AAFM BOARDS – DERMATOLOGY
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
When should antihypertensive medication be given in acute ischemic stroke in the elderly? - ANSWER 1).
should not be given during the first 48-72 hours as long as they are not candidates for, or recipients of,
reperfusion therapy with alteplase or thrombectomy;
2). do not have a comorbid condition requiring acute blood pressure lowering;
3). and do not have a blood pressure >220/120 mm Hg.
However, patients with a history of hypertension can generally resume their home blood pressure
medications once they are safely eating and drinking.
Intensive behavioral intervention has been shown to be more effective than other treatment modalities
in treating children who have been diagnosed with - ANSWER Autism
A 30-year-old male is treated with topical medications for his papulopustular rosacea with only partial
improvement. He has no drug allergies.The preferred oral antibiotic in this situation is - ANSWER 1st line
doxycycline (100-200 mg daily or 40 mg of a modified release formulation) and minocycline (100-200 mg
daily)
2nd line for those who can't take tetracyclines are oral metronidazole or macrolides such as azithromycin
and clarithromycin
A 63-year-old male sees you after carotid ultrasonography at a local health fair showed a 50% occlusion
of his left proximal internal carotid artery. He has never had a TIA or stroke and he takes no medications.
He smokes one pack of cigarettes daily. His blood pressure today is 122/76 mm Hg.In addition to
counseling on a healthy diet, exercise, and tobacco cessation, you should recommend - ANSWER statin
therapy and repeat U/S in 1 year
A 25-year-old landscaper presents to the emergency department with a 1-day history of pain and
swelling in his left hand. Three days ago he sustained a puncture wound from a thorn in the palm of his
hand. He has generalized achiness and chills in addition to the hand pain. He has no significant past
medical history. patient's temperature is 37.9°C (100.2°F). His left third finger is diffusely swollen,
erythematous, and held in flexion. There is tenderness along the third tendon in the palm. A radiograph
of the hand is negative for a fracture or foreign body. What would be the most appropriate next step? -
,ANSWER Flexor tenosynovitis requires treatment with prompt intravenous antibiotics and surgical
debridement and irrigation
Which one of the following is considered most useful when implementing shared decision-making? -
ANSWER Number needed to treat
A 27-year-old soccer player presents with anterior hip pain along with a clicking sensation in the hip
when he runs or attempts lateral movements. The flexion, adduction, and internal rotation (FADIR) test
and the flexion, abduction, and external rotation (FABER) test both elicit pain. You suspect a labral
tear.The most accurate imaging test for the suspected diagnosis is - ANSWER MRI
labral tears usually present with anterior hip pain and may have catching, popping, or clicking sounds
associated with activities such as gymnastics, soccer, dancing, basketball, or hockey. On physical
examination the flexion, adduction, and internal rotation (FADIR) test and the flexion, abduction, and
external rotation (FABER) test will elicit pain. Although initial imaging may include radiographs of the hip,
MRI is often needed for diagnosis. MR arthrography with gadolinium injection into the hip joint has been
the standard to diagnose labral tears, but newer MR technology (3-tesla MRI with specialized protocols)
allow for imaging of the joint without the need for intra-articular contrast.
Psychogenic tremor - ANSWER characterized by an abrupt onset, spontaneous remission, changing
characteristics, and extinction with distraction, such as with alternating finger tapping or mental
concentration on serial 7s.
Cerebellar tremor - ANSWER Neurologic testing will reveal past-pointing on finger-to-nose testing. MRI of
the brain is the diagnostic test of choice.
Parkinsonian tremor - ANSWER noted at rest and decreases with voluntary movement. Bradykinesia,
rigidity, and postural instability may also be noted
essential tremor - ANSWER symmetric tremors that may involve the hands, wrists, head, voice, or lower
extremities. May be treated pharmacologically with propranolol, primidone (mysoline), or topiramate.
Enhanced physiologic tremor - ANSWER a postural tremor of low amplitude exacerbated by medication.
It may also be worse with caffeine use or anxiety.
, Which one of the following treatments has been shown to improve the quality of life for a patient with
tinnitus? - ANSWER Cognitive behavioral therapy, acoustic stimulation, and educational counseling
A patient's office spirometry results demonstrate an obstructive pattern. - ANSWER causes of an
obstructive pattern include asthma, COPD, α1-antitrypsin deficiency, and bronchiectasis, cystic fibrosis,
among others
Office spirometry causing restrictive patterns include - ANSWER adverse reactions to nitrofurantoin,
methotrexate, and amiodarone. Chest wall conditions such as kyphosis, scoliosis, and morbid obesity
A 62-year-old male with hypertension presents to your office with substernal chest pain radiating into his
left arm for the past 20 minutes. He also has diaphoresis and nausea. He has a blood pressure of 156/96
mm Hg, a pulse rate of 84 beats/min, and an oxygen saturation of 94% on room air. An EKG shows ST-
segment elevations in leads V1 and V2. Your medical assistant calls 911 for immediate transport to the
local hospital emergency department. While awaiting the ambulance's arrival you give the patient
aspirin, 325 mg.Which one of the following would be most appropriate regarding oxygen therapy at this
time? - ANSWER Although it seems plausible and beneficial, evidence does not support a benefit from
supplemental oxygen unless the patient is hypoxic. The 2013 American Heart Assocation guidelines
recommend oxygen if the patient has an oxygen saturation <90% or if the patient is in respiratory
distress. A Cochrane analysis showed a higher risk of death for patients with acute myocardial infarction
(AMI) treated with oxygen than for patients without hypoxemia and AMI managed on room air.
What are macules and patches? - ANSWER Flat spots on the skin
What are papules? - ANSWER raised lesions
What are nodules? - ANSWER Solid, elevated, hard or soft, greater than 1 cm that may extend deeper
into dermis than papule
What are plaques? - ANSWER scaly raised lesions with erythematous base.
What are pustules? - ANSWER raised lesions with pus
What are vesicles and bullae? - ANSWER Blisters that contain clear, watery fluid
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
When should antihypertensive medication be given in acute ischemic stroke in the elderly? - ANSWER 1).
should not be given during the first 48-72 hours as long as they are not candidates for, or recipients of,
reperfusion therapy with alteplase or thrombectomy;
2). do not have a comorbid condition requiring acute blood pressure lowering;
3). and do not have a blood pressure >220/120 mm Hg.
However, patients with a history of hypertension can generally resume their home blood pressure
medications once they are safely eating and drinking.
Intensive behavioral intervention has been shown to be more effective than other treatment modalities
in treating children who have been diagnosed with - ANSWER Autism
A 30-year-old male is treated with topical medications for his papulopustular rosacea with only partial
improvement. He has no drug allergies.The preferred oral antibiotic in this situation is - ANSWER 1st line
doxycycline (100-200 mg daily or 40 mg of a modified release formulation) and minocycline (100-200 mg
daily)
2nd line for those who can't take tetracyclines are oral metronidazole or macrolides such as azithromycin
and clarithromycin
A 63-year-old male sees you after carotid ultrasonography at a local health fair showed a 50% occlusion
of his left proximal internal carotid artery. He has never had a TIA or stroke and he takes no medications.
He smokes one pack of cigarettes daily. His blood pressure today is 122/76 mm Hg.In addition to
counseling on a healthy diet, exercise, and tobacco cessation, you should recommend - ANSWER statin
therapy and repeat U/S in 1 year
A 25-year-old landscaper presents to the emergency department with a 1-day history of pain and
swelling in his left hand. Three days ago he sustained a puncture wound from a thorn in the palm of his
hand. He has generalized achiness and chills in addition to the hand pain. He has no significant past
medical history. patient's temperature is 37.9°C (100.2°F). His left third finger is diffusely swollen,
erythematous, and held in flexion. There is tenderness along the third tendon in the palm. A radiograph
of the hand is negative for a fracture or foreign body. What would be the most appropriate next step? -
,ANSWER Flexor tenosynovitis requires treatment with prompt intravenous antibiotics and surgical
debridement and irrigation
Which one of the following is considered most useful when implementing shared decision-making? -
ANSWER Number needed to treat
A 27-year-old soccer player presents with anterior hip pain along with a clicking sensation in the hip
when he runs or attempts lateral movements. The flexion, adduction, and internal rotation (FADIR) test
and the flexion, abduction, and external rotation (FABER) test both elicit pain. You suspect a labral
tear.The most accurate imaging test for the suspected diagnosis is - ANSWER MRI
labral tears usually present with anterior hip pain and may have catching, popping, or clicking sounds
associated with activities such as gymnastics, soccer, dancing, basketball, or hockey. On physical
examination the flexion, adduction, and internal rotation (FADIR) test and the flexion, abduction, and
external rotation (FABER) test will elicit pain. Although initial imaging may include radiographs of the hip,
MRI is often needed for diagnosis. MR arthrography with gadolinium injection into the hip joint has been
the standard to diagnose labral tears, but newer MR technology (3-tesla MRI with specialized protocols)
allow for imaging of the joint without the need for intra-articular contrast.
Psychogenic tremor - ANSWER characterized by an abrupt onset, spontaneous remission, changing
characteristics, and extinction with distraction, such as with alternating finger tapping or mental
concentration on serial 7s.
Cerebellar tremor - ANSWER Neurologic testing will reveal past-pointing on finger-to-nose testing. MRI of
the brain is the diagnostic test of choice.
Parkinsonian tremor - ANSWER noted at rest and decreases with voluntary movement. Bradykinesia,
rigidity, and postural instability may also be noted
essential tremor - ANSWER symmetric tremors that may involve the hands, wrists, head, voice, or lower
extremities. May be treated pharmacologically with propranolol, primidone (mysoline), or topiramate.
Enhanced physiologic tremor - ANSWER a postural tremor of low amplitude exacerbated by medication.
It may also be worse with caffeine use or anxiety.
, Which one of the following treatments has been shown to improve the quality of life for a patient with
tinnitus? - ANSWER Cognitive behavioral therapy, acoustic stimulation, and educational counseling
A patient's office spirometry results demonstrate an obstructive pattern. - ANSWER causes of an
obstructive pattern include asthma, COPD, α1-antitrypsin deficiency, and bronchiectasis, cystic fibrosis,
among others
Office spirometry causing restrictive patterns include - ANSWER adverse reactions to nitrofurantoin,
methotrexate, and amiodarone. Chest wall conditions such as kyphosis, scoliosis, and morbid obesity
A 62-year-old male with hypertension presents to your office with substernal chest pain radiating into his
left arm for the past 20 minutes. He also has diaphoresis and nausea. He has a blood pressure of 156/96
mm Hg, a pulse rate of 84 beats/min, and an oxygen saturation of 94% on room air. An EKG shows ST-
segment elevations in leads V1 and V2. Your medical assistant calls 911 for immediate transport to the
local hospital emergency department. While awaiting the ambulance's arrival you give the patient
aspirin, 325 mg.Which one of the following would be most appropriate regarding oxygen therapy at this
time? - ANSWER Although it seems plausible and beneficial, evidence does not support a benefit from
supplemental oxygen unless the patient is hypoxic. The 2013 American Heart Assocation guidelines
recommend oxygen if the patient has an oxygen saturation <90% or if the patient is in respiratory
distress. A Cochrane analysis showed a higher risk of death for patients with acute myocardial infarction
(AMI) treated with oxygen than for patients without hypoxemia and AMI managed on room air.
What are macules and patches? - ANSWER Flat spots on the skin
What are papules? - ANSWER raised lesions
What are nodules? - ANSWER Solid, elevated, hard or soft, greater than 1 cm that may extend deeper
into dermis than papule
What are plaques? - ANSWER scaly raised lesions with erythematous base.
What are pustules? - ANSWER raised lesions with pus
What are vesicles and bullae? - ANSWER Blisters that contain clear, watery fluid
