AAFP Board Review Questions

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Questions and Answers

What are absolute contraindications to electroconvulsive therapy (ECT)?

There are no absolute contraindications to ECT.

What is the most appropriate initial treatment for community-acquired pneumonia in infants and children?

High-dose amoxicillin.

At what age is it recommended to introduce solid foods into the diet for normal term infants?

4-6 months of age.

What is the recommended treatment for midshaft posteromedial tibial stress fractures?

An air stirrup leg brace (Aircast). Signup and view all the answers

What is the most appropriate test to screen for late-onset male hypogonadism?

Total testosterone. Signup and view all the answers

What is the first-line treatment for pediatric HSV-1 infection?

Acyclovir suspension. Signup and view all the answers

What is the most accurate maneuver for detecting an ACL tear?

Lachman test. Signup and view all the answers

What is the diagnosis of multiple myeloma based on?

Evidence of myeloma-related end-organ impairment and M protein. Signup and view all the answers

What findings are typical of femoral neuropathy?

History of weakness of the lower left leg and discomfort in the anterior thigh. Signup and view all the answers

What decreases the risk of cancer for women using low-dose estrogen oral contraceptives?

Ovary. Signup and view all the answers

What are the clinical hallmarks of polymyalgia rheumatica?

Pain and stiffness in the shoulder and pelvic girdle. Signup and view all the answers

What are the three subtypes of frontotemporal dementia?

Behavioral variant, semantic dementia, progressive nonfluent aphasia. Signup and view all the answers

What is the hallmark biochemical feature of refeeding syndrome?

Hypophosphatemia. Signup and view all the answers

What methods can reduce the risk of oral candidiasis with inhaled corticosteroids for asthma?

Rinse mouth after each administration and use a valved holding chamber. Signup and view all the answers

When should laryngoscopy be recommended for hoarseness?

When hoarseness does not resolve within 3 months or a serious cause is suspected. Signup and view all the answers

What are some causes of right heart failure?

Left heart failure, myocarditis, pulmonic stenosis, ventricular septal defects. Signup and view all the answers

What are the metabolites of codeine-containing medications and diazepam?

Morphine for codeine-containing medications and oxazepam for diazepam. Signup and view all the answers

What is the most appropriate initial management of hypercalcemia of malignancy?

Normal saline intravenously. Signup and view all the answers

Why is myomectomy preferred over fibroid embolization in some patients?

Desire for future pregnancy. Signup and view all the answers

What are the hallmarks of melanosis coli?

Brown to black leopard spotting of the colonic mucosa. Signup and view all the answers

What happens to the murmur of mitral valve prolapse with the Valsalva maneuver?

Becomes longer and louder. Signup and view all the answers

What is the most common hip disorder in 8-15 year-old males and overweight/obese children?

Slipped capital femoral epiphysis. Signup and view all the answers

PEG tubes are associated w/ an increase in what?

Restraints. Signup and view all the answers

What is the highest risk group for colorectal cancer?

Patients with family history of colorectal cancer. Signup and view all the answers

What drugs are associated with drug-induced pleural disease/lupus pleuritis?

Hydralazine, procainamide, quinidine, amiodarone, bleomycin, cyclophosphamide, mitomycin, bromocriptine, methotrexate, minoxidil. Signup and view all the answers

What is the treatment for tachycardia in a patient with a history of Wolff-Parkinson-White syndrome?

Procainamide. Signup and view all the answers

Is doxycycline contraindicated in pregnancy?

True Signup and view all the answers

Will steady extra caloric intake result in weight gain indefinitely?

False Signup and view all the answers

What is the initial medical management of asthma?

Low-dose inhaled corticosteroid daily with SABA as needed. Signup and view all the answers

Name some tumor necrosis factor inhibitors and the testing required prior to initiation.

Infliximab, adalimumab, certolizumab pegol, golimumab. Screen for TB, HBV, HCV. Signup and view all the answers

What tests are used to detect HCV antibody and determine active from past infection?

Detection by enzyme immunoassay, confirmation by recombinant immunoblot assay, active/past infection by RNA polymerase chain reaction. Signup and view all the answers

What precautions should be initiated for a patient with an MRSA infection?

Strict handwashing practices and barrier precautions for wounds & medical devices. Signup and view all the answers

What procedures should metformin be withheld for and what are the consequences of not doing so?

Procedures causing reduction in kidney function; lactic acidosis. Signup and view all the answers

What are the guidelines on combination therapy for nursing-home acquired pneumonia?

Use antipseudomonal cephalosporin or carbapenem with antipseudomonal fluoroquinolone or aminoglycoside and anti-MRSA agent. Signup and view all the answers

Is there significant risk of congenital anomalies from SSRI use in pregnancy?

False Signup and view all the answers

Match the following classic presentations with their condition:

Pyloric stenosis = Palpable mass between 4-6 weeks of age Choledochal cyst = Classic triad of RUQ pain, jaundice, palpable mass Meckel's diverticulum = Painless lower GI bleeding in infants Intussusception = Paroxysms of colicky abdominal pain Intestinal malrotation = Bilious vomiting within the first 4 weeks of life Signup and view all the answers

What are the indications for teriparatide?

Treatment of severe osteoporosis, patients with multiple risk factors, or failure of bisphosphonate therapy. Signup and view all the answers

What is the most likely infectious agent for acute dysuria, frequency, pyuria with no associated hematuria?

Sexually transmitted urethritis caused by C. trachomatis or N. gonorrhoeae. Signup and view all the answers

What do you interpret if a patient takes 14 seconds on the 'Timed Get Up and Go' test?

Increased risk of falls. Signup and view all the answers

Match the following gait/balance disorders with their characteristics:

Cautious gait = Abducted arms/legs, slow movement, wide-based stance Cerebellar degeneration = Wide-based and staggering ataxic gait Frontal lobe degeneration = Magnetic gait with start and turn hesitation Parkinson's disease = Short-stepped and shuffling gait Motor neuropathy = Steppage gait with excessive hip/knee flexion Signup and view all the answers

What are the CDC recommendations on initiating treatment in a patient with suspected influenza?

Initiate treatment with antiviral medications based on clinical symptoms alone. Signup and view all the answers

What are the recommendations for aspirin use in primary prevention of cardiovascular disease?

Men 45-79 for prevention of myocardial infarction; women 55-79 for prevention of ischemic stroke. Signup and view all the answers

Is there sufficient evidence to support the benefit/harm of aspirin use for cardiovascular disease prevention in individuals over 80?

True Signup and view all the answers

What populations are recommendations against the use of aspirin?

Women with fever >38.0°C, chest pain, orthopnea, wheezes, and rhonchi. Signup and view all the answers

What is known as 'nursemaid's elbow'?

'Subluxation of the head of the radius'. Signup and view all the answers

What is the appropriate management for fever in children under 29 days?

Undergo complete sepsis workup and be admitted. Signup and view all the answers

What elements are part of the initial emergency department treatment for acute asthma exacerbations in children?

Repeated doses of a short-acting β2-agonist and IV magnesium sulfate. Signup and view all the answers

What is the most common cause of death during the first 6 months of life?

Sudden infant death syndrome. Signup and view all the answers

What documentation should lead to considering deliberate suffocation?

Infant >6 months, previous similar sibling deaths, and evidence of pulmonary hemorrhage. Signup and view all the answers

What measures can help reduce calcium oxalate stone formation?

Low-sodium, restricted-protein diet and increased fluid intake. Signup and view all the answers

What is the initial imaging modality for suspected stress fractures?

Plain radiographs. Signup and view all the answers

What should you suspect in a patient presenting with metabolic acidosis of unknown cause?

Ethylene glycol poisoning. Signup and view all the answers

Study Notes

Electroconvulsive Therapy

No absolute contraindications to electroconvulsive therapy (ECT).

Community-Acquired Pneumonia in Children

Diagnosis primarily based on history and physical examination.
Symptoms include fever, cyanosis, and abnormal respiratory findings.
Outpatient antibiotics appropriate if the child is not toxic, hypoxemic, or distressed.
High-dose amoxicillin is the preferred treatment.

Introduction of Solid Foods

Recommended age to introduce solid foods to normal term infants is 4-6 months as the extrusion reflex disappears by 4 months.

Midshaft Posteromedial Tibial Stress Fractures

Treated using an air stirrup leg brace (Aircast).

Male Hypogonadism Screening

Total testosterone is the most appropriate initial test for screening late-onset male hypogonadism.

Pediatric HSV-1 Infection

Acyclovir suspension is the standard treatment.

ACL Tear Detection

Lachman test is the most accurate for detecting an ACL tear with a sensitivity range of 60%-100%.
Anterior drawer test shows a sensitivity of 9%-93%.
Pivot shift test shows sensitivity between 27%-95%.

Diagnosis of Multiple Myeloma

Diagnosis requires evidence of end-organ impairment like hypercalcemia or renal failure, along with the presence of M protein or monoclonal plasma cells.

Femoral Neuropathy Symptoms

Weakness in the lower left leg, knee giving way, and discomfort in the anterior thigh are typical symptoms.
Commonly associated with diabetes mellitus.

Low-Dose Estrogen Oral Contraceptives

Users have a 50% lower risk of ovarian cancer.

Polymyalgia Rheumatica

Characterized by pain and stiffness in the shoulder and pelvic girdle with a dramatic corticosteroid response.

Frontotemporal Dementia Subtypes

Includes behavioral variant, semantic dementia, and progressive nonfluent aphasia.

Refeeding Syndrome Biochemical Feature

Hypophosphatemia is the hallmark biochemical feature.

Risk Reduction for Oral Candidiasis with Inhaled Corticosteroids

Rinse mouth after each use of inhaled corticosteroids and use a valved holding chamber.

Laryngoscopy Recommendation for Hoarseness

Recommended if hoarseness persists beyond 3 months or if a serious cause is suspected.

Causes of Right Heart Failure

Left heart failure is the most common cause, followed by myocarditis, pulmonic stenosis, and ventricular septal defects.

Metabolites of Medications

Codeine metabolism results in morphine, while diazepam metabolizes to oxazepam.

Management of Hypercalcemia of Malignancy

Initial management involves intravenous normal saline.

Myomectomy vs. Fibroid Embolization

Preference for myomectomy is indicated by the desire for future pregnancy.

Melanosis Coli Characteristics

Notable by brown to black leopard spotting of the colonic mucosa due to anthraquinone laxative abuse.

Mitral Valve Prolapse and Valsalva Maneuver

The murmur becomes longer and louder with the Valsalva maneuver.

Common Hip Disorder in Youth

Slipped capital femoral epiphysis is the most common in males aged 8-15 years and in overweight/obese children.

PEG Tubes and Restraints

PEG tubes are associated with an increased use of restraints.

Colorectal Cancer Screening Recommendations

Highest risk group includes those with a first-degree relative diagnosed before age 60 or two second-degree relatives.
Screening should start at age 40 or 10 years before the earliest diagnosis in the family, with rescreening every 5 years.

Drugs Inducing Pleural Disease

Medications include hydralazine, procainamide, quinidine, amiodarone, bleomycin, cyclophosphamide, mitomycin, bromocriptine, methotrexate, and minoxidil.

Tachycardia Management in Wolff-Parkinson-White Syndrome

Procainamide is the treatment of choice.

Doxycycline in Pregnancy

Contraindicated during the second and third trimesters due to risk of permanent tooth discolouration.

Steady Extra Caloric Intake

Weight gain will plateau rather than continue indefinitely.

Initial Asthma Management

Low-dose inhaled corticosteroid daily with short-acting beta agonist (SABA) as needed.

Tumor Necrosis Factor Inhibitors

Include infliximab, adalimumab, certolizumab pegol, and golimumab, requiring screening for TB, HBV, and HCV before initiation.

HCV Testing Protocol

Detection through enzyme immunoassay, confirmation with recombinant immunoblot assay, and differentiation of active from past infection via RNA polymerase chain reaction.

MRSA Infection Precautions

Strict handwashing by staff, visitors, and residents; implement barrier precautions for wounds and medical devices.

Metformin Use and Procedures

Withhold metformin during procedures that reduce kidney function to prevent lactic acidosis.

Nursing-Home Acquired Pneumonia Treatment

Recommended combination therapy includes antipseudomonal cephalosporins or carbapenems, antipseudomonal fluoroquinolones or aminoglycosides, and anti-MRSA agents.

SSRIs in Pregnancy

Generally no significant risk for congenital anomalies except for paroxetine, which increases the risk of cardiac malformations in the first trimester.

Classic Pediatric Presentations

Pyloric stenosis: palpable mass at 4-6 weeks.
Choledochal cyst: triad of RUQ pain, jaundice, palpable mass.
Meckel's diverticulum: painless GI bleeding in infants.
Intussusception: colicky abdominal pain with palpable mass.
Intestinal malrotation: bilious vomiting in the first 4 weeks.

Teriparatide Indications

Used for severe osteoporosis, multiple risk factors, or failed bisphosphonate therapy.

Common Infectious Agents in Urethritis

Urethritis likely caused by C. trachomatis, N. gonorrhoeae, or HSV if symptoms include dysuria and pyuria but no hematuria.

"Timed Get Up and Go" Test Interpretation

14 seconds indicates increased fall risk, while >20 seconds indicates severe gait impairment.

Gait and Balance Disorders Characteristics

Cautious gait: wide stance and careful movements.
Cerebellar degeneration: ataxic, wide-based gait.
Frontal lobe degeneration: "magnetic" gait with hesitation.
Parkinson's disease: shuffling gait with decreased step length.
Motor neuropathy: steppage gait, excessive hip and knee flexion.

CDC Influenza Treatment Recommendations

Initiate antiviral treatment based solely on clinical symptoms.

Aspirin Use for Cardiovascular Disease Prevention

Recommended for men aged 45-79 for myocardial infarction prevention and women aged 55-79 for ischemic stroke prevention.

Insufficient Evidence for Aspirin Use

Not enough evidence to recommend aspirin for cardiovascular disease prevention in those older than 80 years.

Aspirin Recommendations AGAINST Use

Avoid in patients with fever >38.0°C, chest pain, orthopnea, wheezes, or rhonchi.

Nursemaid's Elbow

Common injury in children under 5, occurring from a sudden upward pull, resulting in subluxation of the radial head.

Fever in Infants Under 29 Days

Complete sepsis workup and admission required; common pathogens include group B Streptococcus and E. coli, treated with ampicillin and cefotaxime.

Acute Asthma Exacerbation Treatment in Children

Involves repeated doses of a short-acting β2-agonist, correcting hypoxia, and possibly using IV magnesium sulfate.

Sudden Infant Death Syndrome (SIDS)

Leading cause of death in infants aged 2-4 months, characterized by specific terminal activities and lividity.

Deliberate Suffocation Risk Indicators

Consider if documentation includes infants over 6 months, prior sibling deaths, or specific pulmonary evidence.

Calcium Oxalate Stone Formation Prevention

Low-sodium, restricted-protein diet, increased fluid intake, oxalate restriction, and potassium citrate to raise urinary pH.

Initial Imaging for Stress Fractures

First-line imaging is plain radiographs; MRI serves as second-line if needed.

Suspecting Ethylene Glycol Poisoning

Indicators include metabolic acidosis, renal failure, intoxicated appearance without alcohol odor, urinary crystals; treat with fomepizole. Ethylene glycol is found in engine coolant and cleaners.

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Description

Test your knowledge with this quiz on critical topics from the AAFP board review. Focus areas include absolute contraindications for electroconvulsive therapy and treatment protocols for community-acquired pneumonia in infants and children. Perfect for medical students and professionals preparing for board exams.