AAFP Board Exam Review Questions and Answers
(All Correct Answers) 2022
-What screening test has most potential for overdx?
{{Correct Ans- PSA- Overdiagnosis is the diagnosis of a disease that will not produce symptoms during a
patient's lifetime. It tends to occur with cancers that have very slow rates of growth.
Prostate cancer is most often a slow-growing cancer and is often present without
symptoms in older men. The introduction of prostate-specific antigen (PSA) screening was
accompanied by a marked rise in the rate of diagnosis of prostate cancer while mortality
decreased much less significantly, and this decrease was probably largely attributable to
improved treatment.
-What is the treatment for mallet fracture?
{{Correct Ans- The recommended treatment for a mallet fracture is splinting the distal interphalangeal
(DIP) joint in
extension (SOR B). The usual duration of splinting is 8 weeks. It is important that extension be
maintained
throughout the duration of treatment because flexion can affect healing and prolong the time needed
for
treatment. If the finger fracture involves >30% of the intra-articular surface, referral to a hand or
orthopedic surgeon can be considered. However, conservative therapy appears to have outcomes
similar
to those of surgical treatment and therefore is generally preferred.
-If subluxed radial head is suspected in a child, is imaging needed?
{{Correct Ans- As long as there are no outward signs of fracture or abuse it is considered safe and
appropriate to attempt reduction of the radial head before moving on to imaging studies. With the
child's elbow in 90° of flexion, the hand is fully supinated by the examiner and the elbow is then brought
into full flexion. Usually the child will begin to use the affected arm again within a couple of minutes. If
,ecchymosis, significant swelling, or pain away from the joint is present, or if symptoms do not improve
after attempts at reduction, then a plain radiograph is recommended.
-A 17-year-old female sees you for a preparticipation evaluation. She has run 5 miles a day for the last 6
months, and has lost 6 lb over the past 2 months. Her last menstrual period was 3 months ago. Other
than the fact that she appears to be slightly underweight, her examination is normal.
To fit the criteria for the female athlete triad, she must have which one of the following?
{{Correct Ans- The initial definition of the female athlete triad was amenorrhea, osteoporosis, and
disordered eating. The American College of Sports Medicine modified this in 2007, emphasizing that the
triad components occur on a continuum rather than as individual pathologic conditions. The definitions
have therefore expanded. Disordered eating is no longer defined as the formal diagnosis of an eating
disorder. Energy availability,defined as dietary energy intake minus exercise energy expenditures, is now
considered a risk factor for the triad, as dietary restrictions and substantial energy expenditures disrupt
pituitary and ovarian function.
Athletes who have amenorrhea for 6 months, disordered eating, and/or a history of a stress fracture
resulting from minimal trauma should have a bone density test. Low bone mineral density for age is the
term used to describe at-risk female athletes with a Z-score of -1 to -2. Osteoporosis is defined as having
clinical risk factors for experiencing a fracture, along with a Z-score <-2.
-what is the work up for secondary amenorrhea?
{{Correct Ans- This patient suffers from secondary amenorrhea (defined as the cessation of regular
menses for 3 months or irregular menses for 6 months). The most common causes of secondary
amenorrhea are polycystic ovary syndrome, primary ovarian failure, hypothalamic amenorrhea, and
hyperprolactinemia. With a normal physical examination, negative pregnancy test, and no history of
chronic disease, a hormonal
workup is indicated, including TSH, LH, and FSH levels (SOR C).
A hormonal challenge with medroxyprogesterone to provoke withdrawal bleeding is used to assess
functional anatomy and estrogen levels (SOR C). However, it has poor specificity and sensitivity for
ovarian function and a poor correlation with estrogen levels.
,Pelvic ultrasonography is indicated in the workup of primary amenorrhea to confirm the presence of a
uterus and detect structural abnormalities of the reproductive organs. Likewise, karyotyping can be used
for patients with primary amenorrhea, as conditions such as Turner's syndrome and androgen
insensitivity syndrome are due to chromosomal abnormalities.
A CBC and metabolic panel would not be initial considerations in the workup of amenorrhea unless the
patient has a known chronic disease which may affect the results.
-What's the first line treatment for primary dysmenorrhea?
{{Correct Ans- The first-line treatment for primary dysmenorrhea should be NSAIDs (SOR A). They should
be started
at the onset of menses and continued for the first 1-2 days of the menstrual cycle.
Combined oral contraceptives may be effective for primary dysmenorrhea, but there i s a lack of high-
quality randomized, controlled trials demonstrating pain improvement (SOR B). They may be a good
choice if the patient also desires contraception. Although combined oral contraceptives and
intramuscular and subcutaneous progestin-only contraceptives are effective treatments for
dysmenorrhea caused by endometriosis, they are NOT first-line therapy for primary dysmenorrhea.
-A 24-year-old female presents with pelvic pain. She says that the pain is present on most days, but is
worse during her menses. Ibuprofen has helped in the past but is no longer effective. Her menses are
normal and she has only one sexual partner. A physical examination is normal.
Which one of the following should be the next step in the workup of this patient?
{{Correct Ans- The initial evaluation for chronic pelvic pain should include a urinalysis and culture,
cervical swabs for gonorrhea and Chlamydia, a CBC, an erythrocyte sedimentation rate, a β-hCG level,
and pelvic ultrasonography. CT and MRI are not part of the recommended initial diagnostic workup, but
may be helpful in further assessing any abnormalities found on pelvic ultrasonography. Referral for
diagnostic laparoscopy is appropriate if the initial workup does not reveal a source of the pain, or if
endometriosis or adhesions are suspected. Colonoscopy would be indicated if the history or
examination suggests a gastrointestinal source for the pain after the initial evaluation.
-what can induce ovulation in PCOS?
, {{Correct Ans- This patient fits the criteria for polycystic ovary syndrome (oligomenorrhea, acne,
hirsutism, hyperandrogenism, infertility). Symptoms also include insulin resistance. Evidence of
polycystic ovaries is not required for the diagnosis.
Metformin has the most evidence supporting its use in this situation, and is the only treatment listed
that is likely to decrease hirsutism and improve insulin resistance and menstrual irregularities.
Metformin and clomiphene alone or in combination are first-line agents for ovulation induction.
Clomiphene does not improve hirsutism, however. Progesterone is not indicated for any of this patient's
problems. Spironolactone will improve hirsutism and menstrual irregularities, but is not indicated for
ovulation induction.
-What is the first step for evaluating a thyroid nodule?
{{Correct Ans- Thyroid nodules >1 cm that are discovered incidentally on examination or imaging studies
merit further evaluation. Nodules <1 cm should also be fully evaluated when found in patients with a
family history of thyroid cancer, a personal history of head and neck irradiation, or a finding of cervical
node enlargement.
Reasonable first steps include measurement of TSH or ultrasound examination. The American
Thyroid Association's guidelines recommend that TSH be the initial evaluation (SOR A) and that this be
followed by a radionuclide thyroid scan if results are abnormal. Diagnostic ultrasonography is
recommended for all patients with a suspected thyroid nodule, a nodular goiter, or a nodule found
incidentally on another imaging study (SOR A). Routine measurement of serum thyroglobulin or
calcitonin levels is not currently recommended.
-CDC guidelines for a flu outbreak?
{{Correct Ans- The occurrence of two or more laboratory-confirmed cases of influenza A is considered an
outbreak in a long-term care facility. The CDC has specific recommendations for managing an outbreak,
which include *chemoprophylaxis with an appropriate medication for all residents who are
asymptomatic and treatment for all residents who are symptomatic*, regardless of laboratory
confirmation of infection or vaccination
status.
(All Correct Answers) 2022
-What screening test has most potential for overdx?
{{Correct Ans- PSA- Overdiagnosis is the diagnosis of a disease that will not produce symptoms during a
patient's lifetime. It tends to occur with cancers that have very slow rates of growth.
Prostate cancer is most often a slow-growing cancer and is often present without
symptoms in older men. The introduction of prostate-specific antigen (PSA) screening was
accompanied by a marked rise in the rate of diagnosis of prostate cancer while mortality
decreased much less significantly, and this decrease was probably largely attributable to
improved treatment.
-What is the treatment for mallet fracture?
{{Correct Ans- The recommended treatment for a mallet fracture is splinting the distal interphalangeal
(DIP) joint in
extension (SOR B). The usual duration of splinting is 8 weeks. It is important that extension be
maintained
throughout the duration of treatment because flexion can affect healing and prolong the time needed
for
treatment. If the finger fracture involves >30% of the intra-articular surface, referral to a hand or
orthopedic surgeon can be considered. However, conservative therapy appears to have outcomes
similar
to those of surgical treatment and therefore is generally preferred.
-If subluxed radial head is suspected in a child, is imaging needed?
{{Correct Ans- As long as there are no outward signs of fracture or abuse it is considered safe and
appropriate to attempt reduction of the radial head before moving on to imaging studies. With the
child's elbow in 90° of flexion, the hand is fully supinated by the examiner and the elbow is then brought
into full flexion. Usually the child will begin to use the affected arm again within a couple of minutes. If
,ecchymosis, significant swelling, or pain away from the joint is present, or if symptoms do not improve
after attempts at reduction, then a plain radiograph is recommended.
-A 17-year-old female sees you for a preparticipation evaluation. She has run 5 miles a day for the last 6
months, and has lost 6 lb over the past 2 months. Her last menstrual period was 3 months ago. Other
than the fact that she appears to be slightly underweight, her examination is normal.
To fit the criteria for the female athlete triad, she must have which one of the following?
{{Correct Ans- The initial definition of the female athlete triad was amenorrhea, osteoporosis, and
disordered eating. The American College of Sports Medicine modified this in 2007, emphasizing that the
triad components occur on a continuum rather than as individual pathologic conditions. The definitions
have therefore expanded. Disordered eating is no longer defined as the formal diagnosis of an eating
disorder. Energy availability,defined as dietary energy intake minus exercise energy expenditures, is now
considered a risk factor for the triad, as dietary restrictions and substantial energy expenditures disrupt
pituitary and ovarian function.
Athletes who have amenorrhea for 6 months, disordered eating, and/or a history of a stress fracture
resulting from minimal trauma should have a bone density test. Low bone mineral density for age is the
term used to describe at-risk female athletes with a Z-score of -1 to -2. Osteoporosis is defined as having
clinical risk factors for experiencing a fracture, along with a Z-score <-2.
-what is the work up for secondary amenorrhea?
{{Correct Ans- This patient suffers from secondary amenorrhea (defined as the cessation of regular
menses for 3 months or irregular menses for 6 months). The most common causes of secondary
amenorrhea are polycystic ovary syndrome, primary ovarian failure, hypothalamic amenorrhea, and
hyperprolactinemia. With a normal physical examination, negative pregnancy test, and no history of
chronic disease, a hormonal
workup is indicated, including TSH, LH, and FSH levels (SOR C).
A hormonal challenge with medroxyprogesterone to provoke withdrawal bleeding is used to assess
functional anatomy and estrogen levels (SOR C). However, it has poor specificity and sensitivity for
ovarian function and a poor correlation with estrogen levels.
,Pelvic ultrasonography is indicated in the workup of primary amenorrhea to confirm the presence of a
uterus and detect structural abnormalities of the reproductive organs. Likewise, karyotyping can be used
for patients with primary amenorrhea, as conditions such as Turner's syndrome and androgen
insensitivity syndrome are due to chromosomal abnormalities.
A CBC and metabolic panel would not be initial considerations in the workup of amenorrhea unless the
patient has a known chronic disease which may affect the results.
-What's the first line treatment for primary dysmenorrhea?
{{Correct Ans- The first-line treatment for primary dysmenorrhea should be NSAIDs (SOR A). They should
be started
at the onset of menses and continued for the first 1-2 days of the menstrual cycle.
Combined oral contraceptives may be effective for primary dysmenorrhea, but there i s a lack of high-
quality randomized, controlled trials demonstrating pain improvement (SOR B). They may be a good
choice if the patient also desires contraception. Although combined oral contraceptives and
intramuscular and subcutaneous progestin-only contraceptives are effective treatments for
dysmenorrhea caused by endometriosis, they are NOT first-line therapy for primary dysmenorrhea.
-A 24-year-old female presents with pelvic pain. She says that the pain is present on most days, but is
worse during her menses. Ibuprofen has helped in the past but is no longer effective. Her menses are
normal and she has only one sexual partner. A physical examination is normal.
Which one of the following should be the next step in the workup of this patient?
{{Correct Ans- The initial evaluation for chronic pelvic pain should include a urinalysis and culture,
cervical swabs for gonorrhea and Chlamydia, a CBC, an erythrocyte sedimentation rate, a β-hCG level,
and pelvic ultrasonography. CT and MRI are not part of the recommended initial diagnostic workup, but
may be helpful in further assessing any abnormalities found on pelvic ultrasonography. Referral for
diagnostic laparoscopy is appropriate if the initial workup does not reveal a source of the pain, or if
endometriosis or adhesions are suspected. Colonoscopy would be indicated if the history or
examination suggests a gastrointestinal source for the pain after the initial evaluation.
-what can induce ovulation in PCOS?
, {{Correct Ans- This patient fits the criteria for polycystic ovary syndrome (oligomenorrhea, acne,
hirsutism, hyperandrogenism, infertility). Symptoms also include insulin resistance. Evidence of
polycystic ovaries is not required for the diagnosis.
Metformin has the most evidence supporting its use in this situation, and is the only treatment listed
that is likely to decrease hirsutism and improve insulin resistance and menstrual irregularities.
Metformin and clomiphene alone or in combination are first-line agents for ovulation induction.
Clomiphene does not improve hirsutism, however. Progesterone is not indicated for any of this patient's
problems. Spironolactone will improve hirsutism and menstrual irregularities, but is not indicated for
ovulation induction.
-What is the first step for evaluating a thyroid nodule?
{{Correct Ans- Thyroid nodules >1 cm that are discovered incidentally on examination or imaging studies
merit further evaluation. Nodules <1 cm should also be fully evaluated when found in patients with a
family history of thyroid cancer, a personal history of head and neck irradiation, or a finding of cervical
node enlargement.
Reasonable first steps include measurement of TSH or ultrasound examination. The American
Thyroid Association's guidelines recommend that TSH be the initial evaluation (SOR A) and that this be
followed by a radionuclide thyroid scan if results are abnormal. Diagnostic ultrasonography is
recommended for all patients with a suspected thyroid nodule, a nodular goiter, or a nodule found
incidentally on another imaging study (SOR A). Routine measurement of serum thyroglobulin or
calcitonin levels is not currently recommended.
-CDC guidelines for a flu outbreak?
{{Correct Ans- The occurrence of two or more laboratory-confirmed cases of influenza A is considered an
outbreak in a long-term care facility. The CDC has specific recommendations for managing an outbreak,
which include *chemoprophylaxis with an appropriate medication for all residents who are
asymptomatic and treatment for all residents who are symptomatic*, regardless of laboratory
confirmation of infection or vaccination
status.
