Family Medicine Board Review Exam
UPDATED QUESTIONS AND CORRECT
ANSWERS
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 - CORRECT ANSWER ANSWER: 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 - CORRECT ANSWER ANSWER: 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 - CORRECT
ANSWER ANSWER: 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 - CORRECT ANSWER ANSWER: 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 - CORRECT ANSWER ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening,
Papanicolaou (Pap) testing
should begin at age 21 irrespective of sexual activity and should be continued every 3 years
until age 29. The preferred screening strategy beginning at age 30 is Pap testing with HPV
, co-testing, which should be continued every 5 years until age 65. Cervical screening may be
discontinued at that time if the patient's last two tests have been negative and the patient was
tested within the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes - CORRECT ANSWER ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and
health care-associated pneumonia, which is related to gastric overgrowth by gram-negative
bacteria. Long-term treatment of Barrett's esophagus is an indication for chronic proton pump
inhibitor (PPI) use. PPI therapy does not increase the risk of gout, hypertension, or type 2
diabetes.
An 87-year-old female comes to your office for an annual health maintenance visit. She
appears cachectic and tells you that for the past 6 months she has had a decreased appetite
and generalized muscle weakness. The patient is alert and oriented to person and place. She
has a 10% weight loss, dry mucous membranes, and tenting of the skin on the extensor
surface of her hands. While inflating the blood pressure cuff on her right arm you observe
carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
E) Hyponatremia - CORRECT ANSWER ANSWER: B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the
nerves that control them, is present in up to 94% of patients with hypocalcemia.
Hypercalcemia is more likely to present with hyperreflexia. Patients with hypokalemia,
hypernatremia, or hyponatremia may present with weakness and confusion, but tetany is not a
common sign of either sodium or potassium imbalance.
UPDATED QUESTIONS AND CORRECT
ANSWERS
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 - CORRECT ANSWER ANSWER: 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 - CORRECT ANSWER ANSWER: 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 - CORRECT
ANSWER ANSWER: 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 - CORRECT ANSWER ANSWER: 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 - CORRECT ANSWER ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening,
Papanicolaou (Pap) testing
should begin at age 21 irrespective of sexual activity and should be continued every 3 years
until age 29. The preferred screening strategy beginning at age 30 is Pap testing with HPV
, co-testing, which should be continued every 5 years until age 65. Cervical screening may be
discontinued at that time if the patient's last two tests have been negative and the patient was
tested within the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes - CORRECT ANSWER ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and
health care-associated pneumonia, which is related to gastric overgrowth by gram-negative
bacteria. Long-term treatment of Barrett's esophagus is an indication for chronic proton pump
inhibitor (PPI) use. PPI therapy does not increase the risk of gout, hypertension, or type 2
diabetes.
An 87-year-old female comes to your office for an annual health maintenance visit. She
appears cachectic and tells you that for the past 6 months she has had a decreased appetite
and generalized muscle weakness. The patient is alert and oriented to person and place. She
has a 10% weight loss, dry mucous membranes, and tenting of the skin on the extensor
surface of her hands. While inflating the blood pressure cuff on her right arm you observe
carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
E) Hyponatremia - CORRECT ANSWER ANSWER: B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the
nerves that control them, is present in up to 94% of patients with hypocalcemia.
Hypercalcemia is more likely to present with hyperreflexia. Patients with hypokalemia,
hypernatremia, or hyponatremia may present with weakness and confusion, but tetany is not a
common sign of either sodium or potassium imbalance.
