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AOBFP Family Medicine study materials
AOBFP Family Medicine study resources

AOBFP Family Medicine practice questions

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Question 1Family Medicine

Which adult vaccination is recommended annually for all persons aged 50 years and older without contraindications?

  1. Tetanus-diphtheria booster
  2. Measles-mumps-rubella vaccine
  3. Inactivated influenza vaccine Correct answer.
  4. Hepatitis B vaccine series

Explanation

Influenza vaccination is recommended annually for essentially everyone aged 6 months and older, including all adults over 50. Tetanus-diphtheria boosters are given every 10 years, not annually.

Question 2Family Medicine

A 55-year-old man has a fasting plasma glucose of 118 mg/dL on two occasions. What is the most appropriate classification?

  1. Normal glucose tolerance
  2. Prediabetes Correct answer.
  3. Reactive hypoglycemia
  4. Diabetes mellitus

Explanation

A fasting plasma glucose of 100-125 mg/dL defines prediabetes (impaired fasting glucose). Values of 126 mg/dL or higher on two occasions diagnose diabetes.

Question 3Family Medicine

Which finding best supports a diagnosis of acute otitis media rather than otitis media with effusion?

  1. Bulging tympanic membrane with marked erythema Correct answer.
  2. Retracted tympanic membrane with decreased mobility
  3. Air-fluid level in an otherwise normal-appearing membrane
  4. Serous fluid behind an intact tympanic membrane

Explanation

Acute otitis media requires middle-ear effusion plus signs of acute inflammation, classically a bulging, erythematous tympanic membrane. Effusion alone without acute inflammation defines otitis media with effusion.

Question 4Family Medicine

A 28-year-old woman at 10 weeks gestation reports nausea and vomiting. Which medication is generally considered first-line pharmacologic therapy when lifestyle measures fail?

  1. Ondansetron
  2. Metoclopramide
  3. Prednisone
  4. Doxylamine with pyridoxine Correct answer.

Explanation

Delayed-release doxylamine combined with pyridoxine is the preferred first-line pharmacologic treatment for nausea and vomiting of pregnancy. Other antiemetics are reserved for refractory symptoms.

Question 5Family Medicine

Which blood pressure threshold defines stage 2 hypertension in an adult according to current US guidelines?

  1. 160/100 mm Hg or higher Correct answer.
  2. 140/90 mm Hg or higher
  3. 130/80 mm Hg or higher
  4. 150/95 mm Hg or higher

Explanation

Stage 2 hypertension is defined as a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher under the 2017 ACC/AHA framework, with stage 1 beginning at 130/80. The 160/100 threshold marks a more severe category in older frameworks.

Question 6Family Medicine

What is the recommended daily dietary calcium intake for a healthy 60-year-old woman?

  1. 800 mg
  2. 2000 mg
  3. 1200 mg Correct answer.
  4. 600 mg

Explanation

Women aged 51 and older should aim for approximately 1200 mg of elemental calcium daily, ideally from diet with supplementation as needed. Younger adults generally require about 1000 mg daily.

Question 7Family Medicine

Which is the most common cause of community-acquired pneumonia in adults?

  1. Haemophilus influenzae
  2. Mycoplasma pneumoniae
  3. Streptococcus pneumoniae Correct answer.
  4. Legionella pneumophila

Explanation

Streptococcus pneumoniae remains the most frequently identified cause of community-acquired pneumonia in adults. Atypical organisms and Haemophilus are less common overall.

Question 8Family Medicine

A 45-year-old woman has a firm, mobile, well-circumscribed breast mass. Which imaging study is the most appropriate initial evaluation?

  1. PET-CT scan
  2. Fine-needle aspiration biopsy
  3. MRI of the breast
  4. Diagnostic mammography with ultrasound Correct answer.

Explanation

For a palpable breast mass in a woman over 30, diagnostic mammography combined with targeted ultrasound is the standard initial imaging approach. Tissue sampling follows if imaging is suspicious.

Question 9Family Medicine

A 62-year-old man with chronic kidney disease has an estimated GFR of 40 mL/min/1.73 m2. Which medication class should be used with caution because of reduced clearance?

  1. Lisinopril
  2. Metformin Correct answer.
  3. Amlodipine
  4. Loop diuretics

Explanation

Metformin is renally cleared and should be dose-reduced or avoided when eGFR falls below 45 mL/min/1.73 m2 because of lactic acidosis risk. ACE inhibitors are used with monitoring rather than avoided for clearance reasons.

Question 10Family Medicine

A 30-year-old woman has a 3-day history of dysuria, frequency, and urgency without fever or flank pain. What is the most appropriate management?

  1. Intravenous antibiotics in the emergency department
  2. Empiric oral antibiotic for uncomplicated cystitis Correct answer.
  3. Urine culture followed by observation
  4. Renal ultrasound before treatment

Explanation

Typical symptoms of uncomplicated cystitis in a nonpregnant woman support empiric oral antibiotic therapy without routine culture. Culture is reserved for complicated, recurrent, or atypical presentations.

Question 11Family Medicine

A 24-year-old man has a positive purified protein derivative test with 12 mm induration. He is asymptomatic and has no known exposure. What is the most appropriate next step?

  1. Order a chest radiograph and evaluate for active disease Correct answer.
  2. No further testing is needed
  3. Repeat the tuberculin skin test in 6 months
  4. Start a 3-month regimen of isoniazid and rifapentine

Explanation

A positive tuberculin skin test requires a chest radiograph and clinical evaluation to exclude active tuberculosis before latent infection treatment is considered. Treatment of latent TB is started only after active disease is ruled out.

Question 12Family Medicine

A 70-year-old man has a serum creatinine of 1.4 mg/dL. Using the Cockcroft-Gault equation, which factor most affects the calculated creatinine clearance?

  1. Serum potassium
  2. Body weight and age Correct answer.
  3. Serum albumin
  4. Dietary protein intake

Explanation

The Cockcroft-Gault formula incorporates age, weight, sex, and serum creatinine to estimate creatinine clearance. Potassium, protein intake, and albumin are not variables in the equation.

Question 13Family Medicine

A 6-year-old child presents with a sore throat, fever, and tonsillar exudates. Which finding most supports group A streptococcal pharyngitis?

  1. Cough and rhinorrhea
  2. Hoarseness and coryza
  3. Anterior cervical lymphadenopathy with tender nodes Correct answer.
  4. Conjunctivitis

Explanation

Tender anterior cervical lymphadenopathy along with fever, exudates, and absence of cough supports streptococcal pharyngitis. Cough, rhinorrhea, and conjunctivitis suggest viral etiology.

Question 14Family Medicine

A patient with type 2 diabetes has an HbA1c of 8.5% on metformin monotherapy. Which addition offers cardiovascular and renal benefit independent of glucose lowering?

  1. SGLT2 inhibitor Correct answer.
  2. DPP-4 inhibitor
  3. Sulfonylurea
  4. Thiazolidinedione

Explanation

SGLT2 inhibitors reduce major adverse cardiovascular events and slow progression of chronic kidney disease in patients with type 2 diabetes. These benefits extend beyond glycemic control.

Question 15Family Medicine

A 50-year-old woman has a 6-month history of fatigue, cold intolerance, weight gain, and constipation. Which laboratory test is the most appropriate initial screening test?

  1. Serum T3
  2. Thyroid-stimulating immunoglobulin
  3. Serum TSH Correct answer.
  4. Thyroid ultrasound

Explanation

Serum TSH is the most sensitive initial test for primary thyroid dysfunction. Abnormal results prompt measurement of free T4 to confirm and characterize the disorder.

Question 16Family Medicine

A 58-year-old man with a 30-pack-year smoking history asks about lung cancer screening. Which criterion best determines eligibility for annual low-dose CT screening?

  1. Any smoking history with chronic cough
  2. Age 50-80 with at least a 20-pack-year history and current or former smoking Correct answer.
  3. Any age with occupational asbestos exposure
  4. Age 40-50 with a family history of lung cancer

Explanation

Current USPSTF guidance recommends annual low-dose CT for adults aged 50-80 with at least a 20-pack-year history who currently smoke or quit within the past 15 years. Screening is not based on symptoms or family history alone.

Question 17Family Medicine

A 35-year-old woman reports a severe unilateral headache with visual aura lasting 20 minutes, followed by throbbing pain. Which medication is contraindicated for acute treatment?

  1. Acetaminophen
  2. Ergotamine Correct answer.
  3. Ibuprofen
  4. Sumatriptan

Explanation

Ergotamine is contraindicated in migraine with aura because of vasoconstrictive risk. Triptans and simple analgesics are preferred for acute treatment when appropriately selected.

Question 18Family Medicine

A 2-month-old infant has a temperature of 38.2°C. What is the most appropriate initial management?

  1. Full sepsis evaluation including cultures and empiric antibiotics Correct answer.
  2. Reassurance and follow-up in 24 hours
  3. Urine culture only
  4. Home observation with antipyretics

Explanation

Fever in an infant younger than 3 months requires a comprehensive sepsis evaluation, including blood, urine, and cerebrospinal fluid studies, with empiric antibiotics pending results. Young infants are at high risk for serious bacterial infection.

Question 19Family Medicine

A 40-year-old woman has a positive hepatitis C antibody test and detectable HCV RNA. Which is the most appropriate next step?

  1. Interferon-based therapy
  2. Repeat antibody testing in 6 months
  3. Direct-acting antiviral therapy after assessing liver fibrosis Correct answer.
  4. Liver biopsy before any treatment

Explanation

Detectable HCV RNA confirms active infection and warrants direct-acting antiviral therapy, which cures most patients. Fibrosis assessment guides monitoring but does not delay treatment.

Question 20Family Medicine

A 68-year-old woman has a DXA T-score of -2.7 at the femoral neck. What does this value indicate?

  1. Osteopenia
  2. Severe osteomalacia
  3. Normal bone density
  4. Osteoporosis Correct answer.

Explanation

A T-score of -2.5 or lower at any site defines osteoporosis. Scores between -1.0 and -2.5 indicate osteopenia.

Question 21Family Medicine

A 45-year-old man has a blood pressure of 150/95 mm Hg on three separate visits and no other cardiovascular risk factors. What is the most appropriate initial management?

  1. Immediate emergency department referral
  2. Lifestyle modification alone
  3. Reassurance and repeat blood pressure in 1 year
  4. Start antihypertensive medication along with lifestyle changes Correct answer.

Explanation

Stage 2 hypertension warrants initiation of pharmacologic therapy together with lifestyle modification. Lifestyle changes alone are reserved for lower-risk stage 1 disease.

Question 22Family Medicine

A 7-year-old child with asthma uses a short-acting beta-agonist more than twice weekly but has no nighttime symptoms. What is the most appropriate step?

  1. Increase SABA to four times daily
  2. Continue as-needed SABA alone
  3. Start oral prednisone
  4. Add daily low-dose inhaled corticosteroid Correct answer.

Explanation

Frequent SABA use indicates inadequate control and warrants adding daily controller therapy, typically a low-dose inhaled corticosteroid. SABA alone is not appropriate for persistent asthma.

Question 23Family Medicine

A 55-year-old woman has a 4 cm solitary pulmonary nodule with smooth margins on chest radiograph. She is a nonsmoker. What is the most appropriate next step?

  1. Repeat chest radiograph in 1 year
  2. CT of the chest Correct answer.
  3. PET scan without prior CT
  4. Immediate surgical resection

Explanation

CT of the chest characterizes the nodule and guides further management, including comparison with prior imaging and assessment of malignant features. Immediate surgery or PET without CT is premature.

Question 24Family Medicine

A 32-year-old woman at 34 weeks gestation has a blood pressure of 158/102 mm Hg and 3+ proteinuria. Which diagnosis is most likely?

  1. Acute fatty liver of pregnancy
  2. Gestational hypertension
  3. Chronic hypertension
  4. Preeclampsia with severe features Correct answer.

Explanation

Hypertension after 20 weeks with significant proteinuria indicates preeclampsia, and a systolic pressure of 140 mm Hg or higher with severe-range values plus proteinuria supports severe features. Gestational hypertension lacks proteinuria.

Question 25Family Medicine

A 60-year-old man presents with sudden painless loss of vision in one eye described as a curtain descending. What is the most appropriate immediate action?

  1. Refer for urgent ophthalmologic evaluation for possible retinal detachment Correct answer.
  2. Schedule ophthalmology follow-up in 1 week
  3. Prescribe topical antibiotic drops
  4. Reassure and observe

Explanation

A curtain-like visual field loss suggests retinal detachment, a sight-threatening emergency requiring urgent ophthalmologic evaluation. Delay risks permanent vision loss.

Question 26Family Medicine

A 28-year-old woman at 10 weeks gestation has a blood pressure of 146/94 mm Hg on two occasions before pregnancy and no proteinuria. Which diagnosis is most likely?

  1. Chronic hypertension Correct answer.
  2. Gestational hypertension
  3. Preeclampsia without severe features
  4. White-coat hypertension

Explanation

Hypertension that predates pregnancy or is present before 20 weeks gestation is classified as chronic hypertension. Gestational hypertension arises after 20 weeks without proteinuria, and preeclampsia requires new hypertension plus proteinuria or end-organ dysfunction after 20 weeks.

Question 27Family Medicine

Which immunization is recommended for all adults aged 50 years and older in the United States?

  1. Yellow fever vaccine
  2. Pneumococcal conjugate vaccine
  3. Meningococcal conjugate vaccine
  4. Zoster recombinant vaccine Correct answer.

Explanation

The recombinant zoster vaccine is recommended for adults aged 50 and older regardless of prior zoster history. Pneumococcal vaccination is generally recommended at age 65 or earlier with specific risk conditions, not routinely at 50.

Question 28Family Medicine

A 4-year-old child has a barking cough, hoarse voice, and inspiratory stridor that began overnight. Which intervention is the most appropriate first-line treatment?

  1. Nebulized albuterol
  2. Oral amoxicillin
  3. Inhaled ipratropium
  4. A single dose of oral dexamethasone Correct answer.

Explanation

The presentation is croup, a viral laryngotracheitis. A single dose of oral dexamethasone is first-line therapy and reduces airway edema and symptom duration.

Question 29Family Medicine

Which finding is most characteristic of an acute otitis media effusion on pneumatic otoscopy?

  1. Normal tympanic membrane translucency
  2. Positive pneumatic otoscopy with brisk movement
  3. Increased tympanic membrane mobility
  4. Decreased tympanic membrane mobility Correct answer.

Explanation

Middle ear effusion stiffens the tympanic membrane and reduces its mobility on pneumatic otoscopy. Brisk normal movement suggests an aerated middle ear without effusion.

Question 30Family Medicine

A 65-year-old man has a hemoglobin of 10.8 g/dL and a mean corpuscular volume of 72 fL. Which is the most likely cause?

  1. Vitamin B12 deficiency
  2. Alcohol use disorder
  3. Hypothyroidism
  4. Iron deficiency Correct answer.

Explanation

A microcytic anemia (MCV below 80 fL) in an older adult most often reflects iron deficiency, which warrants evaluation for gastrointestinal blood loss. B12 deficiency and hypothyroidism typically produce macrocytic anemia.

Question 31Family Medicine

Which is the most effective single behavioral measure to reduce the risk of sudden infant death syndrome?

  1. Placing the infant supine for sleep Correct answer.
  2. Placing the infant prone for sleep
  3. Keeping the room warm with heavy blankets
  4. Using a firm pillow under the head

Explanation

Supine sleeping is the most strongly supported modifiable measure to reduce SIDS risk. Prone sleeping, soft bedding, and overheating increase risk.

Question 32Family Medicine

A 55-year-old man has a fasting glucose of 118 mg/dL and an HbA1c of 6.2%. What is the most appropriate diagnosis?

  1. Normal glucose tolerance
  2. Prediabetes Correct answer.
  3. Type 1 diabetes mellitus
  4. Type 2 diabetes mellitus

Explanation

A fasting glucose of 100 to 125 mg/dL or an HbA1c of 5.7% to 6.4% defines prediabetes. Diabetes requires a fasting glucose of 126 mg/dL or higher or an HbA1c of 6.5% or higher.

Question 33Family Medicine

Which is the recommended first-line treatment for uncomplicated type 2 diabetes in most adults without contraindications?

  1. Basal insulin
  2. Thiazolidinedione
  3. Sulfonylurea
  4. Metformin Correct answer.

Explanation

Metformin remains the preferred initial pharmacologic agent because of its efficacy, low cost, weight neutrality, and favorable safety profile. Other agents are added when glycemic goals are not met.

Question 34Family Medicine

A 30-year-old woman has recurrent episodes of palpitations, sweating, and tremor relieved by eating. Which test is most appropriate to confirm the diagnosis?

  1. Fasting glucose with supervised 72-hour fast Correct answer.
  2. Serum cortisol
  3. 24-hour urinary metanephrines
  4. Serum thyroxine

Explanation

Symptoms of hypoglycemia relieved by eating suggest an insulin-mediated hypoglycemic disorder. A supervised 72-hour fast documenting Whipple's triad is the standard confirmatory test.

Question 35Family Medicine

A 45-year-old man has a 3-week history of epigastric pain that improves with meals and occasionally awakens him at night. Which test is most appropriate initially?

  1. Serum lipase
  2. Helicobacter pylori stool antigen Correct answer.
  3. Upper GI series with barium
  4. Abdominal CT with contrast

Explanation

Pain that improves with eating and occurs at night suggests duodenal ulcer disease, for which H. pylori testing is the appropriate initial step. Endoscopy is reserved for alarm features or failure to respond.

Question 36Family Medicine

A 24-year-old woman has a 2-day history of unilateral facial weakness with inability to close the right eye and loss of the right nasolabial fold, with sparing of the forehead on the left. Which diagnosis is most likely?

  1. Bell palsy Correct answer.
  2. Myasthenia gravis
  3. Multiple sclerosis
  4. Acute ischemic stroke

Explanation

Involvement of the entire half of the face, including the forehead, indicates a peripheral facial nerve lesion, most commonly Bell palsy. Central lesions spare the forehead because of bilateral cortical innervation of the upper face.

Question 37Family Medicine

A 68-year-old woman has a 3-month history of progressive dyspnea and dry cough. She has never smoked. Examination reveals bibasilar crackles and clubbing. Which diagnosis should be considered first?

  1. Idiopathic pulmonary fibrosis Correct answer.
  2. Chronic obstructive pulmonary disease
  3. Asthma
  4. Pulmonary embolism

Explanation

Progressive dyspnea, dry cough, bibasilar crackles, and clubbing in an older never-smoker suggest idiopathic pulmonary fibrosis. High-resolution CT confirms the diagnosis.

Question 38Family Medicine

A 50-year-old woman has a 4 cm firm, irregular breast mass and palpable axillary nodes. Which finding most strongly suggests locally advanced disease?

  1. Matted axillary lymph nodes Correct answer.
  2. Serous nipple discharge
  3. Cyclic breast tenderness
  4. A single mobile axillary node

Explanation

Matted or fixed axillary lymph nodes suggest nodal disease with extracapsular spread, consistent with locally advanced breast cancer. A single mobile node may be reactive, and nipple discharge or cyclic tenderness are nonspecific.

Question 39Family Medicine

A 35-year-old man has a 2-week history of low back pain after heavy lifting, with no red flags. Which is the most appropriate initial management?

  1. Oral corticosteroids for 6 weeks
  2. Immediate MRI of the lumbar spine
  3. NSAIDs and early return to activity Correct answer.
  4. Bed rest for 2 weeks

Explanation

Acute mechanical low back pain without red flags is managed with NSAIDs and early mobilization. Prolonged bed rest delays recovery, and imaging is reserved for red flags or persistent symptoms.

Question 40Family Medicine

A 70-year-old woman has a 6-month history of fatigue and pallor. Laboratory studies show a hemoglobin of 9 g/dL with a normal MCV and a creatinine of 2.4 mg/dL. Which is the most likely cause?

  1. Aplastic anemia
  2. Iron deficiency anemia
  3. Anemia of chronic kidney disease Correct answer.
  4. Hemolytic anemia

Explanation

Anemia in chronic kidney disease results from inadequate erythropoietin production and is typically normocytic. Iron deficiency causes microcytosis, and hemolysis or aplastic anemia have different laboratory patterns.

Question 41Family Medicine

A 40-year-old man has a blood pressure of 162/104 mm Hg on repeated visits. Which medication class is most appropriate as initial therapy for stage 2 hypertension?

  1. Clonidine monotherapy
  2. Alpha-blocker monotherapy
  3. Thiazide diuretic plus an ACE inhibitor Correct answer.
  4. Loop diuretic monotherapy

Explanation

Stage 2 hypertension warrants initiation of two agents from different classes, such as a thiazide diuretic with an ACE inhibitor. Monotherapy is generally reserved for stage 1 hypertension.

Question 42Family Medicine

A 25-year-old woman has a positive urine pregnancy test and severe right lower quadrant pain with vaginal spotting. Which finding most suggests an ectopic pregnancy?

  1. A serum beta-hCG of 50 mIU/mL
  2. A normal-sized uterus with a thickened endometrium
  3. A gestational sac with fetal cardiac activity in the uterus
  4. An empty uterus on transvaginal ultrasound with a positive pregnancy test Correct answer.

Explanation

A positive pregnancy test with an empty uterus on transvaginal ultrasound is highly suspicious for ectopic pregnancy. An intrauterine gestational sac with cardiac activity confirms a normal intrauterine pregnancy.

Question 43Family Medicine

A 6-year-old child has a 2-week history of periorbital edema, foamy urine, and weight gain. Which is the most likely diagnosis?

  1. IgA nephropathy
  2. Urinary tract infection
  3. Acute poststreptococcal glomerulonephritis
  4. Nephrotic syndrome Correct answer.

Explanation

Periorbital edema, foamy urine, and weight gain in a child suggest nephrotic syndrome with proteinuria and hypoalbuminemia. Minimal change disease is the most common cause in this age group.

Question 44Family Medicine

A 55-year-old woman has a 1-week history of severe burning pain in a unilateral dermatomal distribution followed by grouped vesicles. Which treatment is most appropriate if started within 72 hours?

  1. Oral amoxicillin
  2. Topical corticosteroid
  3. Oral acyclovir Correct answer.
  4. Oral fluconazole

Explanation

The presentation is herpes zoster. Antiviral therapy with acyclovir, valacyclovir, or famciclovir started within 72 hours reduces duration and complications.

Question 45Family Medicine

A 32-year-old woman has a 3-month history of fatigue and diffuse hair loss. Laboratory studies show a TSH of 8.5 mIU/L and a free T4 within the normal range. Which is the most appropriate management?

  1. Start methimazole
  2. Start liothyronine
  3. Recheck TSH in 6 months without treatment
  4. Start levothyroxine Correct answer.

Explanation

A mildly elevated TSH with a normal free T4 indicates subclinical hypothyroidism, and treatment with levothyroxine is appropriate when symptoms are present. Methimazole treats hyperthyroidism.

Question 46Family Medicine

A 45-year-old man has sudden onset of severe unilateral flank pain radiating to the groin with hematuria. Noncontrast CT shows a 6 mm distal ureteral stone. Which is the most appropriate initial management?

  1. Open surgical stone removal
  2. Percutaneous nephrolithotomy
  3. Ureteroscopy with stone removal
  4. Observation with analgesia and hydration Correct answer.

Explanation

Stones smaller than 10 mm may pass spontaneously, so initial management is analgesia and hydration with follow-up. Urologic intervention is reserved for larger stones, obstruction, or infection.

Question 47Family Medicine

A 60-year-old woman has a 3-month history of fatigue, weight loss, and hyperpigmentation of the skin and buccal mucosa. Which laboratory finding most supports primary adrenal insufficiency?

  1. Low morning cortisol with elevated ACTH Correct answer.
  2. Elevated aldosterone with low renin
  3. Elevated serum cortisol after ACTH stimulation
  4. Suppressed plasma renin activity

Explanation

Primary adrenal insufficiency produces low cortisol with elevated ACTH due to loss of feedback, and hyperpigmentation results from elevated ACTH. The ACTH stimulation test confirms the diagnosis.

Question 48Family Medicine

A 68-year-old man has a nonhealing ulcer on the helix of his ear with rolled pearly borders and telangiectasias. Which is the most likely diagnosis?

  1. Actinic keratosis
  2. Squamous cell carcinoma
  3. Basal cell carcinoma Correct answer.
  4. Melanoma

Explanation

A pearly papule with rolled borders and telangiectasias on a sun-exposed area is characteristic of basal cell carcinoma. Actinic keratosis is a rough scaly macule that does not ulcerate with pearly borders.

Question 49Family Medicine

A 52-year-old woman has a 6-month history of episodic flushing, diarrhea, and a new heart murmur. Which test is most appropriate to confirm the diagnosis?

  1. 24-hour urinary 5-hydroxyindoleacetic acid Correct answer.
  2. Serum chromogranin A
  3. Plasma metanephrines
  4. Serum calcitonin

Explanation

Flushing, diarrhea, and cardiac involvement suggest carcinoid syndrome, in which serotonin is metabolized to 5-HIAA. A 24-hour urinary 5-HIAA is the confirmatory test.

Question 50Family Medicine

A 30-year-old woman has a 2-week history of polyuria, polydipsia, and weight loss. Laboratory studies show a glucose of 420 mg/dL and a pH of 7.25 with elevated ketones. Which is the most appropriate initial management?

  1. Subcutaneous insulin and outpatient follow-up
  2. Intravenous fluids and intravenous insulin Correct answer.
  3. Oral metformin and dietary counseling
  4. Oral glipizide and hydration

Explanation

The presentation is diabetic ketoacidosis, which requires intravenous fluid resuscitation and intravenous insulin with electrolyte monitoring. Outpatient management is inappropriate for DKA.