FAMILY PRACTICE GUIDELINES
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity & Sensitivity
Stem: A 68-year-old Somali man with limited English presents
for an annual visit. He is sedentary, has BMI 31, and mentions
“heat in the chest” but declines extensive testing. How should
you proceed to balance cultural sensitivity with necessary risk
stratification?
A. Accept refusal and schedule routine follow-up in one year.
B. Use a trained medical interpreter to elicit cardiovascular risk
and offer targeted screening now.
C. Recommend immediate referral to cardiology without further
primary care assessment.
D. Offer culturally adapted herbal remedies and defer
Page | 1
,biomedical screening.
Correct answer: B
Rationale — Correct: Use of a trained interpreter improves
accurate history and informed decision-making; offering
targeted screening (BP, ECG if indicated, lipid panel) respects
autonomy while addressing elevated cardiovascular risk (BMI,
age). FPG–aligned family practice approach balances culture
and evidence.
Rationale — Incorrect:
A. Passive acceptance risks missed urgent pathology given age
and risk factors.
C. Immediate specialty referral without primary assessment is
unnecessary and may alienate patient.
D. Offering only herbal remedies without biomedical screening
neglects standard preventive care.
Teaching point: Always use professional interpreters and
prioritize targeted risk screening.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
2
Reference: Ch. 1 — Health Maintenance Guidelines — Adult
Risk Assessment Form
Stem: A 45-year-old woman with two prior pregnancies
presents for a physical. She reports occasional palpitations,
smokes 10 cigarettes/day, and has family history of early
Page | 2
,coronary disease. Her BP today 128/78, BMI 27. Which element
most changes her preventive plan?
A. Occasional palpitations.
B. Family history of early coronary disease.
C. Smoking 10 cigarettes/day.
D. BMI 27.
Correct answer: C
Rationale — Correct: Active tobacco use is the highest-yield
modifiable risk factor affecting screening, counseling,
pharmacotherapy (e.g., nicotine replacement), and
cardiovascular risk reduction per FPG preventive priorities.
Smoking cessation counseling and assist/referral are indicated.
Rationale — Incorrect:
A. Palpitations warrant evaluation but don’t immediately drive
broad preventive strategy.
B. Family history raises risk — requires earlier lipid screening
but less immediate than active smoking.
D. BMI 27 suggests overweight; address lifestyle but tobacco is
higher-priority modifiable risk.
Teaching point: Address tobacco first in adult risk mitigation—
highest modifiable mortality risk.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
3
Page | 3
, Reference: Ch. 1 — Health Maintenance Guidelines — Adult
Preventive Healthcare (Immunizations)
Stem: A 72-year-old woman with COPD presents for preventive
care. She had PPSV23 at age 65 but no influenza vaccine this
season and unsure about zoster. What is the best next step?
A. Give influenza vaccine now and administer recombinant
zoster vaccine series.
B. Re-give PPSV23 now and defer influenza.
C. Administer live zoster vaccine only.
D. No vaccines now because COPD is a contraindication.
Correct answer: A
Rationale — Correct: Annual influenza vaccine is indicated in
older adults and those with COPD. Recombinant zoster vaccine
(2 doses) is recommended for adults ≥50, including those with
COPD. PPSV23 was appropriately given at 65; revaccination is
not routinely indicated now.
Rationale — Incorrect:
B. Repeat PPSV23 unnecessarily; influenza should not be
deferred.
C. Live zoster is contra-indicated in some immunocompromised
patients and is no longer preferred over recombinant vaccine.
D. COPD is an indication, not a contraindication, for
recommended vaccinations.
Teaching point: Offer annual influenza and recombinant zoster
to older adults with COPD.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
Page | 4
6TH EDITION
• AUTHOR(S)JILL C. CASH
TEST BANK
1
Reference: Ch. 1 — Health Maintenance Guidelines — Cultural
Diversity & Sensitivity
Stem: A 68-year-old Somali man with limited English presents
for an annual visit. He is sedentary, has BMI 31, and mentions
“heat in the chest” but declines extensive testing. How should
you proceed to balance cultural sensitivity with necessary risk
stratification?
A. Accept refusal and schedule routine follow-up in one year.
B. Use a trained medical interpreter to elicit cardiovascular risk
and offer targeted screening now.
C. Recommend immediate referral to cardiology without further
primary care assessment.
D. Offer culturally adapted herbal remedies and defer
Page | 1
,biomedical screening.
Correct answer: B
Rationale — Correct: Use of a trained interpreter improves
accurate history and informed decision-making; offering
targeted screening (BP, ECG if indicated, lipid panel) respects
autonomy while addressing elevated cardiovascular risk (BMI,
age). FPG–aligned family practice approach balances culture
and evidence.
Rationale — Incorrect:
A. Passive acceptance risks missed urgent pathology given age
and risk factors.
C. Immediate specialty referral without primary assessment is
unnecessary and may alienate patient.
D. Offering only herbal remedies without biomedical screening
neglects standard preventive care.
Teaching point: Always use professional interpreters and
prioritize targeted risk screening.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
2
Reference: Ch. 1 — Health Maintenance Guidelines — Adult
Risk Assessment Form
Stem: A 45-year-old woman with two prior pregnancies
presents for a physical. She reports occasional palpitations,
smokes 10 cigarettes/day, and has family history of early
Page | 2
,coronary disease. Her BP today 128/78, BMI 27. Which element
most changes her preventive plan?
A. Occasional palpitations.
B. Family history of early coronary disease.
C. Smoking 10 cigarettes/day.
D. BMI 27.
Correct answer: C
Rationale — Correct: Active tobacco use is the highest-yield
modifiable risk factor affecting screening, counseling,
pharmacotherapy (e.g., nicotine replacement), and
cardiovascular risk reduction per FPG preventive priorities.
Smoking cessation counseling and assist/referral are indicated.
Rationale — Incorrect:
A. Palpitations warrant evaluation but don’t immediately drive
broad preventive strategy.
B. Family history raises risk — requires earlier lipid screening
but less immediate than active smoking.
D. BMI 27 suggests overweight; address lifestyle but tobacco is
higher-priority modifiable risk.
Teaching point: Address tobacco first in adult risk mitigation—
highest modifiable mortality risk.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
3
Page | 3
, Reference: Ch. 1 — Health Maintenance Guidelines — Adult
Preventive Healthcare (Immunizations)
Stem: A 72-year-old woman with COPD presents for preventive
care. She had PPSV23 at age 65 but no influenza vaccine this
season and unsure about zoster. What is the best next step?
A. Give influenza vaccine now and administer recombinant
zoster vaccine series.
B. Re-give PPSV23 now and defer influenza.
C. Administer live zoster vaccine only.
D. No vaccines now because COPD is a contraindication.
Correct answer: A
Rationale — Correct: Annual influenza vaccine is indicated in
older adults and those with COPD. Recombinant zoster vaccine
(2 doses) is recommended for adults ≥50, including those with
COPD. PPSV23 was appropriately given at 65; revaccination is
not routinely indicated now.
Rationale — Incorrect:
B. Repeat PPSV23 unnecessarily; influenza should not be
deferred.
C. Live zoster is contra-indicated in some immunocompromised
patients and is no longer preferred over recombinant vaccine.
D. COPD is an indication, not a contraindication, for
recommended vaccinations.
Teaching point: Offer annual influenza and recombinant zoster
to older adults with COPD.
Citation: Cash, J. C. (2025). Family Practice Guidelines (6th Ed.).
Ch. 1.
Page | 4
