Family Medicine Aquifer Test Study
Guide questions with answers
A 34-year-old cisgender ed fem ale w ho has n o past m edical pr oblem s and is not
cur r ently taking any m edications com es in to your offi ce because she n oticed a
tender lum p in her left br east startin g appr oxim ately on e m on th ago. She is
w or r ied because she has a m ater nal aun t w ho had br east can cer that w as B RCA
positive, though her m other is B RCA n egative. Her per iods have been r egular sin ce
they star ted at the age of 13 and occur ever y 32 days. She is cur r en tly
m enstr uating. She has thr ee childr en , aged 12, 9, an d 4. On exam , her B MI is 32,
up fr om 28 thr ee year s ago, and her other vital sign s are stable. On br east exam ,
you note a m obile r ubber y m ass appr oxim ately 1 x 1cm that has r egular bor der s
and is tender to palpation. Y ou appr eciate n o axillar y aden opathy. The r est of her
physical exam is unr em ar kable. Of the in for m ation pr ovided, w hich of the
follow ing puts this patient at incr eased r isk for br east can cer ?
The bes - ** VERIFIED ANSW ERS **✔✔E. W eight
A 64-year -old cisgender ed fem ale w ho is over w eight w ith w ell-con tr olled
hyper tension com es to your offi ce w ith con cer n s of a lum p in her br east that she
noticed w hile show er ing. She r epor ts havin g n o pain , ten der n ess, or sk in chan ges.
A per tinent r eview of system s is n egative. Men ar che began at the age of 10. Her
fi r st child w as bor n w hen she w as 31 an d she had her secon d an d last child at the
age of 33. She exper ienced m enopause at the age of 44. Her m other died of colon
cancer w hen she w as 65 and her father passed aw ay fr om m etastatic pr ostate
cancer at the age of 70. She has no histor y of tobacco use ever an d occasion ally
dr inks a glass of w ine w ith dinner . Her B MI is 34. W hich of the in for m ation
pr ovided thus far puts the patien t at decr eased r isk for br east can cer ?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Age
· B . Age at fi r st bir th
· C. Age at m enar che
· D. Age - ** VERIFIED ANSW ERS **✔✔D. Age at m en opause
,A 63-year old cisgender ed fem ale com es in to your offi ce for her an n ual pr even tive
exam . She has hyper tension and type 2 diabetes. She is n ot sexually active. Her
blood pr essur e is 125/80 and her physical exam other w ise is w ithin nor m al lim its.
Y ou r ecom m end infl uenza and zoster vaccin ation . Her last colon oscopy w as eight
year s ago and her last m am m ogr am on e year ago; both w er e n or m al. She has
never had an abnor m al Pap test. At the age of 45 she had a total hyster ectom y for
fi br oids. Of the details pr ovided about this patien t, w hich is an appr opr iate r eason
to explain w hy she does not need a Pap test today?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. She exper ienced m enopause m or e than 10 year s ago
· B . She had a total hyster ectom y for fi br oids
· C. She has never had an abnorm al Pap test
· D. She is 63 year s old
· E. She is not sexually active - ** VERIFIED ANSW ERS **✔✔B . She had a total
hyster ectom y for fi br oids
A 47-year -old cisgender ed fem ale com es in to your offi ce for a health car e
m aintenance exam . She has hyper ten sion an d type 2 diabetes. She is n ot sexually
active and has not yet exper ienced m en opause. Ther e is n o fam ily histor y of
cancer . Her blood pr essur e is 118/78, her B MI is 34, an d the r em ainder of her
physical exam is w ithin nor m al lim its. Her vaccin ation s ar e up to date, and she has
a Pap test today and w ill have labs dr aw n . Accor din g to USPSTF, w hich of the
follow ing is the best r ecom m endation to give her con cer n in g m am m ogr aphy?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Should have star ted at age 40 and ever y year ther eafter
· B . Should have star ted at age 40 and ever y tw o year s ther eafter
· C. Should have star ted at age 45 and ever y year ther eafter
· D. Star t at age 50 and ever y year ther eafter
E. Star t at age 50 and ever y tw o year s ther eafter - ** VERIFIED ANSW ERS **✔✔E.
Star t at age 50 and ever y tw o year s ther eafter
,A 25-year -old patient pr esents to the offi ce for follow -up on an xiety an d tobacco
dependence. She r epor ts she is doin g w ell on her n ew m edication to help w ith both
her m ood and sm oking, though she con tin ues to sm ok e. She r ecen tly star ted her
fi r st sexual r elationship w ith a new fem ale par tn er . She r eceived a tetan us vaccin e
at the age of 18, and she r eceived her fl u vaccin e this year . Her blood pr essur e is
122/70, and her physical exam is w ithin n or m al lim its. Y ou r eview her r ecen t Pap
test, w hich w as negative. W hich of the follow in g in dicates the vaccin es she should
r eceive today?
Choose the single best answ er .
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. HPV vaccine alone
· B . HPV vaccine and pneum ococcal con jugate vaccin e (PCV13)
· C. HPV vaccine and pneum ococcal polysacchar ide vaccin e (PPSV23)
· D. HPV vaccine and Zoster vaccin e
· E. No vaccines ar e needed - ** VERIFIED ANSW ERS **✔✔C. HPV vaccin e and
pneum ococcal polysacchar ide vaccin e (PPSV23)
A 55-year -old m ale w ith no signifi can t past m edical histor y pr esen ts for a r outin e
physical exam . He last saw a doctor fi ve year s ago. Social histor y is r em ar kable for
a 35-pack-year tobacco histor y sin ce the age of 20. He in dicates that his w ife an d
childr en have ur ged him to quit sm ok in g for the last few m on ths. W hen you ask
him if he has consider ed quitting, he r eplies, "I just don 't see w hat the big deal is!"
W hich stage of change best descr ibes this patien t at this tim e?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Action
· B . Contem plation
· C. Maintenance
· D. Pr econtem plation
· E. Pr eparation - ** VERIFIED ANSW ERS **✔✔D. Pr econ tem plation
A 48-year -old m ale w ith a past m edical histor y that in cludes hyper ten sion , chr on ic
obstr uctive pulm onar y disease (COPD), an d hyper lipidem ia pr esen ts to clin ic as a
, new patient in October for a gener al physical exam . Histor y r eveals that he has
been sm oking a pack of cigar ettes daily sin ce age 20. He dr in k s tw o beer s daily. He
is inter m ittently nonadher ent w ith his m edication s. Review of the state
im m unization database r eveals that the on ly im m un ization he has r eceived as an
adult w as a tetanus diphther ia shot adm in ister ed 12 year s ago. W hich of the
follow ing vaccine com binations w ould be m ost appr opr iate for this patien t?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Infl uenza, m eningococcal, and zoster
· B . Infl uenza, pneum ococcal, and Tdap
· C. Infl uenza, zoster , and Tdap
· D. Meningococcal, pneum ococcal, an d Tdap
· E. Meningococcal, pneum ococcal, an d zoster - ** VERIFIED ANSW ERS **✔✔B .
Infl uenza, pneum ococcal, and Tdap
A 55-year -old m ale com es to the clin ic for a visit. He has r ead about the dan ger s of
being over w eight and inquir es about w hich categor y he fi ts into. He is 5' 10'' (1.78
m ) and w eighs 220 lbs (100 kg), B MI = 31.6. W hich of the follow in g categor ies
m ost accur ately descr ibes the patien t based on his B MI?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Ideal
· B . Mor bidly (ver y sever ely) obese
· C. Obese
· D. Over w eight
E. Under w eight - ** VERIFIED ANSW ERS **✔✔C. Obese
A 55-year -old m ale w ith a fam ily histor y of m elan om a pr esen ts to the clin ic for
evaluation of a skin lesion on his back w hich appear ed thr ee m onths ago. His w ife
fi r st aler ted him to it, hasn't noticed it chan ge an d he has n ot n oticed an y
sym ptom s associated w ith it. Physical exam in ation r eveals a 7 m m un ifor m ly black
m acule that is sym m etr ically r oun d w ith shar ply dem ar cated bor der s on his upper
back near the r ight shoulder . W hich of the follow in g char acter istics w ould m ost
justify it being biopsied today?
Guide questions with answers
A 34-year-old cisgender ed fem ale w ho has n o past m edical pr oblem s and is not
cur r ently taking any m edications com es in to your offi ce because she n oticed a
tender lum p in her left br east startin g appr oxim ately on e m on th ago. She is
w or r ied because she has a m ater nal aun t w ho had br east can cer that w as B RCA
positive, though her m other is B RCA n egative. Her per iods have been r egular sin ce
they star ted at the age of 13 and occur ever y 32 days. She is cur r en tly
m enstr uating. She has thr ee childr en , aged 12, 9, an d 4. On exam , her B MI is 32,
up fr om 28 thr ee year s ago, and her other vital sign s are stable. On br east exam ,
you note a m obile r ubber y m ass appr oxim ately 1 x 1cm that has r egular bor der s
and is tender to palpation. Y ou appr eciate n o axillar y aden opathy. The r est of her
physical exam is unr em ar kable. Of the in for m ation pr ovided, w hich of the
follow ing puts this patient at incr eased r isk for br east can cer ?
The bes - ** VERIFIED ANSW ERS **✔✔E. W eight
A 64-year -old cisgender ed fem ale w ho is over w eight w ith w ell-con tr olled
hyper tension com es to your offi ce w ith con cer n s of a lum p in her br east that she
noticed w hile show er ing. She r epor ts havin g n o pain , ten der n ess, or sk in chan ges.
A per tinent r eview of system s is n egative. Men ar che began at the age of 10. Her
fi r st child w as bor n w hen she w as 31 an d she had her secon d an d last child at the
age of 33. She exper ienced m enopause at the age of 44. Her m other died of colon
cancer w hen she w as 65 and her father passed aw ay fr om m etastatic pr ostate
cancer at the age of 70. She has no histor y of tobacco use ever an d occasion ally
dr inks a glass of w ine w ith dinner . Her B MI is 34. W hich of the in for m ation
pr ovided thus far puts the patien t at decr eased r isk for br east can cer ?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Age
· B . Age at fi r st bir th
· C. Age at m enar che
· D. Age - ** VERIFIED ANSW ERS **✔✔D. Age at m en opause
,A 63-year old cisgender ed fem ale com es in to your offi ce for her an n ual pr even tive
exam . She has hyper tension and type 2 diabetes. She is n ot sexually active. Her
blood pr essur e is 125/80 and her physical exam other w ise is w ithin nor m al lim its.
Y ou r ecom m end infl uenza and zoster vaccin ation . Her last colon oscopy w as eight
year s ago and her last m am m ogr am on e year ago; both w er e n or m al. She has
never had an abnor m al Pap test. At the age of 45 she had a total hyster ectom y for
fi br oids. Of the details pr ovided about this patien t, w hich is an appr opr iate r eason
to explain w hy she does not need a Pap test today?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. She exper ienced m enopause m or e than 10 year s ago
· B . She had a total hyster ectom y for fi br oids
· C. She has never had an abnorm al Pap test
· D. She is 63 year s old
· E. She is not sexually active - ** VERIFIED ANSW ERS **✔✔B . She had a total
hyster ectom y for fi br oids
A 47-year -old cisgender ed fem ale com es in to your offi ce for a health car e
m aintenance exam . She has hyper ten sion an d type 2 diabetes. She is n ot sexually
active and has not yet exper ienced m en opause. Ther e is n o fam ily histor y of
cancer . Her blood pr essur e is 118/78, her B MI is 34, an d the r em ainder of her
physical exam is w ithin nor m al lim its. Her vaccin ation s ar e up to date, and she has
a Pap test today and w ill have labs dr aw n . Accor din g to USPSTF, w hich of the
follow ing is the best r ecom m endation to give her con cer n in g m am m ogr aphy?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Should have star ted at age 40 and ever y year ther eafter
· B . Should have star ted at age 40 and ever y tw o year s ther eafter
· C. Should have star ted at age 45 and ever y year ther eafter
· D. Star t at age 50 and ever y year ther eafter
E. Star t at age 50 and ever y tw o year s ther eafter - ** VERIFIED ANSW ERS **✔✔E.
Star t at age 50 and ever y tw o year s ther eafter
,A 25-year -old patient pr esents to the offi ce for follow -up on an xiety an d tobacco
dependence. She r epor ts she is doin g w ell on her n ew m edication to help w ith both
her m ood and sm oking, though she con tin ues to sm ok e. She r ecen tly star ted her
fi r st sexual r elationship w ith a new fem ale par tn er . She r eceived a tetan us vaccin e
at the age of 18, and she r eceived her fl u vaccin e this year . Her blood pr essur e is
122/70, and her physical exam is w ithin n or m al lim its. Y ou r eview her r ecen t Pap
test, w hich w as negative. W hich of the follow in g in dicates the vaccin es she should
r eceive today?
Choose the single best answ er .
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. HPV vaccine alone
· B . HPV vaccine and pneum ococcal con jugate vaccin e (PCV13)
· C. HPV vaccine and pneum ococcal polysacchar ide vaccin e (PPSV23)
· D. HPV vaccine and Zoster vaccin e
· E. No vaccines ar e needed - ** VERIFIED ANSW ERS **✔✔C. HPV vaccin e and
pneum ococcal polysacchar ide vaccin e (PPSV23)
A 55-year -old m ale w ith no signifi can t past m edical histor y pr esen ts for a r outin e
physical exam . He last saw a doctor fi ve year s ago. Social histor y is r em ar kable for
a 35-pack-year tobacco histor y sin ce the age of 20. He in dicates that his w ife an d
childr en have ur ged him to quit sm ok in g for the last few m on ths. W hen you ask
him if he has consider ed quitting, he r eplies, "I just don 't see w hat the big deal is!"
W hich stage of change best descr ibes this patien t at this tim e?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Action
· B . Contem plation
· C. Maintenance
· D. Pr econtem plation
· E. Pr eparation - ** VERIFIED ANSW ERS **✔✔D. Pr econ tem plation
A 48-year -old m ale w ith a past m edical histor y that in cludes hyper ten sion , chr on ic
obstr uctive pulm onar y disease (COPD), an d hyper lipidem ia pr esen ts to clin ic as a
, new patient in October for a gener al physical exam . Histor y r eveals that he has
been sm oking a pack of cigar ettes daily sin ce age 20. He dr in k s tw o beer s daily. He
is inter m ittently nonadher ent w ith his m edication s. Review of the state
im m unization database r eveals that the on ly im m un ization he has r eceived as an
adult w as a tetanus diphther ia shot adm in ister ed 12 year s ago. W hich of the
follow ing vaccine com binations w ould be m ost appr opr iate for this patien t?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Infl uenza, m eningococcal, and zoster
· B . Infl uenza, pneum ococcal, and Tdap
· C. Infl uenza, zoster , and Tdap
· D. Meningococcal, pneum ococcal, an d Tdap
· E. Meningococcal, pneum ococcal, an d zoster - ** VERIFIED ANSW ERS **✔✔B .
Infl uenza, pneum ococcal, and Tdap
A 55-year -old m ale com es to the clin ic for a visit. He has r ead about the dan ger s of
being over w eight and inquir es about w hich categor y he fi ts into. He is 5' 10'' (1.78
m ) and w eighs 220 lbs (100 kg), B MI = 31.6. W hich of the follow in g categor ies
m ost accur ately descr ibes the patien t based on his B MI?
The best option is indicated below . Y our selection s ar e in dicated by the shaded
boxes.
· A. Ideal
· B . Mor bidly (ver y sever ely) obese
· C. Obese
· D. Over w eight
E. Under w eight - ** VERIFIED ANSW ERS **✔✔C. Obese
A 55-year -old m ale w ith a fam ily histor y of m elan om a pr esen ts to the clin ic for
evaluation of a skin lesion on his back w hich appear ed thr ee m onths ago. His w ife
fi r st aler ted him to it, hasn't noticed it chan ge an d he has n ot n oticed an y
sym ptom s associated w ith it. Physical exam in ation r eveals a 7 m m un ifor m ly black
m acule that is sym m etr ically r oun d w ith shar ply dem ar cated bor der s on his upper
back near the r ight shoulder . W hich of the follow in g char acter istics w ould m ost
justify it being biopsied today?
