AAFP Exam Questions And Answers
A 52-year-old male presents with moderate symptoms of prostatism. A prostate
examination is normal. His post-void residual volume is 90 mL. His PSA level is
0.75 ng/mL (N 0.0-4.0). He says his nocturia has become troublesome and you
decide to initiate therapy.This patient does NOT meet the criteria for use of
which one of the following? (check one) A. Doxazosin (Cardura)
Finasteride (Proscar)
Tadalafil (Cialis)
Tamsulosin (Flomax)
Silodosin (Rapaflo) - ANSWER B
Pharmacologic options for benign prostatic hyperplasia and lower urinary tract
symptoms include an α-adrenergic blocker, a 5-α-reductase inhibitor (if there is
evidence of prostatic enlargement or a PSA level >1.5 ng/mL), a phosphodiesterase-
5 inhibitor, or antimuscarinic therapy. The first three have proven efficacy as
monotherapies.
A 35-year-old female comes to your office for evaluation of a tremor. During the
interview you note jerking movements first in one hand and then the other, but when
the patient is distracted the symptom resolves. Aside from the intermittent tremor the
neurologic examination is unremarkable. She does not drink caffeinated beverages
and takes no medications.Which one of the following is the most likely diagnosis?
(check one)
Parkinson's disease
Cerebellar tremor
Essential tremor
Physio - ANSWER E
Psychogenic tremor is characterized by an abrupt onset, spontaneous remission,
changing characteristics,and extinction with distraction. Cerebellar tremor is an
intention tremor with ipsilateral involvement onthe side of the lesion. Neurologic
testing will reveal past-pointing on finger-to-nose testing. CT or MRIof the head is
the diagnostic test of choice. Parkinsonian tremor is noted at rest, is asymmetric,
anddecreases with voluntary movement. Bradykinesia, rigidity, and postural
instability are generally noted.For atypical presentations a single-photon emission
CT or positron emission tomography may help withthe diagnosis. One of the
treatment options is carbidopa/levodopa.Patients who have essential tremor have
symmetric, fine tremors that may involve the hands, wrists, head,voice, or lower
extremities. This may improve with ingestion of small amounts of alcohol. There is
nospecific diagnostic test but the tremor is treated with propranolol or primidone.
Enhanced physiologictre
, A 69-year-old male with type 2 diabetes mellitus, obesity, and a history of
coronary
artery disease sees you for follow-up of his diabetes. His hemoglobin A1c has
increased
to 8.7% despite therapy with metformin (Glucophage), 1000 mg twice daily, and
insulin glargine (Lantus).Which one of the following additional medications would
be most effective for reducing his blood glucose level and lowering his risk of
cardiovascular events? (check one) A. Exenatide (Byetta)
Glipizide (Glucotrol)
Li - ANSWER C
Liraglutide, exenatide, and dulaglutide are all GLP-1 receptor agonists. Of these,
only liraglutide has been shown to lower the risk of recurrent cardiovascular events
and has received FDA approval for this indication. Glipizide (a sulfonylurea),
rosiglitazone, and sitagliptin have not been associated with improved cardiovascular
outcomes.
Empagliflozin, an SGLT2 inhibitor, has also been associated with secondary
prevention of cardiovascular disease.
You are initiating pharmacologic therapy for a 75-year-old patient with depression.
Which one of the following would be most appropriate for this patient? (check
one) A. Amitriptyline
Escitalopram (Lexapro)
Imipramine (Tofranil)
Paroxetine (Paxil) - ANSWER B
Escitalopram is a preferred antidepressant for older patients (SOR C). Paroxetine
should generally be avoided in older patients due to a higher likelihood of adverse
effects (SOR C). Amitriptyline, imipramine, and paroxetine are highly anticholinergic
and sedating, and according to the Beers Criteria, they can cause orthostatic
hypotension. They have an "avoid" recommendation (SOR A).
The dietary herbal supplement with the highest risk for drug interactions is (check
one)
A. black
cohosh
B.
ginseng
C. St. John's wort (Hypericum
perforatum)
D. saw
palmetto
E. valerian - ANSWER
A 52-year-old male presents with moderate symptoms of prostatism. A prostate
examination is normal. His post-void residual volume is 90 mL. His PSA level is
0.75 ng/mL (N 0.0-4.0). He says his nocturia has become troublesome and you
decide to initiate therapy.This patient does NOT meet the criteria for use of
which one of the following? (check one) A. Doxazosin (Cardura)
Finasteride (Proscar)
Tadalafil (Cialis)
Tamsulosin (Flomax)
Silodosin (Rapaflo) - ANSWER B
Pharmacologic options for benign prostatic hyperplasia and lower urinary tract
symptoms include an α-adrenergic blocker, a 5-α-reductase inhibitor (if there is
evidence of prostatic enlargement or a PSA level >1.5 ng/mL), a phosphodiesterase-
5 inhibitor, or antimuscarinic therapy. The first three have proven efficacy as
monotherapies.
A 35-year-old female comes to your office for evaluation of a tremor. During the
interview you note jerking movements first in one hand and then the other, but when
the patient is distracted the symptom resolves. Aside from the intermittent tremor the
neurologic examination is unremarkable. She does not drink caffeinated beverages
and takes no medications.Which one of the following is the most likely diagnosis?
(check one)
Parkinson's disease
Cerebellar tremor
Essential tremor
Physio - ANSWER E
Psychogenic tremor is characterized by an abrupt onset, spontaneous remission,
changing characteristics,and extinction with distraction. Cerebellar tremor is an
intention tremor with ipsilateral involvement onthe side of the lesion. Neurologic
testing will reveal past-pointing on finger-to-nose testing. CT or MRIof the head is
the diagnostic test of choice. Parkinsonian tremor is noted at rest, is asymmetric,
anddecreases with voluntary movement. Bradykinesia, rigidity, and postural
instability are generally noted.For atypical presentations a single-photon emission
CT or positron emission tomography may help withthe diagnosis. One of the
treatment options is carbidopa/levodopa.Patients who have essential tremor have
symmetric, fine tremors that may involve the hands, wrists, head,voice, or lower
extremities. This may improve with ingestion of small amounts of alcohol. There is
nospecific diagnostic test but the tremor is treated with propranolol or primidone.
Enhanced physiologictre
, A 69-year-old male with type 2 diabetes mellitus, obesity, and a history of
coronary
artery disease sees you for follow-up of his diabetes. His hemoglobin A1c has
increased
to 8.7% despite therapy with metformin (Glucophage), 1000 mg twice daily, and
insulin glargine (Lantus).Which one of the following additional medications would
be most effective for reducing his blood glucose level and lowering his risk of
cardiovascular events? (check one) A. Exenatide (Byetta)
Glipizide (Glucotrol)
Li - ANSWER C
Liraglutide, exenatide, and dulaglutide are all GLP-1 receptor agonists. Of these,
only liraglutide has been shown to lower the risk of recurrent cardiovascular events
and has received FDA approval for this indication. Glipizide (a sulfonylurea),
rosiglitazone, and sitagliptin have not been associated with improved cardiovascular
outcomes.
Empagliflozin, an SGLT2 inhibitor, has also been associated with secondary
prevention of cardiovascular disease.
You are initiating pharmacologic therapy for a 75-year-old patient with depression.
Which one of the following would be most appropriate for this patient? (check
one) A. Amitriptyline
Escitalopram (Lexapro)
Imipramine (Tofranil)
Paroxetine (Paxil) - ANSWER B
Escitalopram is a preferred antidepressant for older patients (SOR C). Paroxetine
should generally be avoided in older patients due to a higher likelihood of adverse
effects (SOR C). Amitriptyline, imipramine, and paroxetine are highly anticholinergic
and sedating, and according to the Beers Criteria, they can cause orthostatic
hypotension. They have an "avoid" recommendation (SOR A).
The dietary herbal supplement with the highest risk for drug interactions is (check
one)
A. black
cohosh
B.
ginseng
C. St. John's wort (Hypericum
perforatum)
D. saw
palmetto
E. valerian - ANSWER
