AAFP Questions and answers Practice test 2023 A 52 -year -old male presents with moderate symptoms of prostatism. A prostate examination is normal. His post -void residual volume is 90 mL. His PSA level is 0.75 ng/mL (N 0.0 -4.0). He says his nocturia has become troublesome and you decide to initiate ther apy. This patient does NOT meet the criteria for use of which one of the following? Finasteride (Use if there is evidence of prostatic enlargement or a PSA level >1.5 ng/mL), A factory worker sustains a forced flexion injury of the distal interphalangeal ( DIP) joint, resulting in a small bone fragment at the dorsal surface of the proximal distal phalanx (mallet fracture). Which one of the following is the most appropriate management strategy? (Check one) A. Buddy taping and early range of motion B. Splintin g the DIP joint in extension C. Splinting the DIP joint in flexion D. Referral for surgical repair B 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, refer ral 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. Which one of the following drugs is NOT effective for maintenance the rapy in bipolar disorders? (Check one) A. Haloperidol B. Lamotrigine (Lamictal) C. Lithium D. Quetiapine (Seroquel) E. Valproate sodium (Depacon) A Lithium, valproate, lamotrigine, and some antipsychotics (including quetiapine) are effective treatments for both acute depression and maintenance therapy of bipolar disorders. Haloperidol is an effective treatment for acute mania in bipolar disorders, but not for maintenance therapy or acute depression. A 30 -year -old ill -appearing male presents with right hand and arm pain and a rapidly expanding area of redness. On examination he has a temperature of 38.9°C (102.0°F), a pulse rate of 120 beats/min, and a blood pressure of 116/74 mm Hg. He also has erythema from the dorsal hand to the elbow, violaceous bullae on the dorsal hand and wrist, and severe pain with dorsiflexion of the wrist or fingers. Which one of the following is the most appropriate initial step in the management of this patient? (Check one) A. Oral dicloxacillin and outpatient follow -up within the next 24 hours B. Intravenous metronidazole C. Consultation with an infectious disease specialist for antibiotic managemen D. Immediate surgical consultation for operative debridement E. Incision and drainage with wound cultures in the emergency department D This patient has physical findings consistent with a necrotizing skin and soft -tissue infection, or necrotizing fasciitis. Severe pain and skin changes outside the realm of cellulitis, including bullae and deeper discoloration, are strong indi cations of necrotizing fasciitis. Antimicrobial therapy is essential but is not sufficient by itself; aggressive surgical debridement within 12 hours reduces the risk of amputation and death. A mother brings her 2 -year -old daughter to your office because t he child is not using her left arm. Earlier in the day the mother left the toddler under the supervision of her 12 -year -old sister while she went to the store. When she returned the toddler was playing with toys using only her right arm, and was holding th e left arm slightly pronated, flexed, and close to her body. The older daughter was unaware of any injury to the girl's arm, and the child does not seem distressed or traumatized. Physical examination of the child's clavicle, shoulder, wrist, and hand do not elicit any signs of pain or change in function. She does seem to have some tenderness near the lateral elbow and resists your attempts to examine that area. There is no ecchymosis, swelling, or deformity of the elbow. Which one of the following would be most appropriate at this point? (Check one) A. Plain radiographs of the affected elbow B. Ultrasonography of the affected elbow C. Evaluation by an orthopedic surgeon within 24 hours D. Attempted reduction of the subluxed radial head E. Placement in a s plint and follow -up in the office if there is no C A mother brings her 2 -year -old daughter to your office because the child is not using her left arm. Earlier in the day the mother left the toddler under the supervision of her 12 -year -old sister while she went to the store. When she returned the toddler was playing with toys using only her right arm, and was holding the left arm slightly pronated, flexed, and close to her body. The older daughter was unaware of any injury to the girl's arm, and the child does not seem distressed or traumatized. Physical examination of the child's clavicle, shoulder, wrist, and hand do not elicit any signs of pain or change in function. She does seem to have some tenderness near the lateral elbow and resists your att empts to examine that area. There is no ecchymosis, swelling, or deformity of the elbow. Which one of the following would be most appropriate at this point? (Check one) A. Plain radiographs of the affected elbow B. Ultrasonography of the affected elbow C. Evaluation by an orthopedic surgeon within 24 hours D. Attempted reduction of the subluxed radial head E. Placement in a splint and follow -up in the office if there is no improvement in the next 1 -2 weeks D. Radial head subluxation, or nursemaid's elbow, is the most common orthopedic condition of the elbow in children 1 -4 years of age, although it can be encountered before 1 year of age and in children as old as 9 years of age. The mechanism of injury is partial displacement of the radial head when the child's arm undergoes axial traction while in a pronated and fully extended position. The classic history includes a caregiver picking up (or pulling) a toddler by the arm. In half of all cases, however, no inciting event is recalled. 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 the n 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 12 -year -old male uses a short -acting bronchodilator three times per week to control his asthma. Lately he has been waking up about twice a week because of his symptoms. Which one of the following medications would be most appropriate? (Check one) A. Inhaled medium -dose corticosteroids B. A scheduled short -acting bronchodilator C. A scheduled long -acting bronchodilator D. A leukotriene inhibitor E. Ordering a free T 4 A This patient has moderate per sistent asthma. Although many parents are concerned about corticosteroid
