AAFP QUESTIONS FM EXAM STUDY GUIDE WITH
COMPLETE SOLUTIONS
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) - ANSWER B. Finasteride (Proscar)
Pharmacologic options for BPH and lower urinary tract symptoms include an
α-adrenergic blocker, a 5-α-reductase inhibitor (if there is evidence of prostatic
enlargement or a PSA level >1.5 ng/mL), a phosphodiesterase-5 inhibitor, or
antimuscarinic therapy. The first three have proven efficacy as monotherapies.
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? (check
one)
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 - ANSWER D. FSH and LH levels
TIn men who are diagnosed with hypogonadism with symptoms of testosterone
deficiency and unequivocally and consistently low serum testosterone concentrations,
,further evaluation with FSH and LH levels is advised as the initial workup to distinguish
between primary and secondary hypogonadism. If secondary hypogonadism is
indicated by low or inappropriately normal FSH and LH levels, prolactin and serum iron
levels and measurement of TIBC are recommended to determine secondary causes of
hypogonadism, with possible further evaluation to include other pituitary hormone
levels and MRI of the pituitary. If primary hypogonadism is found, karyotyping may be
indicated for Klinefelter's syndrome.
A 4-year-old female is brought to your office because of a history of constipation over
the past several months. Her mother reports that the child has 1-2 bowel movements
per week composed of small lumps of hard stool. She strains to have the bowel
movements, and they are painful. The child eats normally like her two siblings.Which
one of the following would be most effective at this time? (check one)
A. Daily fiber supplements
B. Lactulose
C. Magnesium hydroxide (Milk of Magnesia)
D. Polyethylene glycol (MiraLAX)
E. Senna - ANSWER D. Polyethylene glycol (MiraLAX)
This patient presents with symptoms compatible with functional constipation. Daily use
of polyethyleneglycol (PEG) solution has been found to be more effective than lactulose,
senna, or magnesium hydroxidein head-to-head studies.
A 30-year-old female presents with a 5-day history of subjective fever and malaise. She
does not have a thermometer at home but has felt alternately warm and chilled. She has
felt generally unwell and is sleeping more than usual. She has had a decreased appetite
but has been drinking fluids without difficulty. She does not have a runny nose, cough,
headache, abdominal pain, vomiting, diarrhea, joint pain, rash, or pain with urination.
Her medical history includes substance use disorder and she takes
buprenorphine/naloxone (Suboxone). She smokes one pack of cigarettes daily, has 0-2
alcoholic drinks daily, and began using intravenous heroin again 1 week ago.
An examination reveals a blood pressure of 112/68 mm Hg, a pulse rate of 88 beats/min,
a respiratory rate of 16/min, a temperature of 38.9°C (102.0°F), and an oxygen
,saturation of 95% on room air. The patient appears fatigued and uncomfortable but
nontoxic. Her h - ANSWER C
A patient who uses intravenous drugs and has a fever without a clear source must be
evaluated forinfectious endocarditis (IE). The first step in this evaluation is to obtain
blood cultures. Although thispatient might have a less serious condition, it is critical to
evaluate for bacteremia in this situation. If theconcern for IE is high, blood cultures
should be obtained and antibiotics may be started while waiting forresults and
arranging for urgent echocardiography.
Which one of the following is the most appropriate first-line therapy for primary
dysmenorrhea? (check one)
A. Combined monophasic oral contraceptives
B. Combined multiphasic oral contraceptives
C. Subdermal etonogestrel (Nexplanon)
D. Intramuscular medroxyprogesterone (Depo-Provera)
E. NSAIDs - ANSWER E. NSAIDs
They should be started at the onset of menses and continued for the first 1-2 days of the
menstrual cycle. Combined oralcontraceptives may be effective for primary
dysmenorrhea, but there is a lack of high-quality randomized,controlled trials
demonstrating pain improvement (SOR B). They may be a good choice if the patient
alsodesires contraception. Although combined oral contraceptives and intramuscular
and subcutaneous progestin-only contraceptives are effective treatments for
dysmenorrhea caused by endometriosis, they are not first-line therapy for primary
dysmenorrhea.
A 10-year-old male has an 8-mm induration 2 days after a tuberculin skin test. He shares
a bedroom with his 18-year-old brother who was recently diagnosed with tuberculosis.
There are no other historical or physical examination findings to suggest active
tuberculosis infection and a chest radiograph is normal.Which one of the following
would be most appropriate at this point? (check one)
, A. toring with annual tuberculin skin testing
B. Observation and repeat tuberculin skin testing in 3 weeks
C. Rifampin (Rifadin) daily for 4 months
D. Isoniazid daily for 9 months
E. Once-weekly isoniazid and rifampin for 3 months - ANSWER D. Isoniazid daily for 9
months
Based on CDC guidelines an induration >5 mm at 48-72 hours following an intradermal
injection of tuberculin is a positive test in individuals who have been in recent contact
with a person with infectious TB, those with radiographic evidence of prior TB,
HIV-infected persons, and immunosuppressed patients.
For other individuals at increased risk for TB, the threshold for a positive test is an
induration >10 mm at 48-72 hours. For those with no known risks for TB infection, the
induration must exceed 15 mm in size to be considered positive.
Once positive, there is no indication for additional skin tests. A positive screening test
along with a ROS, a PE, and a CXR that do not show evidence of active infection
confirms the diagnosis of latent TB.
For children age 2-11 years, treatment with isoniazid, 10-20 mg/kg daily or 20-40 mg/kg
twice weekly for 9 months, is the preferred and most efficacious treatment regimen.
The shorter 6-month treatment course is considered an acceptable option for adults,
but it is not recommended for children. The use of rifampin alone or in combination with
isoniazid is also an acceptable option for adults but not for children <12.
A 45-year-old female who works as a house cleaner presents with left shoulder pain. On
examination she has pain and relative weakness when pushing toward the midline
against resistance while the shoulder is adducted and the elbow is bent to 90°. With the
elbow still at 90° she is unable to keep her left hand away from her body when you
position her hand behind her back.This presentation is most consistent with an injury of
which one of the following tendons? (check one)
COMPLETE SOLUTIONS
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) - ANSWER B. Finasteride (Proscar)
Pharmacologic options for BPH and lower urinary tract symptoms include an
α-adrenergic blocker, a 5-α-reductase inhibitor (if there is evidence of prostatic
enlargement or a PSA level >1.5 ng/mL), a phosphodiesterase-5 inhibitor, or
antimuscarinic therapy. The first three have proven efficacy as monotherapies.
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? (check
one)
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 - ANSWER D. FSH and LH levels
TIn men who are diagnosed with hypogonadism with symptoms of testosterone
deficiency and unequivocally and consistently low serum testosterone concentrations,
,further evaluation with FSH and LH levels is advised as the initial workup to distinguish
between primary and secondary hypogonadism. If secondary hypogonadism is
indicated by low or inappropriately normal FSH and LH levels, prolactin and serum iron
levels and measurement of TIBC are recommended to determine secondary causes of
hypogonadism, with possible further evaluation to include other pituitary hormone
levels and MRI of the pituitary. If primary hypogonadism is found, karyotyping may be
indicated for Klinefelter's syndrome.
A 4-year-old female is brought to your office because of a history of constipation over
the past several months. Her mother reports that the child has 1-2 bowel movements
per week composed of small lumps of hard stool. She strains to have the bowel
movements, and they are painful. The child eats normally like her two siblings.Which
one of the following would be most effective at this time? (check one)
A. Daily fiber supplements
B. Lactulose
C. Magnesium hydroxide (Milk of Magnesia)
D. Polyethylene glycol (MiraLAX)
E. Senna - ANSWER D. Polyethylene glycol (MiraLAX)
This patient presents with symptoms compatible with functional constipation. Daily use
of polyethyleneglycol (PEG) solution has been found to be more effective than lactulose,
senna, or magnesium hydroxidein head-to-head studies.
A 30-year-old female presents with a 5-day history of subjective fever and malaise. She
does not have a thermometer at home but has felt alternately warm and chilled. She has
felt generally unwell and is sleeping more than usual. She has had a decreased appetite
but has been drinking fluids without difficulty. She does not have a runny nose, cough,
headache, abdominal pain, vomiting, diarrhea, joint pain, rash, or pain with urination.
Her medical history includes substance use disorder and she takes
buprenorphine/naloxone (Suboxone). She smokes one pack of cigarettes daily, has 0-2
alcoholic drinks daily, and began using intravenous heroin again 1 week ago.
An examination reveals a blood pressure of 112/68 mm Hg, a pulse rate of 88 beats/min,
a respiratory rate of 16/min, a temperature of 38.9°C (102.0°F), and an oxygen
,saturation of 95% on room air. The patient appears fatigued and uncomfortable but
nontoxic. Her h - ANSWER C
A patient who uses intravenous drugs and has a fever without a clear source must be
evaluated forinfectious endocarditis (IE). The first step in this evaluation is to obtain
blood cultures. Although thispatient might have a less serious condition, it is critical to
evaluate for bacteremia in this situation. If theconcern for IE is high, blood cultures
should be obtained and antibiotics may be started while waiting forresults and
arranging for urgent echocardiography.
Which one of the following is the most appropriate first-line therapy for primary
dysmenorrhea? (check one)
A. Combined monophasic oral contraceptives
B. Combined multiphasic oral contraceptives
C. Subdermal etonogestrel (Nexplanon)
D. Intramuscular medroxyprogesterone (Depo-Provera)
E. NSAIDs - ANSWER E. NSAIDs
They should be started at the onset of menses and continued for the first 1-2 days of the
menstrual cycle. Combined oralcontraceptives may be effective for primary
dysmenorrhea, but there is a lack of high-quality randomized,controlled trials
demonstrating pain improvement (SOR B). They may be a good choice if the patient
alsodesires contraception. Although combined oral contraceptives and intramuscular
and subcutaneous progestin-only contraceptives are effective treatments for
dysmenorrhea caused by endometriosis, they are not first-line therapy for primary
dysmenorrhea.
A 10-year-old male has an 8-mm induration 2 days after a tuberculin skin test. He shares
a bedroom with his 18-year-old brother who was recently diagnosed with tuberculosis.
There are no other historical or physical examination findings to suggest active
tuberculosis infection and a chest radiograph is normal.Which one of the following
would be most appropriate at this point? (check one)
, A. toring with annual tuberculin skin testing
B. Observation and repeat tuberculin skin testing in 3 weeks
C. Rifampin (Rifadin) daily for 4 months
D. Isoniazid daily for 9 months
E. Once-weekly isoniazid and rifampin for 3 months - ANSWER D. Isoniazid daily for 9
months
Based on CDC guidelines an induration >5 mm at 48-72 hours following an intradermal
injection of tuberculin is a positive test in individuals who have been in recent contact
with a person with infectious TB, those with radiographic evidence of prior TB,
HIV-infected persons, and immunosuppressed patients.
For other individuals at increased risk for TB, the threshold for a positive test is an
induration >10 mm at 48-72 hours. For those with no known risks for TB infection, the
induration must exceed 15 mm in size to be considered positive.
Once positive, there is no indication for additional skin tests. A positive screening test
along with a ROS, a PE, and a CXR that do not show evidence of active infection
confirms the diagnosis of latent TB.
For children age 2-11 years, treatment with isoniazid, 10-20 mg/kg daily or 20-40 mg/kg
twice weekly for 9 months, is the preferred and most efficacious treatment regimen.
The shorter 6-month treatment course is considered an acceptable option for adults,
but it is not recommended for children. The use of rifampin alone or in combination with
isoniazid is also an acceptable option for adults but not for children <12.
A 45-year-old female who works as a house cleaner presents with left shoulder pain. On
examination she has pain and relative weakness when pushing toward the midline
against resistance while the shoulder is adducted and the elbow is bent to 90°. With the
elbow still at 90° she is unable to keep her left hand away from her body when you
position her hand behind her back.This presentation is most consistent with an injury of
which one of the following tendons? (check one)
