AQUIFER FAMILY MEDICINE END OF CASE EXAMQ p p p p p p p
UESTIONS 2023- p
2024 ACTUAL EXAM 170 QUESTIONS AND CORRE p p p p p p
CT DETAILED ANSWERSWITH RATIONALES (100
p p p p p
% VERIFIED ANSWERS) p p
|ALREADY GRADED A+ p p
A 34-year-
p
old woman who has no past medical problems nor is currently taking any medicati
p p p p p p p p p p p p p
ons comes into your office because she noticed a tender lump in her left breast sta
p p p p p p p p p p p p p p p
rting approximately one month ago. She is worried because she hasan aunt who ha
p p p p p p p p p p p p p p
d breast cancer that was BRCA positive, though her mother is BRCA negative. Her p
p p p p p p p p p p p p p p
eriods have been regular since they started at the age of 13 and occur every 32 day
p p p p p p p p p p p p p p p p
s. She is currently menstruating. She has three children aged 12, 9, and 4. On exam,
p p p p p p p p p p p p p p p
pher BMI is 32, up from 28 three years ago and her other vital signs are stable. On b
p p p p p p p p p p p p p p p p p p
reast exam, you note a mobile rubbery mass of approximately 1 x 1cm and with re
p p p p p p p p p p p p p p p
gular borders that is tender to palpation. You appreciate no axillary adenopathy. T
p p p p p p p p p p p p
he rest of her physical exam is unremarkable.Of the information provided, which o
p p p p p p p p p p p p p
f the following places this patient at increased risk for breast cancer?
p p p p p p p p p p p
A. Age
B. Weight
C. Parity - Correct answer-The correct answer is B.
p p p p p p p
,With a BMI of 32, obesity is the one risk factor for this patient based on the inform
p p p p p p p p p p p p p p p p p
ation given. Other risk factors for breast cancer include family history of breast can
p p p p p p p p p p p p p
cer in a first degree relative (mother or sister -
p p p p p p p p p
not aunt), prolonged estrogen exposure (menarche before age 12, menopause aft
p p p p p p p p p p p
er 45, advanced age at first pregnancy), genetic predisposition (BRCA 1 or 2 mutati
p p p p p p p p p p p p p
on), advanced age (breast cancer risk increases with age, and this patient is relativ
p p p p p p p p p p p p p
ely young), femalesex, increased breast density and certain exposures (diethylstilb
p p p p p p p p p p
estrol, hormone or radiation therapy, heavy smoking).
p p p p p p
A 64-year-old woman who is overweight with well-
p p p p p p p
controlled hypertension comesto your office complaining of a lump in her breast th
p p p p p p p p p p p p p
at she noticed while showering. She denies any pain, tenderness, or skin changes.
p p p p p p p p p p p p p
A pertinent review of systems is negative. Menarche began at the age of 10. Her fir
p p p p p p p p p p p p p p p
st child was born when she was 31 and she had her second and last child at the age
p p p p p p p p p p p p p p p p p p p
of 33. She experienced menopause at the age of 44. Her mother died of colon canc
p p p p p p p p p p p p p p p
er when she was 65 and her father passed away from metastatic prostate cancer at
p p p p p p p p p p p p p p
pthe age of 70. She has no history of tobacco use ever and occasionally drinks a glas
p p p p p p p p p p p p p p p p
s ofwine with dinner. Her BMI is 34. Which of the information provided thus far put
p p p p p p p p p p p p p p p p
s the patient at decreased risk for breast cancer?
p p p p p p p p
A. Age
B. Weight
C. Age at first birth p p p
D. Age at menarche p p
E. Age at menopause - Correct answer-The correct answer is E.
p p p p p p p p p
The patient experienced menopause at the age of 44, which shortens her time ofe
p p p p p p p p p p p p p p
strogen exposure, a known risk factor for the development of breast cancer.
p p p p p p p p p p p
Factors associated with decreased breast cancer risk include pregnancy at an earl
p p p p p p p p p p p
y age, late menarche, early menopause, high parity and medications such as
p p p p p p p p p p p
,selective estrogen receptor modulators along with NSAIDs and aspirin. Risk factor
p p p p p p p p p p
s for breast cancer include family history of breast cancer in a first degree relative
p p p p p p p p p p p p p p p
(mother or sister), prolonged estrogen exposure (menarche before age 12, meno
p p p p p p p p p p
pause after 55, advanced age at pregnancy, obesity after menopause),female sex,
p p p p p p p p p p p p
genetic predisposition (BRCA 1 or 2 mutation), advanced age (breastcancer risk inc
p p p p p p p p p p p p
reases with age), increased breast density and exposures (diethylstilbestrol, horm
p p p p p p p p p
one or radiation therapy, smoking).
p p p p
A 63-
p
year old woman comes into your office for her annual preventive exam. Shehas hy
p p p p p p p p p p p p p p
pertension and type 2 diabetes. She is not sexually active. Her blood pressure is 12
p p p p p p p p p p p p p p
5/80 and her physical exam otherwise is within normal limits. You recommend infl
p p p p p p p p p p p p
uenza and zoster vaccination. Her last colonoscopy was eight years ago and her la
p p p p p p p p p p p p p
st mammogram one year ago was normal. She has never hadan abnormal Pap sm
p p p p p p p p p p p p p p
ear. At the age of 45 she had a total hysterectomy for fibroids. You tell her she doe
p p p p p p p p p p p p p p p p p
s not require a Pap smear today because:
p p p p p p p
A. She has never had an abnormal Pap smear
p p p p p p p
B. She is not sexually active
p p p p
C. She had a total hysterectomy for fibroids
p p p p p p
D. She is 63 years old
p p p p
E. She experienced menopause more than 10 years ago - Correct answer-
p p p p p p p p p p
Thecorrect answer is C.
p p p p
The patient described above underwent a total hysterectomy (total removal of th
p p p p p p p p p p p
e uterus and cervix with or without oophorectomy) for benign reasons (fibroids).
p p p p p p p p p p p p
USPSTF guidelines recommend against continued cervical cancer screening in pati
p p p p p p p p p
ents whose uterus has been removed for benign disease and evidence showed cyt
p p p p p p p p p p p p
ologic screening to be very low yield and poor evidence thatscreening to detect va
p p p p p p p p p p p p p p
ginal cancers improves health outcomes in women after hysterectomy for benign
p p p p p p p p p p p
disease. Cervical cancer screening should begin at the
p p p p p p p
, age of 21 and women between the ages of 65 and 70 who have had three or more
p p p p p p p p p p p p p p p p p
normal Pap tests in the past ten years may choose to stop cervical cancer
p p p p p p p p p p p p p
screening. Not being sexually active; age 63; only having had normal PAP smears
p p p p p p p p p p p p
and years since menopause are not reasons to stop screening for cervical cancer.
p p p p p p p p p p p p
A 47-year-
p
old woman comes into your office for a health care maintenance exam.She has hyp
p p p p p p p p p p p p p p
ertension and type 2 diabetes. She is not sexually active and has not yet experience
p p p p p p p p p p p p p p
d menopause. There is no family history of cancer. Her blood pressure is 118/78, he
p p p p p p p p p p p p p p
r BMI is 34 and the remainder of her physical exam is withinnormal limits. Her vacci
p p p p p p p p p p p p p p p p
nations are up-to- p p
date, she has a PAP smear today and willhave labs drawn. According to USPSTF, whi
p p p p p p p p p p p p p p p
ch of the following is the best recommendation to give her concerning mammogra
p p p p p p p p p p p p
phy?
A. Should have started at age 40 and every year thereafter
p p p p p p p p p
B. Should have started at age 40 and every 2 years thereafter
p p p p p p p p p p
C. Start at age 50 and every year thereafter D.
p p p p p p p p
Start at age 50 and every 2 years thereafter
p p p p p p p p p
E. Should have started at age 45 and every year thereafter - Correct answer-
p p p p p p p p p p p p p
Thecorrect answer is D.
p p p p
Mammography has a sensitivity of 60% to 90% for detecting breast cancer and dec p p p p p p p p p p p p p
reases breast cancer mortality. According to the most recent USPSTF guidelines, ro
p p p p p p p p p p p
utine mammography is not indicated for women younger than 50 years old except
p p p p p p p p p p p p p
as based on patient context (history) and beliefs about risks/benefits. The USPSTF r
p p p p p p p p p p p p
ecommends biennial testing for women between the ages of 50 and 74. There is in
p p p p p p p p p p p p p p
sufficient evidence to assess the benefits versus risk of screenings in women after t
p p p p p p p p p p p p p
he age of 75. Other groups such as the American Cancer Society (ACS) and America
p p p p p p p p p p p p p p
n College of Obstetricians and Gynecologists (ACOG) recommend yearly mammogr
p p p p p p p p p
ams starting at age 40, continuing as long asthe woman is in good health.
p p p p p p p p p p p p p p
UESTIONS 2023- p
2024 ACTUAL EXAM 170 QUESTIONS AND CORRE p p p p p p
CT DETAILED ANSWERSWITH RATIONALES (100
p p p p p
% VERIFIED ANSWERS) p p
|ALREADY GRADED A+ p p
A 34-year-
p
old woman who has no past medical problems nor is currently taking any medicati
p p p p p p p p p p p p p
ons comes into your office because she noticed a tender lump in her left breast sta
p p p p p p p p p p p p p p p
rting approximately one month ago. She is worried because she hasan aunt who ha
p p p p p p p p p p p p p p
d breast cancer that was BRCA positive, though her mother is BRCA negative. Her p
p p p p p p p p p p p p p p
eriods have been regular since they started at the age of 13 and occur every 32 day
p p p p p p p p p p p p p p p p
s. She is currently menstruating. She has three children aged 12, 9, and 4. On exam,
p p p p p p p p p p p p p p p
pher BMI is 32, up from 28 three years ago and her other vital signs are stable. On b
p p p p p p p p p p p p p p p p p p
reast exam, you note a mobile rubbery mass of approximately 1 x 1cm and with re
p p p p p p p p p p p p p p p
gular borders that is tender to palpation. You appreciate no axillary adenopathy. T
p p p p p p p p p p p p
he rest of her physical exam is unremarkable.Of the information provided, which o
p p p p p p p p p p p p p
f the following places this patient at increased risk for breast cancer?
p p p p p p p p p p p
A. Age
B. Weight
C. Parity - Correct answer-The correct answer is B.
p p p p p p p
,With a BMI of 32, obesity is the one risk factor for this patient based on the inform
p p p p p p p p p p p p p p p p p
ation given. Other risk factors for breast cancer include family history of breast can
p p p p p p p p p p p p p
cer in a first degree relative (mother or sister -
p p p p p p p p p
not aunt), prolonged estrogen exposure (menarche before age 12, menopause aft
p p p p p p p p p p p
er 45, advanced age at first pregnancy), genetic predisposition (BRCA 1 or 2 mutati
p p p p p p p p p p p p p
on), advanced age (breast cancer risk increases with age, and this patient is relativ
p p p p p p p p p p p p p
ely young), femalesex, increased breast density and certain exposures (diethylstilb
p p p p p p p p p p
estrol, hormone or radiation therapy, heavy smoking).
p p p p p p
A 64-year-old woman who is overweight with well-
p p p p p p p
controlled hypertension comesto your office complaining of a lump in her breast th
p p p p p p p p p p p p p
at she noticed while showering. She denies any pain, tenderness, or skin changes.
p p p p p p p p p p p p p
A pertinent review of systems is negative. Menarche began at the age of 10. Her fir
p p p p p p p p p p p p p p p
st child was born when she was 31 and she had her second and last child at the age
p p p p p p p p p p p p p p p p p p p
of 33. She experienced menopause at the age of 44. Her mother died of colon canc
p p p p p p p p p p p p p p p
er when she was 65 and her father passed away from metastatic prostate cancer at
p p p p p p p p p p p p p p
pthe age of 70. She has no history of tobacco use ever and occasionally drinks a glas
p p p p p p p p p p p p p p p p
s ofwine with dinner. Her BMI is 34. Which of the information provided thus far put
p p p p p p p p p p p p p p p p
s the patient at decreased risk for breast cancer?
p p p p p p p p
A. Age
B. Weight
C. Age at first birth p p p
D. Age at menarche p p
E. Age at menopause - Correct answer-The correct answer is E.
p p p p p p p p p
The patient experienced menopause at the age of 44, which shortens her time ofe
p p p p p p p p p p p p p p
strogen exposure, a known risk factor for the development of breast cancer.
p p p p p p p p p p p
Factors associated with decreased breast cancer risk include pregnancy at an earl
p p p p p p p p p p p
y age, late menarche, early menopause, high parity and medications such as
p p p p p p p p p p p
,selective estrogen receptor modulators along with NSAIDs and aspirin. Risk factor
p p p p p p p p p p
s for breast cancer include family history of breast cancer in a first degree relative
p p p p p p p p p p p p p p p
(mother or sister), prolonged estrogen exposure (menarche before age 12, meno
p p p p p p p p p p
pause after 55, advanced age at pregnancy, obesity after menopause),female sex,
p p p p p p p p p p p p
genetic predisposition (BRCA 1 or 2 mutation), advanced age (breastcancer risk inc
p p p p p p p p p p p p
reases with age), increased breast density and exposures (diethylstilbestrol, horm
p p p p p p p p p
one or radiation therapy, smoking).
p p p p
A 63-
p
year old woman comes into your office for her annual preventive exam. Shehas hy
p p p p p p p p p p p p p p
pertension and type 2 diabetes. She is not sexually active. Her blood pressure is 12
p p p p p p p p p p p p p p
5/80 and her physical exam otherwise is within normal limits. You recommend infl
p p p p p p p p p p p p
uenza and zoster vaccination. Her last colonoscopy was eight years ago and her la
p p p p p p p p p p p p p
st mammogram one year ago was normal. She has never hadan abnormal Pap sm
p p p p p p p p p p p p p p
ear. At the age of 45 she had a total hysterectomy for fibroids. You tell her she doe
p p p p p p p p p p p p p p p p p
s not require a Pap smear today because:
p p p p p p p
A. She has never had an abnormal Pap smear
p p p p p p p
B. She is not sexually active
p p p p
C. She had a total hysterectomy for fibroids
p p p p p p
D. She is 63 years old
p p p p
E. She experienced menopause more than 10 years ago - Correct answer-
p p p p p p p p p p
Thecorrect answer is C.
p p p p
The patient described above underwent a total hysterectomy (total removal of th
p p p p p p p p p p p
e uterus and cervix with or without oophorectomy) for benign reasons (fibroids).
p p p p p p p p p p p p
USPSTF guidelines recommend against continued cervical cancer screening in pati
p p p p p p p p p
ents whose uterus has been removed for benign disease and evidence showed cyt
p p p p p p p p p p p p
ologic screening to be very low yield and poor evidence thatscreening to detect va
p p p p p p p p p p p p p p
ginal cancers improves health outcomes in women after hysterectomy for benign
p p p p p p p p p p p
disease. Cervical cancer screening should begin at the
p p p p p p p
, age of 21 and women between the ages of 65 and 70 who have had three or more
p p p p p p p p p p p p p p p p p
normal Pap tests in the past ten years may choose to stop cervical cancer
p p p p p p p p p p p p p
screening. Not being sexually active; age 63; only having had normal PAP smears
p p p p p p p p p p p p
and years since menopause are not reasons to stop screening for cervical cancer.
p p p p p p p p p p p p
A 47-year-
p
old woman comes into your office for a health care maintenance exam.She has hyp
p p p p p p p p p p p p p p
ertension and type 2 diabetes. She is not sexually active and has not yet experience
p p p p p p p p p p p p p p
d menopause. There is no family history of cancer. Her blood pressure is 118/78, he
p p p p p p p p p p p p p p
r BMI is 34 and the remainder of her physical exam is withinnormal limits. Her vacci
p p p p p p p p p p p p p p p p
nations are up-to- p p
date, she has a PAP smear today and willhave labs drawn. According to USPSTF, whi
p p p p p p p p p p p p p p p
ch of the following is the best recommendation to give her concerning mammogra
p p p p p p p p p p p p
phy?
A. Should have started at age 40 and every year thereafter
p p p p p p p p p
B. Should have started at age 40 and every 2 years thereafter
p p p p p p p p p p
C. Start at age 50 and every year thereafter D.
p p p p p p p p
Start at age 50 and every 2 years thereafter
p p p p p p p p p
E. Should have started at age 45 and every year thereafter - Correct answer-
p p p p p p p p p p p p p
Thecorrect answer is D.
p p p p
Mammography has a sensitivity of 60% to 90% for detecting breast cancer and dec p p p p p p p p p p p p p
reases breast cancer mortality. According to the most recent USPSTF guidelines, ro
p p p p p p p p p p p
utine mammography is not indicated for women younger than 50 years old except
p p p p p p p p p p p p p
as based on patient context (history) and beliefs about risks/benefits. The USPSTF r
p p p p p p p p p p p p
ecommends biennial testing for women between the ages of 50 and 74. There is in
p p p p p p p p p p p p p p
sufficient evidence to assess the benefits versus risk of screenings in women after t
p p p p p p p p p p p p p
he age of 75. Other groups such as the American Cancer Society (ACS) and America
p p p p p p p p p p p p p p
n College of Obstetricians and Gynecologists (ACOG) recommend yearly mammogr
p p p p p p p p p
ams starting at age 40, continuing as long asthe woman is in good health.
p p p p p p p p p p p p p p
