AAFP Board Review| 160 Questions| with complete solutions
how to differentiate between chlamydial and RSV infections Correct Answer: chlamydia: hx of
conjunctivitis, subacute onset, absence of fever, mild wheezing
meds for BPH and lower urinary tract symptoms Correct Answer: alpha blocker, 5-a-reductase
inhibitor (if there's evidence of prostatic enlargement or PSA > 1.5 ng/mL), phosphodiesterase-5
inhibitor, and antimusc therapy
tx for mallet fracture - forced flexion injury of DIP resulting in a small bone fragment at dorsal
surface of proximal distal phalanx Correct Answer: splinting the DIP in extension
duration of 8 wks
if fx involves > 30% of intra-articular surface - referral to specialist
tx for acute depression and maintenance therapy of bipolar disorders Correct Answer: Li
valproate
lamotrigine
some antipsychotics (including quetiapine)
necrotizing fasciitis Correct Answer: severe pain and skin changes outside the realm of cellulitis
- including bullae and deeper discoloration
tx: aggressive surgical debridement w/in 12 hrs
Pt on amiodarone
what hormone should be monitored? Correct Answer: TSH
f/u q6 months
radial head subluxation or nursemaid's elbow Correct Answer: caused when picking up a toddler
by the arm
partial displacement of radial head when child's arm undergoes axial traction while in a
protonated and fully ext position
tx: reduction of radial head - child's elbow is in 90 deg flexion > hand fully supinated > elbow
brought into full flexion
inhaled corticosteroid use in kids Correct Answer: has not been proven to prematurely close
growth plates
most effective tx for mod persistent asthma w/ least SEs
1st line tx for primary dysmenorrhea Correct Answer: NSAIDs
started at onset of menses and cont for first 1-2 days
1 cm nodule in left lobe of thyroid; confirmed by US
next step in evaluation? Correct Answer: TSH level
followed w/ radionuclide thyroid scan if results abnormal
anti-epileptic med that has the SE of SJS Correct Answer: lamotrigine
,should start at 25 mg qd and titrated q2 wks until goal dosage is reached
CDC guidelines on "outbreaks" Correct Answer: occurence of 2+ lab-confirmed cases of
influenza A = outbreak in long-term care facility
chemoppx w/ appropriate meds for all residents who are asymptomatic and tx those who are
symptomatic regardless of lab confirmation or vaccination status
where to find the strongest evidence for tx, screening, or prevention strategies? Correct Answer:
systematic reviews
meta-analyses
RCTs w/ consistent findings or single high-quality RCT
2 day old infant has flesh-colored papules w/ erythematous base
on face and trunk
contain eosinophils
dx? tx? Correct Answer: erythema toxic neonatorum
happens usually first 2 wks of life
no tx necessary
asymptotic microscopic hematuria measurement? Correct Answer: >3 RBCs/hpf
terminally ill pt
new symptom of resp distress
Pox 94% on room air
lungs clear to auscultation
tx? Correct Answer: opiates
w/o hypoxia - O2 won't be helpful
abd pain
bloody diarrhea
CV risk factors - hx of vascular dementia, peripheral artery dz, HTN, and HLD
nasogastric aspirate neg for bleeding (r/o PUD)
most likely cause of bleeding? Correct Answer: ischemic colitis
also associated w/ fever
SEs of inhaled corticosteroids Correct Answer: inc risk of brusing
candidiasis infection of oropharynx
PNA
inc bone less and fxs
screening for depression Correct Answer: start w/ PHQ-2 - freq of depressed mood and
anhedonia (lost interest) over past 2 wks
f/u w/ PHQ-9
"growing pains" Correct Answer: benign nocturnal limb pains of childhood
crampy pains in thigh, calf, or shin
, kids 4-6 yo; can occur up to 19 yo
tx: supportive care and OTC analgesics if necessary
initial tx of high BP Correct Answer: ACEi
ARBs
CCB
thiazides
note that BB are not first line
polymyalgia rheumatica Correct Answer: seen in elderly pts (rarely seen before 50 yo)
MSK complaints: pain, stiffness, tenderness, dec ROM
labs: inc CRP and ESR
most pts will also have systemic symptoms - fatigue, weight loss, low-grade fever, decline in
appetite, and depression
tx response to 15 mg prednisone is dramatic - w/in 24-48 hrs
pt wants a procedure that it against your moral principles (ex: abortion)
what do you do? Correct Answer: physicians have the responsibility to provide resources on
how to access a safe and legal procedure
severe diabetic ulcer w/ signs of systemic inflammatory response
which IV antibiotics? Correct Answer: piperacillin/tazobactam (Zosyn) and vanc (Vancocin)
mod to severe diabetic foot ulcers - often polymicrobial and include gram+ cocci, gram- bacilli,
and anaerobes
pt euvolemic but have hyponatremia, dec serum osmolality, inc urine osmolality
what drugs can cause this? Correct Answer: SIADH
meds: SSRIs (esp in pts > 65 yo), chlorpropamide, barbs, carbamazepine, opioids, tolbutamide,
vincristine, diuretics, and NSAIDs
MC cause of unintentional deaths in kids? Correct Answer: MVA
PFT results: FVC <80% of predicted, FEV1/FVC 90% of predicted, no improvement w/
bronchodilator use
DLCO low
most likely the problem? Correct Answer: idiopathic pulmonary fibrosis
PFT results suggest restrictive pattern
acute, sharp chest pain relieved by leaning forward
pericardial friction rub
EKG: diffuse ST elections
echo: small pericardial effusion
dx? tx? Correct Answer: acute pericarditis
colchicine and/or NSAIDs
glucocorticoids used in severe/refractory cases or in cases caused by CT dz, autoreactivity, or
uremia
how to differentiate between chlamydial and RSV infections Correct Answer: chlamydia: hx of
conjunctivitis, subacute onset, absence of fever, mild wheezing
meds for BPH and lower urinary tract symptoms Correct Answer: alpha blocker, 5-a-reductase
inhibitor (if there's evidence of prostatic enlargement or PSA > 1.5 ng/mL), phosphodiesterase-5
inhibitor, and antimusc therapy
tx for mallet fracture - forced flexion injury of DIP resulting in a small bone fragment at dorsal
surface of proximal distal phalanx Correct Answer: splinting the DIP in extension
duration of 8 wks
if fx involves > 30% of intra-articular surface - referral to specialist
tx for acute depression and maintenance therapy of bipolar disorders Correct Answer: Li
valproate
lamotrigine
some antipsychotics (including quetiapine)
necrotizing fasciitis Correct Answer: severe pain and skin changes outside the realm of cellulitis
- including bullae and deeper discoloration
tx: aggressive surgical debridement w/in 12 hrs
Pt on amiodarone
what hormone should be monitored? Correct Answer: TSH
f/u q6 months
radial head subluxation or nursemaid's elbow Correct Answer: caused when picking up a toddler
by the arm
partial displacement of radial head when child's arm undergoes axial traction while in a
protonated and fully ext position
tx: reduction of radial head - child's elbow is in 90 deg flexion > hand fully supinated > elbow
brought into full flexion
inhaled corticosteroid use in kids Correct Answer: has not been proven to prematurely close
growth plates
most effective tx for mod persistent asthma w/ least SEs
1st line tx for primary dysmenorrhea Correct Answer: NSAIDs
started at onset of menses and cont for first 1-2 days
1 cm nodule in left lobe of thyroid; confirmed by US
next step in evaluation? Correct Answer: TSH level
followed w/ radionuclide thyroid scan if results abnormal
anti-epileptic med that has the SE of SJS Correct Answer: lamotrigine
,should start at 25 mg qd and titrated q2 wks until goal dosage is reached
CDC guidelines on "outbreaks" Correct Answer: occurence of 2+ lab-confirmed cases of
influenza A = outbreak in long-term care facility
chemoppx w/ appropriate meds for all residents who are asymptomatic and tx those who are
symptomatic regardless of lab confirmation or vaccination status
where to find the strongest evidence for tx, screening, or prevention strategies? Correct Answer:
systematic reviews
meta-analyses
RCTs w/ consistent findings or single high-quality RCT
2 day old infant has flesh-colored papules w/ erythematous base
on face and trunk
contain eosinophils
dx? tx? Correct Answer: erythema toxic neonatorum
happens usually first 2 wks of life
no tx necessary
asymptotic microscopic hematuria measurement? Correct Answer: >3 RBCs/hpf
terminally ill pt
new symptom of resp distress
Pox 94% on room air
lungs clear to auscultation
tx? Correct Answer: opiates
w/o hypoxia - O2 won't be helpful
abd pain
bloody diarrhea
CV risk factors - hx of vascular dementia, peripheral artery dz, HTN, and HLD
nasogastric aspirate neg for bleeding (r/o PUD)
most likely cause of bleeding? Correct Answer: ischemic colitis
also associated w/ fever
SEs of inhaled corticosteroids Correct Answer: inc risk of brusing
candidiasis infection of oropharynx
PNA
inc bone less and fxs
screening for depression Correct Answer: start w/ PHQ-2 - freq of depressed mood and
anhedonia (lost interest) over past 2 wks
f/u w/ PHQ-9
"growing pains" Correct Answer: benign nocturnal limb pains of childhood
crampy pains in thigh, calf, or shin
, kids 4-6 yo; can occur up to 19 yo
tx: supportive care and OTC analgesics if necessary
initial tx of high BP Correct Answer: ACEi
ARBs
CCB
thiazides
note that BB are not first line
polymyalgia rheumatica Correct Answer: seen in elderly pts (rarely seen before 50 yo)
MSK complaints: pain, stiffness, tenderness, dec ROM
labs: inc CRP and ESR
most pts will also have systemic symptoms - fatigue, weight loss, low-grade fever, decline in
appetite, and depression
tx response to 15 mg prednisone is dramatic - w/in 24-48 hrs
pt wants a procedure that it against your moral principles (ex: abortion)
what do you do? Correct Answer: physicians have the responsibility to provide resources on
how to access a safe and legal procedure
severe diabetic ulcer w/ signs of systemic inflammatory response
which IV antibiotics? Correct Answer: piperacillin/tazobactam (Zosyn) and vanc (Vancocin)
mod to severe diabetic foot ulcers - often polymicrobial and include gram+ cocci, gram- bacilli,
and anaerobes
pt euvolemic but have hyponatremia, dec serum osmolality, inc urine osmolality
what drugs can cause this? Correct Answer: SIADH
meds: SSRIs (esp in pts > 65 yo), chlorpropamide, barbs, carbamazepine, opioids, tolbutamide,
vincristine, diuretics, and NSAIDs
MC cause of unintentional deaths in kids? Correct Answer: MVA
PFT results: FVC <80% of predicted, FEV1/FVC 90% of predicted, no improvement w/
bronchodilator use
DLCO low
most likely the problem? Correct Answer: idiopathic pulmonary fibrosis
PFT results suggest restrictive pattern
acute, sharp chest pain relieved by leaning forward
pericardial friction rub
EKG: diffuse ST elections
echo: small pericardial effusion
dx? tx? Correct Answer: acute pericarditis
colchicine and/or NSAIDs
glucocorticoids used in severe/refractory cases or in cases caused by CT dz, autoreactivity, or
uremia
