Family Medicine Board Exam 2016 Questions and Answers

Passing the 2016 ABFM MC-FP Certification Exam is no easy feat – but the correct written report programme volition ensure that yous're adequately prepared for all the content you'll see on the exam.

Amend your proficiency with two free questions taken from the BoardVitals ABFM MC-FP Board Exam Question Bank to put your knowledge to the test.

Question 1

A 23-year-quondam woman returns after an abnormal pap smear result. Her results show low-grade squamous intraepithelial lesion (LSIL) with a positive homo papillomavirus (HPV) test. She has had 3 male person sexual partners in her life over the last 4 years and has been in an exclusive human relationship with the same homo for the final 3 years. She denies consistent use of bulwark protection during intercourse. Her periods are regular, lasting five days every thirty days. She denies menorrhagia, vaginal discharge, aberrant haemorrhage, dysuria, or past history of sexually transmitted infection. She had her offset pap smear two years ago with her regular md in New York state; she is uncertain of the issue. She is a post-graduate student at a local country college in Ohio merely is from New York. What is the appropriate step in management of this patient?

A.) CT of abdomen and pelvis

B.) Obtaining her past medical records regarding previous pap smear and repeating pap smear in 6 months and 12 months

C.) Arranging loop electrosurgical excision process

D.) Clay shoveler'southward fracture

Eastward.) Treatment with podophyllin

Reply:

B.) Obtaining her past medical records regarding previous pap smear and repeating pap smear in half-dozen months and 12 months

Explanation

ANSWER: B. EXPLANATIONS: B. Truthful: The American College of Obstetricians and Gynecologists (ACOG) guidelines for direction of HPV-positive LSIL cytology in adolescents, the 2d-most mutual abnormal cytology, are to echo cervical cytology at 6 months and 12 months. Adolescents have been shown to clear HPV and have low cancer rates. However, colposcopy may also exist a reasonable choice if in that location is a risk of loss to follow-up. Low-grade squamous intraepithelial lesions acquit a take chances CIN 2-3+ at initial colposcopy of 15-30%. Routine screening may resume afterward 2 consecutive negative cytology results or 1 negative HPV. The well-nigh common result is atypical squamous cells (ACS). Aggressive investigation is non recommended since the diagnosis is oft non reproducible and carries a very low gamble for cancer (0.1-0.2%) This case requires the physician to determine whether this patient will exist lost to follow-up. She is at somewhat of a college risk, equally she is from out of land. However, she has presented to talk over an aberrant result and has a regular doctor in her home country who you tin contact and obtain by medical records from. Furthermore, the likelihood that she will clear HPV is loftier. The correct respond in this scenario is therefore to become past medical records and repeat cytology at half-dozen and 12 months. A. Simulated: CT of abdomen and pelvis would non be helpful in this scenario. C. Imitation: Arranging colposcopy may exist the correct pick in some cases of LSIL such every bit older premenopausal women with an HPV positive result or patients that are unlikely to follow-upwards. D. FALSE: Arranging a loop electrosurgical excision procedure is indicated in if there is unsatisfactory colposcopy, suspected microinvasion, lack of correlation between the cytology and colposcopy/biopsies, lesions extending into the endocervical canal, suspected adenocarcinoma, recurrence after ablative or previous excisional procedures, or if invasive disease is unable to exist excluded. E. Simulated: Treating with podophyllin in a tincture of benzoin is used for the treatment of genital warts.

Reference

Smith L. Abnormal Cervical Cytology and Histology in Adolescents. Am Fam Physician. 2006 Oct 15;74:1431-1434. 2. Shaw HA. Loop electrosurgical excision procedure (LEEP). Medscape. Updated June twenty 2013. http://emedicine.medscape.com/commodity/1998067-overview. Accessed September 28, 2013.

Question 2
A 59-year-erstwhile woman presents to the emergency section generally unwell with 2 months of worsening lethargy, nausea, generalized abdominal pain, and constipation. She is a heavy smoker, has hypertension, high cholesterol, and chronic bronchitis. She takes amlodipine 5mg daily and atorvastatin 40mg daily with no recent changes to dose or frequency. She lost 15lbs despite a normal appetite. There has been no recent exacerbation of her chronic cough. She had a couple of episodes of minimal hemoptysis a few months ago just none since and so. Vital signs are within normal limits. Auscultation of the lungs reveals mild decreased air entry throughout and no adventitious sounds. In that location is mild generalized abdominal tenderness to palpation. The rest of the concrete examination is unremarkable. Laboratory investigations are shown below. Chest radiograph shows a discrete mass in the right hilum of approximately 10mm in diameter; otherwise, lung fields are clear without collapse or consolidation. Which of the following is appropriate for initial management of this patient?

A.) 4mg Four zoledronic acid

B.) Four hydration with normal saline

C.) IV hydration with 5% dextrose

D.) 12.5mg hydrochlorothiazide tablet

East.) Non-dissimilarity CT chest

Reply

B.) IV hydration with normal saline

Explanation

Respond: B. EXPLANATIONS: B. TRUE: Malignancy-associated hypercalcemia is a paraneoplastic syndrome that occurs more frequently in some cancers (e.g. lung cancer, breast cancer, multiple myeloma). Signs are variable and reflect the level of serum calcium. Gastrointestinal symptoms are typical and include nausea, vomiting, loss of ambition, intestinal pain, and constipation. Patients often mutter of sluggishness and muscle weakness. Feet, depression, cognitive dysfunction and confusion may also develop. In markedly elevated calcium, progression to coma or cardiac arrhythmia tin occur. In a patient who is a heavy smoker with a history of chronic cough with hemoptysis, a lung cancer primary is a business organisation. There are 2 types of malignancy-associated hypercalcemia, osteolytic hypercalcemia and humoral hypercalcemia, both of which may exist attributable to lung cancer. In the instance of osteolytic hypercalcemia and lung cancer, bony destruction results from metastases. Humoral hypercalcemia results from the release of an endocrine gene such as parathyroid hormone-related protein (PTHrP) or parathyroid hormone (PTH). Secretion of PTHrP is frequently associated with squamous prison cell cancer of the lung, while PTH secretion is more ofttimes related to pocket-size prison cell carcinoma of the lung. This patient is highly suspicious for malignancy, but a diagnosis has non been established. Treatment seeks to restore a eucalcemic state while inhibiting bone resorption. Early handling involves IV hydration to provide resuscitation and to re-establish renal perfusion with calciuresis. A. FALSE: Clinicians generally add bisphosphonates inside 24 hours if there is no improvement. Calcitonin may be added in initial therapy as an adjuvant to inhibit osteoclastic os resorption. C. FALSE: Normal saline is the preferred crystalloid in hypercalcemia. D. FALSE: This choice worsens hypercalcemia. E. FALSE: A non-contrast chest CT is not the best imaging modality for investigating malignancy.

Reference

Clines GA. Mechanisms and treatment of hypercalcemia of malignancy. Curr Opin Endocrinol Diabetes Obes. 2011;xviii:339–346.

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