AAFP| FROM QUESTION TO PERFECTION| STUDY WITH
CONFIDENCE!
Course Code:
Course Title: AAFP.
Programme:
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 100
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,Multiple Myeloma Answer: The diagnosis of multiple myeloma is based on evidence of
myeloma-related end-organ impairment in the presence of M protein, monoclonal plasma cells,
or both. This evidence may include hyper"C"alcemia, "R"enal failure, "A"nemia, or "B"one
lesions.
-Bone pain is characteristic
(1) The diagnosis is confirmed by a bone marrow examination showing >10% plasma cells in
the marrow.
(1) Autologous stem cell transplantation (in pts >65yo)
Diabetic Polyneuropathy Answer: Typically symmetric and distal limb sensory and motor
deficits.
(1) TCA, amitriptyline
(2) Anticonvulsants
(3) Opioids
Meralgia paresthetica/lateral femoral cutaneous neuropathy Answer: Numbness and paresthesia
over anterolateral thigh with no motor dysfunction. LFC n. trapped in inguinal ligament and
ASIS.
Femoral mononeuropathy Answer: Commonly associated with DM. Decreased sensation to
pinprick and light touch over left anterior thigh. Reduced motor strength on hip flexion and knee
extension.
Estrogen OCP Prophylaxis Answer: Women who use low-dose estrogen OCP have at least a
50% lower risk of epithelial ovarian cancer, postmenopausal hip fractures, risk of endometrial
and colorectal cancer.
-Oral drospirenone/ethinyl estradiol (Yaz, Yasmin), especially when taken with Spironolactone
for PCOS can cause hyperkalemia
Refeeding Syndrome Answer: N/V, hypotension, delirium after refeeding due to
hypophosphatemia.
Refractory HTN Answer: 1. Nonadherence
2. Use of alcohol, NSAIDS, certain antidepressants, or sympathomimetics
(1) Spironolactone and chlorthalidone
Hypertensive encephalopathy: Papilledema and confusion
Secondary HTN Answer: 1. CKD (fluid retention)
2. Obstructive Sleep Apnea
3. Primary hyperaldosteronism
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,-As many as 20% of patients referred to specialists for poorly controlled hypertension have
primary hyperaldosteronism.
(1) Screening can be done with a morning plasma aldosterone/renin ratio. If the ratio is 20 or
more and the aldosterone level is >15 ng/dL, then primary hyperaldosteronism is likely.
4. RA.S
(1) An ACE-inhibitor renal scan or renal magnetic resonance angiography
HTN and other diseases Answer: w/ CKD: ACE-I/ARB
w/ Graves or Hyperthyroid: BB
w/ migraine: BB or CCB
w/ stroke: ACE-I with thiazide
w/ CAD or previous MI: BB and ACE-I
w/ diabetes or athrosclerosis: ACE-I
w/ BPH: alpha blocker
w/ osteoperosis: thiazide
w/ Scleroderma: ACE-I
Peri-operative blood pressure management: BB
Obstructive Sleep Apnea Answer: -MC presenting sx is *excessive daytime sleepiness.
-Other symptoms include snoring, unrefreshing or restless sleep, witnessed apneas and nocturnal
choking, morning headache, nocturia or enuresis, gastroesophageal reflux, and reduced libido.
HTN Answer: -An episode of HTN (<180/120) without hx, esp in ER, make sure to rule out
uncomplicated causes such as white-coat and acute pain.
-To dx HTN, multiple measurements need to be done before initiation of meds.
-The routine tests for a newly diagnosed hypertensive patient include: hemoglobin and
hematocrit, potassium, calcium, fasting glucose, a fasting lipid profile, creatinine, urinalysis,
and a resting electrocardiogram.
-Stage 2 hypertension (systolic blood pressure ≥160 mm Hg, or diastolic blood pressure ≥90
mm Hg)
(1) two-drug combination: HCTZ with either an ACE inhibitor, ARB, β-blocker, or CCB
Introduction of solid foods into diet Answer: 4-6 months
Extrusion reflex (pushing foreign material out of mouth with tongue). Disappears at age 4
months.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, Late onset hypogonadism Answer: 59yo male. Decreased libido, decreased spontaneous
erection, reduced beard growth.
(1) serum total testosterone level
Plantar fasciitis Answer: Due to cumulative overload stress. May be assoc. with obesity.
-Pain worse first in morning, improves during day activity and
worse again at night.
(1) OTC insoles
(2) Stretching of plantar fascia (by stretching achilles tendon)
(3) corticosteroid.
Contrast with Fat-pad atrophy
-Seen in geriatric patients.
-Pain worse as day progresses.
Shoulder Dislocation Answer: (1) 7-10 days of rest for capsular healing then PT
Drug Testing Answer: Oxazepam is metabolite of diazepam
Morphine is metabolite of codeine
Hypercalcemia of malignancy Answer: (1) fluid replacement with normal saline to correct
volume depletion that is invariably present and to enhance renal calcium excretion.
(2) IV pamidronate disodium (Aredia), a bisphosphonate or IV plicamycin (Mithramycin)
Hypercalcemic crisis Answer: (1) IV saline for volume repletion
(2) Furosemide
Hyperparathyroidism Answer: PTH will be suppressible into normal levels by oral calcium or
HCTZ.
-In hypercalcemia, always consider familial hypocalciuric hypercalcemia
-Usually caused by a single adenoma of one of the four parathyroid glands.
(1) Referral to a surgeon for consideration of parathyroidectomy. Use technetium scan for
localization.
Uterine fibroids Answer: A myomectomy is preferred over fibroid embolization due to desire
for future pregnancy. These are considered after failure of medical treatment.
Slipped capital femoral epiphysis Answer: -MC hip disorder in age 8-15. Common to boys who
are overweight/obese. Presents with limping and pain, and limited internal rotation of hip when
knee is flexed on PEx.
-Femoral head epiphysis displaced posterior and medially.
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
CONFIDENCE!
Course Code:
Course Title: AAFP.
Programme:
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 100
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,Multiple Myeloma Answer: The diagnosis of multiple myeloma is based on evidence of
myeloma-related end-organ impairment in the presence of M protein, monoclonal plasma cells,
or both. This evidence may include hyper"C"alcemia, "R"enal failure, "A"nemia, or "B"one
lesions.
-Bone pain is characteristic
(1) The diagnosis is confirmed by a bone marrow examination showing >10% plasma cells in
the marrow.
(1) Autologous stem cell transplantation (in pts >65yo)
Diabetic Polyneuropathy Answer: Typically symmetric and distal limb sensory and motor
deficits.
(1) TCA, amitriptyline
(2) Anticonvulsants
(3) Opioids
Meralgia paresthetica/lateral femoral cutaneous neuropathy Answer: Numbness and paresthesia
over anterolateral thigh with no motor dysfunction. LFC n. trapped in inguinal ligament and
ASIS.
Femoral mononeuropathy Answer: Commonly associated with DM. Decreased sensation to
pinprick and light touch over left anterior thigh. Reduced motor strength on hip flexion and knee
extension.
Estrogen OCP Prophylaxis Answer: Women who use low-dose estrogen OCP have at least a
50% lower risk of epithelial ovarian cancer, postmenopausal hip fractures, risk of endometrial
and colorectal cancer.
-Oral drospirenone/ethinyl estradiol (Yaz, Yasmin), especially when taken with Spironolactone
for PCOS can cause hyperkalemia
Refeeding Syndrome Answer: N/V, hypotension, delirium after refeeding due to
hypophosphatemia.
Refractory HTN Answer: 1. Nonadherence
2. Use of alcohol, NSAIDS, certain antidepressants, or sympathomimetics
(1) Spironolactone and chlorthalidone
Hypertensive encephalopathy: Papilledema and confusion
Secondary HTN Answer: 1. CKD (fluid retention)
2. Obstructive Sleep Apnea
3. Primary hyperaldosteronism
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,-As many as 20% of patients referred to specialists for poorly controlled hypertension have
primary hyperaldosteronism.
(1) Screening can be done with a morning plasma aldosterone/renin ratio. If the ratio is 20 or
more and the aldosterone level is >15 ng/dL, then primary hyperaldosteronism is likely.
4. RA.S
(1) An ACE-inhibitor renal scan or renal magnetic resonance angiography
HTN and other diseases Answer: w/ CKD: ACE-I/ARB
w/ Graves or Hyperthyroid: BB
w/ migraine: BB or CCB
w/ stroke: ACE-I with thiazide
w/ CAD or previous MI: BB and ACE-I
w/ diabetes or athrosclerosis: ACE-I
w/ BPH: alpha blocker
w/ osteoperosis: thiazide
w/ Scleroderma: ACE-I
Peri-operative blood pressure management: BB
Obstructive Sleep Apnea Answer: -MC presenting sx is *excessive daytime sleepiness.
-Other symptoms include snoring, unrefreshing or restless sleep, witnessed apneas and nocturnal
choking, morning headache, nocturia or enuresis, gastroesophageal reflux, and reduced libido.
HTN Answer: -An episode of HTN (<180/120) without hx, esp in ER, make sure to rule out
uncomplicated causes such as white-coat and acute pain.
-To dx HTN, multiple measurements need to be done before initiation of meds.
-The routine tests for a newly diagnosed hypertensive patient include: hemoglobin and
hematocrit, potassium, calcium, fasting glucose, a fasting lipid profile, creatinine, urinalysis,
and a resting electrocardiogram.
-Stage 2 hypertension (systolic blood pressure ≥160 mm Hg, or diastolic blood pressure ≥90
mm Hg)
(1) two-drug combination: HCTZ with either an ACE inhibitor, ARB, β-blocker, or CCB
Introduction of solid foods into diet Answer: 4-6 months
Extrusion reflex (pushing foreign material out of mouth with tongue). Disappears at age 4
months.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, Late onset hypogonadism Answer: 59yo male. Decreased libido, decreased spontaneous
erection, reduced beard growth.
(1) serum total testosterone level
Plantar fasciitis Answer: Due to cumulative overload stress. May be assoc. with obesity.
-Pain worse first in morning, improves during day activity and
worse again at night.
(1) OTC insoles
(2) Stretching of plantar fascia (by stretching achilles tendon)
(3) corticosteroid.
Contrast with Fat-pad atrophy
-Seen in geriatric patients.
-Pain worse as day progresses.
Shoulder Dislocation Answer: (1) 7-10 days of rest for capsular healing then PT
Drug Testing Answer: Oxazepam is metabolite of diazepam
Morphine is metabolite of codeine
Hypercalcemia of malignancy Answer: (1) fluid replacement with normal saline to correct
volume depletion that is invariably present and to enhance renal calcium excretion.
(2) IV pamidronate disodium (Aredia), a bisphosphonate or IV plicamycin (Mithramycin)
Hypercalcemic crisis Answer: (1) IV saline for volume repletion
(2) Furosemide
Hyperparathyroidism Answer: PTH will be suppressible into normal levels by oral calcium or
HCTZ.
-In hypercalcemia, always consider familial hypocalciuric hypercalcemia
-Usually caused by a single adenoma of one of the four parathyroid glands.
(1) Referral to a surgeon for consideration of parathyroidectomy. Use technetium scan for
localization.
Uterine fibroids Answer: A myomectomy is preferred over fibroid embolization due to desire
for future pregnancy. These are considered after failure of medical treatment.
Slipped capital femoral epiphysis Answer: -MC hip disorder in age 8-15. Common to boys who
are overweight/obese. Presents with limping and pain, and limited internal rotation of hip when
knee is flexed on PEx.
-Femoral head epiphysis displaced posterior and medially.
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
