppressor.
, For uncomplicated reflux, a trial of thickened feeds and/or switching to a soy formula
would be appropriate, as a milk protein allergy can present similarly.
A trial of an acid suppressor should take place if symptoms are not improved after
omitting cow's milk formula and thickening feeds.
USPSTF recommendation on screening for unhealthy alcohol use in adults 18+ -
ANSWER *pregnant included*
Grade B, use an appropriate questionnaire and counsel if hazardous behavior
USPSTF recommendation on screening for unhealthy alcohol use in ages 12-17 -
ANSWER insufficient evidence
USPSTF recommendation on screening for intimate partner violence - ANSWER Grade B
recommendation for women of reproductive age (adolescent through 40s)
USPSTF recommendation on screening for elder abuse/neglect - ANSWER insufficient
evidence
USPSTF recommendation on behavioral interventions for weight loss to prevent
obesity-related morbidity and mortality in adults - ANSWER Grade B recommendation
If BMI 30 or higher and 18+ years, recommend intensive, multicomponent behavioral
interventions
USPSTF recommendation on screening for syphilis in pregnant women - ANSWER
Grade A, screen at initial visit aka asap
If higher risk community should do third trimester and at delivery, but otherwise only
