American Board of Family Medicine (ABFM) MCQ Practice Questions, Exams
of Medicine
A 42-year-old Asian male presents for follow-up of elevated blood pressure.
He has no additional chronic medical problems and is otherwise
asymptomatic. An examination is significant for a blood pressure of 162/95
mm Hg but is otherwise unremarkable.
Laboratory Findings unremarkable
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association
2017 guidelines, which one of the following would be the most appropriate
medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily - ANSWERANSWER: C
This patient has hypertension and according to both JNC 8 and American
College of Cardiology/American Heart Association 2017 guidelines,
antihypertensive treatment should be initiated. For the general non-African-
American population, monotherapy with an ACE inhibitor, an angiotensin
receptor blocker, a calcium channel blocker, or a thiazide diuretic would be
appropriate for initial management. It is also appropriate to initiate
,combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin
receptor blocker simultaneously. Studies have shown that blood pressure
control is achieved faster with the initiation of combination therapy
compared to monotherapy, without an increase in morbidity.
Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient.
-Blockers, vasodilators, -blockers, and potassium-sparing diuretics are not
recommended as initial choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to CDC
guidelines, who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms - ANSWERANSWER: C
In long-term care facilities, an influenza outbreak is defined as two
laboratory-confirmed cases of influenza
within 72 hours in patients on the same unit. The CDC recommends
chemoprophylaxis for all asymptomatic residents of the affected unit. Any
resident exhibiting symptoms of influenza should be treated for influenza and
not given chemoprophylaxis dosing. Chemoprophylaxis is not recommended
for residents of other units unless there are two laboratory-confirmed cases
in those units. Facility staff of the affected unit can be considered for
chemoprophylaxis if they have not been vaccinated or if they had a recent
vaccination, but chemoprophylaxis is not recommended for all staff in the
entire facility.
,A 24-year-old female presents with a 2-day history of mild to moderate pelvic
pain. She has had two male sex partners in the last 6 months and uses oral
contraceptives and sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and
moderate cervical motion and uterine tenderness. Urine hCG and a urinalysis
are negative. Vaginal microscopy shows only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in
this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography -
ANSWERANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should
be administered at the time of diagnosis and not delayed until the results of
the nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are
returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a
mucopurulent discharge or WBCs on saline microscopy. Acute phase
indicators such as fever, leukocytosis, or an elevated C-reactive protein level
may be helpful but are neither sensitive nor specific. A positive NAAT is not
required for diagnosis and treatment because an upper tract infection may be
present, or the causative agent may not be gonorrhea or Chlamydia. PID
should be considered a polymicrobial infection. Pelvic ultrasonography may
be used if there is a concern about other pathology such as a tubo-ovarian
abscess.
A 24-year-old patient wants to start the process of transitioning from female
to male. He has been working with a psychiatrist who has confirmed the
, diagnosis of gender dysphoria. Which one of the following would be the best
initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone - ANSWERANSWER: E
For patients with gender dysphoria or gender incongruence who desire
hormone treatment, the treatment goal is to suppress endogenous sex
hormone production and maintain sex hormone levels in the normal range
for their affirmed gender. For a female-to-male transgender patient this is
most easily accomplished with testosterone. When testosterone levels are
maintained in the normal genetic male range, gonadotropins and ovarian
hormone production is suppressed, which accomplishes both goals for
hormonal treatment without the need for additional gonadotropin
suppression from medications such as leuprolide. Clomiphene can increase
serum testosterone levels, but only in the presence of a functioning testicle.
Letrozole is an estrogen receptor antagonist, but it would not increase serum
testosterone levels. Spironolactone has androgen receptor blocking effects
and would not accomplish either of the hormone treatment goals.
Based on American Cancer Society guidelines for cervical cancer screening,
when should HPV DNA co-testing first be performed along with Papanicolaou
testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35 - ANSWERANSWER: D
of Medicine
A 42-year-old Asian male presents for follow-up of elevated blood pressure.
He has no additional chronic medical problems and is otherwise
asymptomatic. An examination is significant for a blood pressure of 162/95
mm Hg but is otherwise unremarkable.
Laboratory Findings unremarkable
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association
2017 guidelines, which one of the following would be the most appropriate
medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily - ANSWERANSWER: C
This patient has hypertension and according to both JNC 8 and American
College of Cardiology/American Heart Association 2017 guidelines,
antihypertensive treatment should be initiated. For the general non-African-
American population, monotherapy with an ACE inhibitor, an angiotensin
receptor blocker, a calcium channel blocker, or a thiazide diuretic would be
appropriate for initial management. It is also appropriate to initiate
,combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin
receptor blocker simultaneously. Studies have shown that blood pressure
control is achieved faster with the initiation of combination therapy
compared to monotherapy, without an increase in morbidity.
Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient.
-Blockers, vasodilators, -blockers, and potassium-sparing diuretics are not
recommended as initial choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to CDC
guidelines, who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms - ANSWERANSWER: C
In long-term care facilities, an influenza outbreak is defined as two
laboratory-confirmed cases of influenza
within 72 hours in patients on the same unit. The CDC recommends
chemoprophylaxis for all asymptomatic residents of the affected unit. Any
resident exhibiting symptoms of influenza should be treated for influenza and
not given chemoprophylaxis dosing. Chemoprophylaxis is not recommended
for residents of other units unless there are two laboratory-confirmed cases
in those units. Facility staff of the affected unit can be considered for
chemoprophylaxis if they have not been vaccinated or if they had a recent
vaccination, but chemoprophylaxis is not recommended for all staff in the
entire facility.
,A 24-year-old female presents with a 2-day history of mild to moderate pelvic
pain. She has had two male sex partners in the last 6 months and uses oral
contraceptives and sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and
moderate cervical motion and uterine tenderness. Urine hCG and a urinalysis
are negative. Vaginal microscopy shows only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in
this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography -
ANSWERANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should
be administered at the time of diagnosis and not delayed until the results of
the nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are
returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a
mucopurulent discharge or WBCs on saline microscopy. Acute phase
indicators such as fever, leukocytosis, or an elevated C-reactive protein level
may be helpful but are neither sensitive nor specific. A positive NAAT is not
required for diagnosis and treatment because an upper tract infection may be
present, or the causative agent may not be gonorrhea or Chlamydia. PID
should be considered a polymicrobial infection. Pelvic ultrasonography may
be used if there is a concern about other pathology such as a tubo-ovarian
abscess.
A 24-year-old patient wants to start the process of transitioning from female
to male. He has been working with a psychiatrist who has confirmed the
, diagnosis of gender dysphoria. Which one of the following would be the best
initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone - ANSWERANSWER: E
For patients with gender dysphoria or gender incongruence who desire
hormone treatment, the treatment goal is to suppress endogenous sex
hormone production and maintain sex hormone levels in the normal range
for their affirmed gender. For a female-to-male transgender patient this is
most easily accomplished with testosterone. When testosterone levels are
maintained in the normal genetic male range, gonadotropins and ovarian
hormone production is suppressed, which accomplishes both goals for
hormonal treatment without the need for additional gonadotropin
suppression from medications such as leuprolide. Clomiphene can increase
serum testosterone levels, but only in the presence of a functioning testicle.
Letrozole is an estrogen receptor antagonist, but it would not increase serum
testosterone levels. Spironolactone has androgen receptor blocking effects
and would not accomplish either of the hormone treatment goals.
Based on American Cancer Society guidelines for cervical cancer screening,
when should HPV DNA co-testing first be performed along with Papanicolaou
testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35 - ANSWERANSWER: D
