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ABFM FAMILY MEDICINE BOARD REVIEW
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ABFM FAMILY MEDICINE BOARD REVIEW
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ABFM FAMILYMEDICINE
BOARD REVIEW
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no
additional chronic medical problems and is otherwise asymptomatic. An examination is
significant for a blood pressure of 162/95 mm Hg but is otherwise unremarkable.
Laboratory Findings unremarkable
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association 2017
guidelines, which one of the following would be the most appropriate medication to
initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily - Answers-ANSWER: C
This patient has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Association 2017 guidelines, antihypertensive treatment
should be initiated. For the general non-African-American population, monotherapy with
an ACE inhibitor, an angiotensin receptor blocker, a calcium channel blocker, or a
thiazide diuretic would be appropriate for initial management. It is also appropriate to
initiate combination antihypertensive therapy as an initial management strategy,
although patients should not take an ACE inhibitor and an angiotensin receptor blocker
simultaneously. Studies have shown that blood pressure control is achieved faster with
the initiation of combination therapy compared to monotherapy, without an increase in
morbidity. Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. -
Blockers, vasodilators, -blockers, and potassium-sparing diuretics are not
recommended as initial choices for the treatment of hypertension.
,A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She
has had two male sex partners in the last 6 months and uses oral contraceptives and
sometimes condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical
motion and uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal
microscopy shows only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography - Answers-ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be
administered at the time of diagnosis and not delayed until the results of the nucleic acid
amplification testing (NAAT) for gonorrhea and Chlamydia are returned. The clinical
diagnosis is based on an at-risk woman presenting with lower abdominal or pelvic pain,
accompanied by cervical motion, uterine, or adnexal tenderness that can range from
mild to severe. There is often a mucopurulent discharge or WBCs on saline microscopy.
Acute phase indicators such as fever, leukocytosis, or an elevated C-reactive protein
level may be helpful but are neither sensitive nor specific. A positive NAAT is not
required for diagnosis and treatment because an upper tract infection may be present,
or the causative agent may not be gonorrhea or Chlamydia. PID should be considered a
polymicrobial infection. Pelvic ultrasonography may be used if there is a concern about
other pathology such as a tubo-ovarian abscess.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes - Answers-ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired
and health care-associated pneumonia, which is related to gastric overgrowth by gram-
negative bacteria. Long-term treatment of Barrett's esophagus is an indication for
chronic proton pump inhibitor (PPI) use. PPI therapy does not increase the risk of gout,
hypertension, or type 2 diabetes.
An 87-year-old female comes to your office for an annual health maintenance visit. She
appears cachectic and tells you that for the past 6 months she has had a decreased
appetite and generalized muscle weakness. The patient is alert and oriented to person
and place. She has a 10% weight loss, dry mucous membranes, and tenting of the skin
on the extensor surface of her hands. While inflating the blood pressure cuff on her right
arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
,C) Hypokalemia
D) Hypernatremia
E) Hyponatremia - Answers-ANSWER: B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on
the nerves that control them, is present in up to 94% of patients with hypocalcemia.
Hypercalcemia is more likely to present with hyperreflexia. Patients with hypokalemia,
hypernatremia, or hyponatremia may present with weakness and confusion, but tetany
is not a common sign of either sodium or potassium imbalance.
24-year old female presents to your office with a 3-month history of difficulty sleeping.
She says that she struggles to fall asleep and wakes up multiple times at night at least
three times a week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to
start her day. She lies awake for an hour in bed before falling asleep and spends up to 2
hours awake in the middle of the night trying to fall back asleep. Lately she has been
feeling fatigued and having difficulty
concentrating at work. You conduct a full history and physical examination and tell her to
return in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that
she is sleeping an average of 5½ hours per night. Which one of the following would be
the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for an ho - Answers-ANSWER: D
This patient presents with symptoms of chronic insomnia. Cognitive-behavioral therapy
for insomnia
(CBT-I) and brief behavioral therapy for insomnia (BBT-I) are effective
nonpharmacologic treatments for chronic insomnia. Modified CBT-I and BBT-I can be
administered by a primary care physician. The basic
principles include stimulus control (sleep hygiene) and sleep restriction. Reducing time
in bed increases sleep efficiency. In this case, 6 hours of time in bed would improve the
patient's sleep efficiency and a bedtime of 12:30 a.m. would accomplish this goal.
Generally, reduced time in bed is accomplished by postponing bedtime rather than
getting up earlier. Naps generally do not improve sleep efficiency. While getting out of
bed is recommended after being in bed for 30 minutes without falling asleep, or being
awake for 30 minutes after being asleep, staying up for a prescribed period of time is
not recommended.
A 45-year-old female presents to the emergency department with a 1-week history of
facial swelling and progressive dyspnea with exertion. She was diagnosed 1 week ago
with non-Hodgkin's lymphoma but her medical history is otherwise unremarkable. After
hospital admission, which one of the following would be the most appropriate next step
in the management of this condition?
A) Intravenous antibiotics
B) Urgent chemotherapy and radiation
C) Urgent chemotherapy and plasmapheresis
, D) Urgent echocardiography
E) Urgent bronchoscopy - Answers-ANSWER: B
Because of the prevalence of cancer in the United States, it is important for family
physicians to recognize
oncologic emergencies. This patient presents with signs and symptoms related to
superior vena cava syndrome, which is caused by compression of the superior vena
cava. This is most often caused by lung cancer or lymphoma, but it can also be related
to indwelling catheters, lymph nodes, or metastatic tumors. After ensuring that the
patient is hospitalized and stable, the initial treatment options include intravenous
corticosteroids, chemotherapy, radiation, and occasionally intravascular stenting.
Antibiotics are not warranted because this condition is not the result of an infection.
Hyperviscosity syndrome is another oncologic emergency associated with leukemia,
multiple myeloma, and Waldenström's macroglobulinemia. It is treated with
chemotherapy and plasmapheresis. Echocardiography and bronchoscopy are not
indicated in the initial management of superior vena cava syndrome.
A nonverbal 22-year-old male with intellectual disability is brought to your office by the
staff of the group home where he lives. They report that the patient has been functioning
at his baseline until this morning when he was found to have loud breathing. No other
history is available at the time of this visit. On examination he has a temperature of
37.3°C (99.1°F), a blood pressure of 124/82 mm Hg,
a pulse rate of 100 beats/min, and a respiratory rate of 16/min. The patient appears to
be in mild distress and a high-pitched whistling, crowing sound on inspiration is heard
as you walk in the room. Which one of the following would be the most appropriate next
step for this patient?
A) Oral antibiotics
B) Oral corticosteroids
C) Nebulized albuterol
D) Nebulized epinephrine
E) Urgent evaluation in the emergency department - Answers-ANSWER: E
Stridor is a high-pitched whistling, crowing sound on inspiration. It can be caused by
obstruction of the larynx or trachea by a foreign body, vocal cord edema, a neoplasm, or
a pharyngeal abscess. Acute stridor requires urgent evaluation for obstruction. This
patient may have a foreign body or other obstruction in his airway and requires urgent
assessment. Oral antibiotics, oral corticosteroids, nebulized albuterol, or nebulized
epinephrine would not be appropriate at this time.
A 24-year-old patient wants to start the process of transitioning from female to male. He
has been working with a psychiatrist who has confirmed the diagnosis of gender
dysphoria. Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone - Answers-ANSWER: E
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