AAFP Board Exam Review 2022 COMPLETE SOLUTION 325 Questions with 100% Correct Answers

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What screening test has most potential for overdx? - ✔✔PSA- Overdiagnosis is the diagnosis of a disease that will not produce symptoms during a patient's lifetime. It tends to occur with cancers... that have very slow rates of growth. Prostate cancer is most often a slow-growing cancer and is often present without symptoms in older men. The introduction of prostate-specific antigen (PSA) screening was accompanied by a marked rise in the rate of diagnosis of prostate cancer while mortality decreased much less significantly, and this decrease was probably largely attributable to improved treatment. What is the treatment for mallet fracture? - ✔✔The recommended treatment for a mallet fracture is splinting the distal interphalangeal (DIP) joint in extension (SOR B). The usual duration of splinting is 8 weeks. It is important that extension be maintained throughout the duration of treatment because flexion can affect healing and prolong the time needed for treatment. If the finger fracture involves >30% of the intra-articular surface, referral to a hand or orthopedic surgeon can be considered. However, conservative therapy appears to have outcomes similar to those of surgical treatment and therefore is generally preferred. If subluxed radial head is suspected in a child, is imaging needed? - ✔✔As long as there are no outward signs of fracture or abuse it is considered safe and appropriate to attempt reduction of the radial head before moving on to imaging studies. With the child's elbow in 90° of flexion, the hand is fully supinated by the examiner and the elbow is then brought into full flexion. Usually the child will begin to use the affected arm again within a couple of minutes. If ecchymosis, significant swelling, or pain away from the joint is present, or if symptoms do not improve after attempts at reduction, then a plain radiograph is recommended.A 17-year-old female sees you for a preparticipation evaluation. She has run 5 miles a day for the last 6 months, and has lost 6 lb over the past 2 months. Her last menstrual period was 3 months ago. Other than the fact that she appears to be slightly underweight, her examination is normal. To fit the criteria for the female athlete triad, she must have which one of the following? - ✔✔The initial definition of the female athlete triad was amenorrhea, osteoporosis, and disordered eating. The American College of Sports Medicine modified this in 2007, emphasizing that the triad components occur on a continuum rather than as individual pathologic conditions. The definitions have therefore expanded. Disordered eating is no longer defined as the formal diagnosis of an eating disorder. Energy availability,defined as dietary energy intake minus exercise energy expenditures, is now considered a risk factor for the triad, as dietary restrictions and substantial energy expenditures disrupt pituitary and ovarian function. Athletes who have amenorrhea for 6 months, disordered eating, and/or a history of a stress fracture resulting from minimal trauma should have a bone density test. Low bone mineral density for age is the term used to describe at-risk female athletes with a Z-score of -1 to -2. Osteoporosis is defined as having clinical risk factors for experiencing a fracture, along with a Z-score <-2. what is the work up for secondary amenorrhea? - ✔✔This patient suffers from secondary amenorrhea (defined as the cessation of regular menses for 3 months or irregular menses for 6 months). The most common causes of secondary amenorrhea are polycystic ovary syndrome, primary ovarian failure, hypothalamic amenorrhea, and hyperprolactinemia. With a normal physical examination, negative pregnancy test, and no history of chronic disease, a hormonal workup is indicated, including TSH, LH, and FSH levels (SOR C). A hormonal challenge with medroxyprogesterone to provoke withdrawal bleeding is used to assess functional anatomy and estrogen levels (SOR C). However, it has poor specificity and sensitivity for ovarian function and a poor correlation with estrogen levels. Pelvic ultrasonography is indicated in the workup of primary amenorrhea to confirm the presence of a uterus and detect structural abnormalities of the reproductive organs. Likewise, karyotyping can be used for patients with primary amenorrhea, as conditions such as Turner's syndrome and androgen insensitivity syndrome are due to chromosomal abnormalities. A CBC and metabolic panel would not be initial considerations in the workup of amenorrhea unless the patient has a known chronic disease which may affect the results.What's the first line treatment for primary dysmenorrhea? - ✔✔The first-line treatment for primary dysmenorrhea should be NSAIDs (SOR A). They should be started at the onset of menses and continued for the first 1-2 days of the menstrual cycle. Combined oral contraceptives may be effective for primary dysmenorrhea, but there is a lack of highquality randomized, controlled trials demonstrating pain improvement (SOR B). They may be a good choice if the patient also desires contraception. Although combined oral contraceptives and intramuscular and subcutaneous progestin-only contraceptives are effective treatments for dysmenorrhea caused by endometriosis, they are NOT first-line therapy for primary dysmenorrhea. A 24-year-old female presents with pelvic pain. She says that the pain is present on most days, but is worse during her menses. Ibuprofen has helped in the past but is no longer effective. Her menses are normal and she has only one sexual partner. A physical examination is normal. Which one of the following should be the next step in the workup of this patient? - ✔✔The initial evaluation for chronic pelvic pain should include a urinalysis and culture, cervical swabs for gonorrhea and Chlamydia, a CBC, an erythrocyte sedimentation rate, a β-hCG level, and pelvic ultrasonography. CT and MRI are not part of the recommended initial diagnostic workup, but may be helpful in further assessing any abnormalities found on pelvic ultrasonography. Referral for diagnostic laparoscopy is appropriate if the initial workup does not reveal a source of the pain, or if endometriosis or adhesions are suspected. Colonoscopy would be indicated if the history or examination suggests a gastrointestinal source for the pain after the initial evaluation. what can induce ovulation in PCOS? - ✔✔This patient fits the criteria for polycystic ovary syndrome (oligomenorrhea, acne, hirsutism, hyperandrogenism, infertility). Symptoms also include insulin resistance. Evidence of polycystic ovaries is not required for the diagnosis. Metformin has the most evidence supporting its use in this situation, and is the only treatment listed that is likely to decrease hirsutism and improve insulin resistance and menstrual irregularities. Metformin and clomiphene alone or in combination are first-line agents for ovulation induction. Clomiphene does not improve hirsutism, however. Progesterone is not indicated for any of this patient's problems. Spironolactone will improve hirsutism and menstrual irregularities, but is not indicated for ovulation induction. What is the first step for evaluating a thyroid nodule? - ✔✔Thyroid nodules >1 cm that are discovered incidentally on examination or imaging studies merit further evaluation. Nodules <1 cm should also befully evaluated when found in patients with a family history of thyroid cancer, a personal history of head and neck irradiation, or a finding of cervical node enlargement. Reasonable first steps include measurement of TSH or ultrasound examination. The American Thyroid Association's guidelines recommend that TSH be the initial evaluation (SOR A) and that this be followed by a radionuclide thyroid scan if results are abnormal. Diagnostic ultrasonography is recommended for all patients with a suspected thyroid nodule, a nodular goiter, or a nodule found incidentally on another imaging study (SOR A). Routine measurement of serum thyroglobulin or calcitonin levels is not currently recommended. CDC guidelines for a flu outbreak? - ✔✔The occurrence of two or more laboratory-confirmed cases of influenza A is considered an outbreak in a long-term care facility. The CDC has specific recommendations for managing an outbreak, which include *chemoprophylaxis with an appropriate medication for all residents who are asymptomatic and treatment for all residents who are symptomatic*, regardless of laboratory confirmation of infection or vaccination status. All staff should be considered for chemoprophylaxis regardless of whether they have had direct patient contact with an infected resident or have received the vaccine. Requesting restriction of visitation is recommended; however, it cannot be strictly enforced due to residents' rights. number needed to treat A new drug treatment is shown to reduce the incidence of a complication of a disease by 50%. If the usual incidence of this complication were 1% per year, how many patients with this disease would have to be treated with this medication for 1 year to prevent one occurrence of this complication? - ✔✔Considering relative risk reduction without also considering the absolute rate can distort the importance of a therapy. A useful way to assess the importance of a therapy is to determine the number needed to treat to benefit one patient. To calculate this number, the percentage of absolute risk reduction of a particular therapy is divided into 100. In the case in question, the absolute risk reduction is 0.5% (0.5×.01). Thus, the number-needed-to-treat for the example cited is 200 (100/0.5). Examination of a 2-day-old infant reveals flesh-colored papules with an erythematous base located on the face and trunk, containing eosinophils. Which one of the following would be mostappropriate at this time? - ✔✔This infant has findings consistent with erythema toxicum neonatorum, which usually resolves in the first week or two of life (SOR A). No testing is usually necessary because of the distinct appearance of the lesions. The cause is unknown [Show More]

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