AAFP Family Medicine Certification Practice
Questions and Verified Answers
Question 1
A 34-year-old white primigravida in her first trimester had established moderate
hypertension before becoming pregnant. She currently has a blood pressure of
168/108 mm Hg. You are considering how to best manage her hypertension during
the pregnancy. What medication is associated with the greatest risk of fetal growth
retardation if used for hypertension throughout pregnancy?
Correct Answer
Atenolol (Tenormin)
Atenolol and propranolol are associated with intrauterine growth retardation when
used for prolonged periods during pregnancy. They are class D agents during
pregnancy. Other beta-blockers may not share this risk. Methyldopa, hydralazine,
and calcium channel blockers have not been associated with intrauterine growth
retardation. They are generally acceptable agents to use for established, significant
hypertension during pregnancy
Question 2
In a patient with a solitary thyroid nodule, what findings are associated with a higher
incidence of malignancy?
Correct Answer
When evaluating a patient with a solitary thyroid nodule, red flags indicating
possible thyroid cancer include:
● male gender
● age <20 years or >65 years
● rapid growth of the nodule
● symptoms of local invasion such as dysphagia, neck pain, and hoarseness
● a history of head or neck radiation
● a family history of thyroid cancer
● a hard, fixed nodule >4 cm
● cervical lymphadenopathy.
Page 1 of 416
,Question 3
A 23-year-old female sees you with a complaint of intermittent irregular heartbeats
that occur once every week or two, but do not cause her to feel lightheaded or
fatigued. They last only a few seconds and resolve spontaneously. She has never
passed out, had chest pain, or had difficulty with exertion. She is otherwise healthy,
and a physical examination is normal. What cardiac study should be ordered initially?
Correct Answer
EKG
The symptom of an increased or abnormal sensation of one's heartbeat is referred
to as palpitations. This condition is common to primary care, but is often benign.
Commonly, these sensations have their basis in anxiety or panic. However, about
50% of those who complain of palpitations will be found to have a diagnosable
cardiac condition. It is recommended to start the evaluation for cardiac causes with
an EKG, which will assess the baseline rhythm and screen for signs of chamber
enlargement, previous myocardial infarction, conduction disturbances, and a
prolonged QT interval.
Page 2 of 416
,Question 4
A 26-year-old gravida 3 para 2 was diagnosed with gestational diabetes mellitus at 24
weeks gestation. She was prescribed appropriate nutritional therapy and an exercise
program. After 4 weeks, her fasting plasma glucose levels remain in the range of 105-
110 mg/dL.
What would be the most appropriate treatment for this patient at this time?
Correct Answer
A combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin
(e.g., lispro) twice daily
In addition to an appropriate diet and exercise regimen, pharmacologic therapy
should be initiated in pregnant women with gestational diabetes mellitus whose
fasting plasma glucose levels remain above 100 mg/dL despite diet and exercise.
There is strong evidence that such treatment to maintain fasting plasma glucose
levels below 95 mg/dL and 1-hour postprandial levels below 140 mg/dL results in
improved fetal well-being and neonatal outcomes. While oral therapy with
metformin or glyburide is considered safe and possibly effective, insulin therapy is
the best option for the pharmacologic treatment of gestational diabetes.
Thiazolidinediones such as pioglitazone have not been shown to be effective or safe
in pregnancy.
The use of long-acting basal insulin analogues, such as glargine and detemir, has
not been sufficiently evaluated in pregnancy. Sliding-scale coverage with ultra-
short-acting insulin or insulin analogues, such as lispro and aspart, is generally not
required in most women with gestational diabetes. While it may be effective, it
involves four daily glucose checks and injections.
Most patients are successfully treated with a twice-daily combination of an
intermediate-acting insulin and a short-acting insulin while continuing a diet and
exercise program.
Page 3 of 416
, Question 5
A 27-year-old white female at 12 weeks gestation comes to your office complaining
of a vaginal discharge. On speculum examination you note a purulent cervical
discharge with a friable cervix. A gonorrhea culture is negative. You make a diagnosis
of Chlamydia trachomatis cervicitis.
What is the appropriate treatment?
Correct Answer
Azithromycin (Zithromax)
Azithromycin is the drug of choice for Chlamydia trachomatis infections in pregnant
patients. Metronidazole is used to treat trichomoniasis and Gardnerella vaginitis
after 12 weeks gestation. The use of tetracycline is not appropriate in pregnant
women, and miconazole is used to treat vaginal candidiasis.
Question 6
A 67-year-old female comes to your office because she noticed flashing lights in her
left eye 2 hours ago, and since then has had decreased vision in the lateral aspect of
that eye. On examination she has a blind spot in the lateral visual field of her left eye.
Her fundus is difficult to examine because of an early cataract.
What is the most likely diagnosis?
Correct Answer
Retinal detachment
In a patient complaining of flashes of light and a visual field defect, retinal
detachment is the most likely diagnosis. Many cases of vitreous detachment are
asymptomatic, and it does not cause sudden visual field defects in the absence of a
retinal detachment. A vitreous hemorrhage would cause more blurring of vision in
the entire field of vision. Ocular migraine causes binocular symptoms.
Page 4 of 416
Questions and Verified Answers
Question 1
A 34-year-old white primigravida in her first trimester had established moderate
hypertension before becoming pregnant. She currently has a blood pressure of
168/108 mm Hg. You are considering how to best manage her hypertension during
the pregnancy. What medication is associated with the greatest risk of fetal growth
retardation if used for hypertension throughout pregnancy?
Correct Answer
Atenolol (Tenormin)
Atenolol and propranolol are associated with intrauterine growth retardation when
used for prolonged periods during pregnancy. They are class D agents during
pregnancy. Other beta-blockers may not share this risk. Methyldopa, hydralazine,
and calcium channel blockers have not been associated with intrauterine growth
retardation. They are generally acceptable agents to use for established, significant
hypertension during pregnancy
Question 2
In a patient with a solitary thyroid nodule, what findings are associated with a higher
incidence of malignancy?
Correct Answer
When evaluating a patient with a solitary thyroid nodule, red flags indicating
possible thyroid cancer include:
● male gender
● age <20 years or >65 years
● rapid growth of the nodule
● symptoms of local invasion such as dysphagia, neck pain, and hoarseness
● a history of head or neck radiation
● a family history of thyroid cancer
● a hard, fixed nodule >4 cm
● cervical lymphadenopathy.
Page 1 of 416
,Question 3
A 23-year-old female sees you with a complaint of intermittent irregular heartbeats
that occur once every week or two, but do not cause her to feel lightheaded or
fatigued. They last only a few seconds and resolve spontaneously. She has never
passed out, had chest pain, or had difficulty with exertion. She is otherwise healthy,
and a physical examination is normal. What cardiac study should be ordered initially?
Correct Answer
EKG
The symptom of an increased or abnormal sensation of one's heartbeat is referred
to as palpitations. This condition is common to primary care, but is often benign.
Commonly, these sensations have their basis in anxiety or panic. However, about
50% of those who complain of palpitations will be found to have a diagnosable
cardiac condition. It is recommended to start the evaluation for cardiac causes with
an EKG, which will assess the baseline rhythm and screen for signs of chamber
enlargement, previous myocardial infarction, conduction disturbances, and a
prolonged QT interval.
Page 2 of 416
,Question 4
A 26-year-old gravida 3 para 2 was diagnosed with gestational diabetes mellitus at 24
weeks gestation. She was prescribed appropriate nutritional therapy and an exercise
program. After 4 weeks, her fasting plasma glucose levels remain in the range of 105-
110 mg/dL.
What would be the most appropriate treatment for this patient at this time?
Correct Answer
A combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin
(e.g., lispro) twice daily
In addition to an appropriate diet and exercise regimen, pharmacologic therapy
should be initiated in pregnant women with gestational diabetes mellitus whose
fasting plasma glucose levels remain above 100 mg/dL despite diet and exercise.
There is strong evidence that such treatment to maintain fasting plasma glucose
levels below 95 mg/dL and 1-hour postprandial levels below 140 mg/dL results in
improved fetal well-being and neonatal outcomes. While oral therapy with
metformin or glyburide is considered safe and possibly effective, insulin therapy is
the best option for the pharmacologic treatment of gestational diabetes.
Thiazolidinediones such as pioglitazone have not been shown to be effective or safe
in pregnancy.
The use of long-acting basal insulin analogues, such as glargine and detemir, has
not been sufficiently evaluated in pregnancy. Sliding-scale coverage with ultra-
short-acting insulin or insulin analogues, such as lispro and aspart, is generally not
required in most women with gestational diabetes. While it may be effective, it
involves four daily glucose checks and injections.
Most patients are successfully treated with a twice-daily combination of an
intermediate-acting insulin and a short-acting insulin while continuing a diet and
exercise program.
Page 3 of 416
, Question 5
A 27-year-old white female at 12 weeks gestation comes to your office complaining
of a vaginal discharge. On speculum examination you note a purulent cervical
discharge with a friable cervix. A gonorrhea culture is negative. You make a diagnosis
of Chlamydia trachomatis cervicitis.
What is the appropriate treatment?
Correct Answer
Azithromycin (Zithromax)
Azithromycin is the drug of choice for Chlamydia trachomatis infections in pregnant
patients. Metronidazole is used to treat trichomoniasis and Gardnerella vaginitis
after 12 weeks gestation. The use of tetracycline is not appropriate in pregnant
women, and miconazole is used to treat vaginal candidiasis.
Question 6
A 67-year-old female comes to your office because she noticed flashing lights in her
left eye 2 hours ago, and since then has had decreased vision in the lateral aspect of
that eye. On examination she has a blind spot in the lateral visual field of her left eye.
Her fundus is difficult to examine because of an early cataract.
What is the most likely diagnosis?
Correct Answer
Retinal detachment
In a patient complaining of flashes of light and a visual field defect, retinal
detachment is the most likely diagnosis. Many cases of vitreous detachment are
asymptomatic, and it does not cause sudden visual field defects in the absence of a
retinal detachment. A vitreous hemorrhage would cause more blurring of vision in
the entire field of vision. Ocular migraine causes binocular symptoms.
Page 4 of 416
