AAFP Board Exam Family Medicine
Certification Practice Questions and
Answers |AAFP Family Medicine Board
Question 1
A 50-year-old white female comes to you because she has found a breast mass. Your
examination reveals a firm, fixed, nontender, 2-cm mass. No axillary nodes are
palpable, nor is there any nipple discharge. You send her for a mammogram, and fine-
needle aspiration is performed to obtain cells for cytologic examination. The
mammogram is read as "suspicious" and the fine-needle cytology report reads, "a few
benign ductal epithelioid cells and adipose tissue."
What would be the most appropriate next step?
Correct Answer
An excisional biopsy of the mass
In the ideal setting, the accuracy of fine-needle aspiration may be over 90%. Clinical
information is critical for interpreting the results of fine-needle aspiration, especially
given the fact that the tissue sample is more limited than with a tissue biopsy. It is
crucial to determine whether the findings on fine-needle aspiration explain the
clinical findings. Although the report from the mammogram and the biopsy are not
ominous in this patient, they do not explain the clinical findings. Immediate repeat
fine-needle aspiration or, preferably, a tissue biopsy is indicated. Proceeding directly
to therapy, whether surgery or irradiation, is inappropriate because the diagnosis is
not clearly established. Likewise, any delay in establishing the diagnosis is not
appropriate
Page 1 of 284
,Question 2
A 72-year-old male has had persistent interscapular pain with movement since
rebuilding his deck 1 week ago. He rates the pain as 6 on a 10-point scale. A chest
radiograph shows a thoracic vertebral compression fracture.
What's the appropriate next step?
Correct Answer
Markedly decreased activity until the pain lessens, and follow-up in 1 week
This patient has suffered a thoracic vertebral compression fracture. Most can be
managed conservatively with decreased activity until the pain is tolerable, possibly
followed by some bracing. Vertebroplasty is an option when the pain is not
improved in 2 weeks. Complete bed rest is unnecessary and could lead to
complications. Physical therapy is not indicated, and NSAIDs should be used with
caution.
Question 3
Which medication used to treat rheumatoid arthritis can delay the progression of the
disease?
Correct Answer
Hydroxychloroquine (Plaquenil)
Hydroxychloroquine, originally developed as an antimalarial drug, is a well-known
disease-modifying agent that can slow the progression of rheumatoid arthritis.
Aspirin, indomethacin, and ibuprofen are anti-inflammatory agents. They relieve
pain and improve mobility, but do not alter the progression of the disease.
Capsaicin, a topical substance-P depleter, can relieve pain symptoms.
Page 2 of 284
,Question 4
A 19-year-old college student comes to your office with her mother. The mother
reports that her daughter has frequently been observed engaging in binge eating
followed by induced vomiting. She has also admitted to using laxatives to prevent
weight gain.
What electrolyte abnormality is most likely to be found in this patient?
Correct Answer
Hypokalemia
The patient described is likely suffering from bulimia. These patients use vomiting,
laxatives, or diuretics to prevent weight gain after binge eating. This often causes a
loss of potassium, leading to weakness, cardiac arrhythmias, and respiratory
difficulty. The levels of other electrolytes are not as dramatically affected.
Question 5
An 84-year-old white female presents to your office with symptoms of an upper
respiratory infection and a hacking cough. She admits to smoking one pack of
cigarettes daily since she was 21 years of age. Which one of the following is true with
regard to her tobacco use?
Correct Answer
Sustained-release bupropion (Wellbutrin SR) has been shown to reduce the relapse
rate for up to 12 months
Sustained-release bupropion has been shown to reduce the relapse rate for
smoking cessation and blunt weight gain for 12 months. Beneficial effects of
smoking cessation are seen even among older smokers. Evidence has now shown
that smokers who switch to low-tar or low-nicotine cigarettes do not significantly
decrease their health risks. The approved Food and Drug Administration
medications for smoking cessation (sustained-release bupropion, nicotine patch,
nicotine gum, nicotine inhaler, and nicotine nasal spray) have been shown to be safe
and should be recommended for all patients without contraindications who are
trying to quit smoking. The nicotine patch in particular is safe, and has been shown
not to cause adverse cardiovascular effects. Ref: Fiore MC, Hatsukami DK, Baker TB:
Effective tobacco dependence treatment. JAMA 2002
Page 3 of 284
, Question 6
For a healthy 1-month-old, daily vitamin D intake should be:
Correct Answer
400 IU
It is now recommended that all infants and children, including adolescents, have a
minimum daily intake of 400 IU of vitamin D, beginning soon after birth. The current
recommendation replaces the previous recommendation of a minimum daily intake
of 200 IU/day of vitamin D supplementation beginning in the first 2 months after
birth and continuing through adolescence. These revised guidelines for vitamin D
intake for healthy infants, children, and adolescents are based on evidence from
new clinical trials and the historical precedent of safely giving 400 IU of vitamin D
per day in the pediatric and adolescent population. New evidence supports a
potential role for vitamin D in maintaining innate immunity and
preventing diseases such as diabetes mellitus and cancer.
Question 7
A small child with failure to thrive is found to have a bone age that is markedly
delayed relative to height age and chronologic age. The most likely etiology is:
Correct Answer
Hypothyroidism
Hypothyroidism is associated with markedly delayed bone age relative to height
age and chronologic age. In cystic fibrosis, bone age and height age are equivalent,
but both lag behind chronologic age. Children with chromosomal anomalies such as
trisomy 21 (Down syndrome) or XO have a height age which is delayed relative to
bone age. This pattern is also seen as a result of maternal substance abuse.
Page 4 of 284
Certification Practice Questions and
Answers |AAFP Family Medicine Board
Question 1
A 50-year-old white female comes to you because she has found a breast mass. Your
examination reveals a firm, fixed, nontender, 2-cm mass. No axillary nodes are
palpable, nor is there any nipple discharge. You send her for a mammogram, and fine-
needle aspiration is performed to obtain cells for cytologic examination. The
mammogram is read as "suspicious" and the fine-needle cytology report reads, "a few
benign ductal epithelioid cells and adipose tissue."
What would be the most appropriate next step?
Correct Answer
An excisional biopsy of the mass
In the ideal setting, the accuracy of fine-needle aspiration may be over 90%. Clinical
information is critical for interpreting the results of fine-needle aspiration, especially
given the fact that the tissue sample is more limited than with a tissue biopsy. It is
crucial to determine whether the findings on fine-needle aspiration explain the
clinical findings. Although the report from the mammogram and the biopsy are not
ominous in this patient, they do not explain the clinical findings. Immediate repeat
fine-needle aspiration or, preferably, a tissue biopsy is indicated. Proceeding directly
to therapy, whether surgery or irradiation, is inappropriate because the diagnosis is
not clearly established. Likewise, any delay in establishing the diagnosis is not
appropriate
Page 1 of 284
,Question 2
A 72-year-old male has had persistent interscapular pain with movement since
rebuilding his deck 1 week ago. He rates the pain as 6 on a 10-point scale. A chest
radiograph shows a thoracic vertebral compression fracture.
What's the appropriate next step?
Correct Answer
Markedly decreased activity until the pain lessens, and follow-up in 1 week
This patient has suffered a thoracic vertebral compression fracture. Most can be
managed conservatively with decreased activity until the pain is tolerable, possibly
followed by some bracing. Vertebroplasty is an option when the pain is not
improved in 2 weeks. Complete bed rest is unnecessary and could lead to
complications. Physical therapy is not indicated, and NSAIDs should be used with
caution.
Question 3
Which medication used to treat rheumatoid arthritis can delay the progression of the
disease?
Correct Answer
Hydroxychloroquine (Plaquenil)
Hydroxychloroquine, originally developed as an antimalarial drug, is a well-known
disease-modifying agent that can slow the progression of rheumatoid arthritis.
Aspirin, indomethacin, and ibuprofen are anti-inflammatory agents. They relieve
pain and improve mobility, but do not alter the progression of the disease.
Capsaicin, a topical substance-P depleter, can relieve pain symptoms.
Page 2 of 284
,Question 4
A 19-year-old college student comes to your office with her mother. The mother
reports that her daughter has frequently been observed engaging in binge eating
followed by induced vomiting. She has also admitted to using laxatives to prevent
weight gain.
What electrolyte abnormality is most likely to be found in this patient?
Correct Answer
Hypokalemia
The patient described is likely suffering from bulimia. These patients use vomiting,
laxatives, or diuretics to prevent weight gain after binge eating. This often causes a
loss of potassium, leading to weakness, cardiac arrhythmias, and respiratory
difficulty. The levels of other electrolytes are not as dramatically affected.
Question 5
An 84-year-old white female presents to your office with symptoms of an upper
respiratory infection and a hacking cough. She admits to smoking one pack of
cigarettes daily since she was 21 years of age. Which one of the following is true with
regard to her tobacco use?
Correct Answer
Sustained-release bupropion (Wellbutrin SR) has been shown to reduce the relapse
rate for up to 12 months
Sustained-release bupropion has been shown to reduce the relapse rate for
smoking cessation and blunt weight gain for 12 months. Beneficial effects of
smoking cessation are seen even among older smokers. Evidence has now shown
that smokers who switch to low-tar or low-nicotine cigarettes do not significantly
decrease their health risks. The approved Food and Drug Administration
medications for smoking cessation (sustained-release bupropion, nicotine patch,
nicotine gum, nicotine inhaler, and nicotine nasal spray) have been shown to be safe
and should be recommended for all patients without contraindications who are
trying to quit smoking. The nicotine patch in particular is safe, and has been shown
not to cause adverse cardiovascular effects. Ref: Fiore MC, Hatsukami DK, Baker TB:
Effective tobacco dependence treatment. JAMA 2002
Page 3 of 284
, Question 6
For a healthy 1-month-old, daily vitamin D intake should be:
Correct Answer
400 IU
It is now recommended that all infants and children, including adolescents, have a
minimum daily intake of 400 IU of vitamin D, beginning soon after birth. The current
recommendation replaces the previous recommendation of a minimum daily intake
of 200 IU/day of vitamin D supplementation beginning in the first 2 months after
birth and continuing through adolescence. These revised guidelines for vitamin D
intake for healthy infants, children, and adolescents are based on evidence from
new clinical trials and the historical precedent of safely giving 400 IU of vitamin D
per day in the pediatric and adolescent population. New evidence supports a
potential role for vitamin D in maintaining innate immunity and
preventing diseases such as diabetes mellitus and cancer.
Question 7
A small child with failure to thrive is found to have a bone age that is markedly
delayed relative to height age and chronologic age. The most likely etiology is:
Correct Answer
Hypothyroidism
Hypothyroidism is associated with markedly delayed bone age relative to height
age and chronologic age. In cystic fibrosis, bone age and height age are equivalent,
but both lag behind chronologic age. Children with chromosomal anomalies such as
trisomy 21 (Down syndrome) or XO have a height age which is delayed relative to
bone age. This pattern is also seen as a result of maternal substance abuse.
Page 4 of 284
