AAFP Family Medicine Board EXAM Questions AND Correct Answers
A 1-year-old infant is brought to your office for a well child visit. A
screening CBC reveals her hemoglobin to be 10.5 g/dL (N 11.0-14.0)
with a mean corpuscular volume of 69 µm3 (N 70-84). What is the
most likely cause of her anemia? - ✔✔Iron deficiency
This child has evidence of a mild microcytic anemia, which is most
commonly caused by iron deficiency related to reduced dietary
intake. Less common causes are thalassemia and lead poisoning.
Hemolysis usually causes a normocytic anemia with an elevated
reticulocyte count. Chronic liver disease and hypothyroidism result in
macrocytic anemias.
A 10-week-old term male infant is brought to your office with a 2-day
history of difficulty breathing. He has been healthy since birth, with
the exception of a 3-day episode of wheezing and rhinorrhea 3 weeks
ago. Your initial examination shows an alert infant with increased
work of breathing, rhinorrhea, and wheezing. His oxygen saturation is
93% and his temperature is 38.4°C (101.1°F).
What's the appropriate next step? - ✔✔A trial of nebulized albuterol
(AccuNeb)
The American Academy of Pediatrics guideline on the diagnosis and
management of bronchiolitis recommends against the use of
laboratory or radiographic studies to make the diagnosis, although
additional testing may be appropriate if there is no improvement.
,Bronchiolitis can be caused by a number of different viruses, alone or
in combination, and the knowledge gained from virologic testing
rarely influences management decisions or outcomes for the vast
majority of children.
While the guideline does not support routine use of bronchodilators
in the management of bronchiolitis, it does allow for a trial of
bronchodilators as an option in selected cases, and continuation of
the treatment if the patient shows objective improvement in
respiratory status. Bronchodilators have not been shown to affect the
course of bronchiolitis with respect to outcomes.
The guideline places considerable emphasis on hygienic practices,
including the use of alcohol-based hand sanitizers before and after
contact with the patient or inanimate objects in the immediate
vicinity. Education of the family about hygienic practices is
recommended as well. Returning the child to day care the next day is
potentially harmful.
A 10-year-old male is brought to your office after sustaining a fall on
an outstretched hand. Radiographs show a nondisplaced fracture of
the middle third of the clavicle. Appropriate management would
include: - ✔✔A figure-of-8 splint or sling support
In treating the midshaft clavicular fracture, the goal is reduction of
motion at the fracture site. This rarely requires operative intervention
and can be managed by the family physician without orthopedic
,referral. The fracture site is best stabilized by restricting shoulder
motion to less than 45 degree abduction. Either an arm sling or a
figure-of-8 clavicular splint holding the shoulder back at the "position
of attention" may be used. The figure-of-8 splint offers the advantage
of leaving the elbow and hand free for activity. Ice and analgesics are
used as needed during the acute stage of injury. Early use of heat may
increase the inflammatory response. The patient may use the arm as
pain permits, but should not abduct the arm more than 45 degrees for
several weeks. The risk of adhesive capsulitis is negligible in children.
Repeat radiographs at each follow-up office visit are not necessary,
but a final radiograph should be ordered when clinical union has
occurred to assess callus formation.
A 10-year-old white male is brought to your office with a chief
complaint of "head congestion" associated with moderate malaise
and a low-grade fever for 7 days. He has had a thick, discolored nasal
discharge for the last 2 days. What's the appropriate next step? -
✔✔No antibiotics should be used at this time
Clinical diagnosis of bacterial sinusitis requires the following:
prolonged nonspecific upper respiratory signs and symptoms (i.e.,
rhinosinusitis and cough without improvement for >10-14 days), or
more severe upper respiratory tract signs and symptoms (i.e., fever of
39 degrees C or higher, facial swelling, and facial pain). This individual
does not meet these criteria, so antibiotics should not be used at this
time. Although some believe that mucopurulent rhinitis (thick,
opaque, or discolored nasal discharge) indicates the presence of
bacterial sinusitis, this sign should be recognized as part of the natural
course of a nonspecific, uncomplicated viral upper respiratory
, infection (URI). Sinus radiographs can demonstrate thickened mucosa,
infundibular occlusion, and occasional air-fluid levels in
uncomplicated viral URI.
A 12-year-old female has a cough and slight shortness of breath on a
daily basis. She is awakened by the cough at least 3 nights per week.
What would be the most appropriate treatment for this patient? -
✔✔Inhaled corticosteroids daily
This patient has moderate persistent asthma. The preferred and most
effective treatment is daily inhaled corticosteroids. A leukotriene
inhibitor would be less effective. Oral prednisone daily is not
recommended because of the risk of inducing adrenal insufficiency.
Short- and long-acting β-agonists are not recommended as daily
therapy because either can cause tachyphylaxis. They are considered
rescue medications rather than preventive
treatments.@@//d3cgb598vs7bfg.cloudfront.net/images/upload-
flashcards/back/3/9/58393707_m.jpg
A 12-year-old female is brought to your office with an 8-day history of
sore throat and fever, along with migratory aching joint pain. She is
otherwise healthy and has no history of travel, tick exposure, or prior
systemic illness. A physical examination is notable for exudative
pharyngitis; a blanching, sharply demarcated macular rash over her
trunk; and a III/VI systolic ejection murmur. Joint and neurologic
examinations are normal. A rapid strep test is positive and her C-
reactive protein level is elevated.
A 1-year-old infant is brought to your office for a well child visit. A
screening CBC reveals her hemoglobin to be 10.5 g/dL (N 11.0-14.0)
with a mean corpuscular volume of 69 µm3 (N 70-84). What is the
most likely cause of her anemia? - ✔✔Iron deficiency
This child has evidence of a mild microcytic anemia, which is most
commonly caused by iron deficiency related to reduced dietary
intake. Less common causes are thalassemia and lead poisoning.
Hemolysis usually causes a normocytic anemia with an elevated
reticulocyte count. Chronic liver disease and hypothyroidism result in
macrocytic anemias.
A 10-week-old term male infant is brought to your office with a 2-day
history of difficulty breathing. He has been healthy since birth, with
the exception of a 3-day episode of wheezing and rhinorrhea 3 weeks
ago. Your initial examination shows an alert infant with increased
work of breathing, rhinorrhea, and wheezing. His oxygen saturation is
93% and his temperature is 38.4°C (101.1°F).
What's the appropriate next step? - ✔✔A trial of nebulized albuterol
(AccuNeb)
The American Academy of Pediatrics guideline on the diagnosis and
management of bronchiolitis recommends against the use of
laboratory or radiographic studies to make the diagnosis, although
additional testing may be appropriate if there is no improvement.
,Bronchiolitis can be caused by a number of different viruses, alone or
in combination, and the knowledge gained from virologic testing
rarely influences management decisions or outcomes for the vast
majority of children.
While the guideline does not support routine use of bronchodilators
in the management of bronchiolitis, it does allow for a trial of
bronchodilators as an option in selected cases, and continuation of
the treatment if the patient shows objective improvement in
respiratory status. Bronchodilators have not been shown to affect the
course of bronchiolitis with respect to outcomes.
The guideline places considerable emphasis on hygienic practices,
including the use of alcohol-based hand sanitizers before and after
contact with the patient or inanimate objects in the immediate
vicinity. Education of the family about hygienic practices is
recommended as well. Returning the child to day care the next day is
potentially harmful.
A 10-year-old male is brought to your office after sustaining a fall on
an outstretched hand. Radiographs show a nondisplaced fracture of
the middle third of the clavicle. Appropriate management would
include: - ✔✔A figure-of-8 splint or sling support
In treating the midshaft clavicular fracture, the goal is reduction of
motion at the fracture site. This rarely requires operative intervention
and can be managed by the family physician without orthopedic
,referral. The fracture site is best stabilized by restricting shoulder
motion to less than 45 degree abduction. Either an arm sling or a
figure-of-8 clavicular splint holding the shoulder back at the "position
of attention" may be used. The figure-of-8 splint offers the advantage
of leaving the elbow and hand free for activity. Ice and analgesics are
used as needed during the acute stage of injury. Early use of heat may
increase the inflammatory response. The patient may use the arm as
pain permits, but should not abduct the arm more than 45 degrees for
several weeks. The risk of adhesive capsulitis is negligible in children.
Repeat radiographs at each follow-up office visit are not necessary,
but a final radiograph should be ordered when clinical union has
occurred to assess callus formation.
A 10-year-old white male is brought to your office with a chief
complaint of "head congestion" associated with moderate malaise
and a low-grade fever for 7 days. He has had a thick, discolored nasal
discharge for the last 2 days. What's the appropriate next step? -
✔✔No antibiotics should be used at this time
Clinical diagnosis of bacterial sinusitis requires the following:
prolonged nonspecific upper respiratory signs and symptoms (i.e.,
rhinosinusitis and cough without improvement for >10-14 days), or
more severe upper respiratory tract signs and symptoms (i.e., fever of
39 degrees C or higher, facial swelling, and facial pain). This individual
does not meet these criteria, so antibiotics should not be used at this
time. Although some believe that mucopurulent rhinitis (thick,
opaque, or discolored nasal discharge) indicates the presence of
bacterial sinusitis, this sign should be recognized as part of the natural
course of a nonspecific, uncomplicated viral upper respiratory
, infection (URI). Sinus radiographs can demonstrate thickened mucosa,
infundibular occlusion, and occasional air-fluid levels in
uncomplicated viral URI.
A 12-year-old female has a cough and slight shortness of breath on a
daily basis. She is awakened by the cough at least 3 nights per week.
What would be the most appropriate treatment for this patient? -
✔✔Inhaled corticosteroids daily
This patient has moderate persistent asthma. The preferred and most
effective treatment is daily inhaled corticosteroids. A leukotriene
inhibitor would be less effective. Oral prednisone daily is not
recommended because of the risk of inducing adrenal insufficiency.
Short- and long-acting β-agonists are not recommended as daily
therapy because either can cause tachyphylaxis. They are considered
rescue medications rather than preventive
treatments.@@//d3cgb598vs7bfg.cloudfront.net/images/upload-
flashcards/back/3/9/58393707_m.jpg
A 12-year-old female is brought to your office with an 8-day history of
sore throat and fever, along with migratory aching joint pain. She is
otherwise healthy and has no history of travel, tick exposure, or prior
systemic illness. A physical examination is notable for exudative
pharyngitis; a blanching, sharply demarcated macular rash over her
trunk; and a III/VI systolic ejection murmur. Joint and neurologic
examinations are normal. A rapid strep test is positive and her C-
reactive protein level is elevated.
