Family Medicine Certification Longitudinal Assessment (FMCLA) — Questions and Answers

Question 1: Which screening test is recommended at 24–28 weeks gestation to detect gestational diabetes?

Urinalysis for glucose
Hemoglobin A1c
1-hour 50g glucose challenge test (Correct answer)
Fasting blood glucose alone

Correct answer: 1-hour 50g glucose challenge test

The 1-hour 50g glucose challenge test (GCT) is the standard screening tool for gestational diabetes between 24–28 weeks.

Question 2: Which type of urinary incontinence is most common in elderly women?

Functional incontinence
Stress incontinence
Urge incontinence (Correct answer)
Overflow incontinence

Correct answer: Urge incontinence

Urge incontinence (overactive bladder) is the most prevalent type of incontinence in older women and is characterized by sudden intense urge to void.

Question 3: At what age is it recommended to start routine screening for autism spectrum disorder (ASD) in children?

12 months
18 months (Correct answer)
36 months
24 months

Correct answer: 18 months

The American Academy of Pediatrics (AAP) recommends routine screening for autism spectrum disorder (ASD) in children at 18 months and 24 months of age. This universal screening is crucial for early detection, even in the absence of specific concerns. Early identification allows for prompt intervention, which has been shown to significantly improve developmental outcomes for children with ASD.

Question 4: Which organism is most commonly responsible for bacterial vaginosis?

Gardnerella vaginalis (Correct answer)
Trichomonas vaginalis
Candida albicans
Chlamydia trachomatis

Correct answer: Gardnerella vaginalis

Gardnerella vaginalis drives the disruption of normal vaginal flora that characterizes bacterial vaginosis.

Question 5: Which behavioral intervention has the strongest evidence for effectiveness in treating insomnia?

Hypnosis
Sleep hygiene education
Relaxation techniques
Cognitive-behavioral therapy for insomnia (CBT-I) (Correct answer)

Correct answer: Cognitive-behavioral therapy for insomnia (CBT-I)

Cognitive-behavioral therapy for insomnia (CBT-I) has the strongest evidence for effectiveness in treating chronic insomnia and is considered the gold standard non-pharmacological treatment. CBT-I addresses the underlying thoughts and behaviors that contribute to insomnia, including sleep restriction, stimulus control, and cognitive restructuring. It provides more durable improvements in sleep than medication alone.

Question 6: In suspected sepsis, what is the recommended time frame to administer broad-spectrum antibiotics after recognition?

Within 1 hour (Correct answer)
Within 6 hours
Within 12 hours
Within 3 hours

Correct answer: Within 1 hour

The Surviving Sepsis Campaign recommends antibiotic administration within 1 hour of sepsis recognition to reduce mortality.

Question 7: Which antihypertensive is preferred for treating hypertension during pregnancy?

Hydrochlorothiazide
Labetalol (Correct answer)
Amlodipine
Lisinopril

Correct answer: Labetalol

Labetalol is a preferred antihypertensive in pregnancy; ACE inhibitors like lisinopril are teratogenic and contraindicated.

Question 8: A 2-year-old presents with pruritic, erythematous, weeping patches on the cheeks and extensor surfaces. Family history is positive for asthma and hay fever. The most likely diagnosis is:

Atopic dermatitis (Correct answer)
Psoriasis
Contact dermatitis
Seborrheic dermatitis

Correct answer: Atopic dermatitis

Atopic dermatitis presents in infants on the cheeks and extensor surfaces with a personal or family history of atopy (asthma, allergic rhinitis, eczema) — the atopic triad.

Question 9: Which vitamin deficiency is extremely common in homebound elderly patients and contributes to falls and fractures?

Vitamin E
Vitamin A
Vitamin B12
Vitamin D (Correct answer)

Correct answer: Vitamin D

Vitamin D deficiency is prevalent in homebound elderly due to lack of sun exposure and impairs calcium absorption, increasing fall and fracture risk.

Question 10: What is the first-line pharmacologic treatment for major depressive disorder in adults?

Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
Tricyclic antidepressants (TCAs)
Benzodiazepines
Monoamine oxidase inhibitors (MAOIs)

Correct answer: Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are considered the first-line pharmacologic treatment for major depressive disorder in adults. They are generally well-tolerated, effective, and have a relatively safer side effect profile compared to older antidepressants like TCAs and MAOIs. SSRIs work by increasing serotonin levels in the brain, which helps regulate mood.

Question 11: Which joint is most commonly affected in rheumatoid arthritis that is rarely involved in osteoarthritis?

DIP joints
First CMC joint
MCP joints (Correct answer)
Knee joint

Correct answer: MCP joints

Rheumatoid arthritis classically involves the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, sparing the DIP joints.

Question 12: What is the primary purpose of using the CAGE questionnaire in clinical practice?

To assess for alcohol use disorder (Correct answer)
To evaluate anxiety levels
To screen for depression
To measure cognitive function

Correct answer: To assess for alcohol use disorder

The CAGE questionnaire is a widely used screening tool specifically designed to assess for alcohol use disorder in clinical practice. The acronym CAGE stands for Cut down, Annoyed, Guilty, and Eye-opener, referring to questions about a person's drinking habits. A positive response to two or more questions suggests a potential alcohol problem requiring further evaluation.

Question 13: Which developmental milestone is expected at 9 months of age?

Walking independently
Waving bye-bye (Correct answer)
Saying "mama" and "dada" specifically
Using a pincer grasp

Correct answer: Waving bye-bye

Waving bye-bye is a common social-emotional developmental milestone expected around 9 months of age. This gesture demonstrates the infant's ability to imitate and engage in reciprocal communication. While other milestones like specific word usage or walking occur later, waving bye-bye indicates emerging social understanding and interaction skills.

Question 14: A patient presents with epistaxis that does not stop with 20 minutes of direct pressure. What is the next step?

Emergent surgical ligation
Oral antifibrinolytics
Posterior nasal packing
Anterior nasal packing (Correct answer)

Correct answer: Anterior nasal packing

Anterior nasal packing is the next step for epistaxis refractory to direct pressure, addressing the most common anterior bleed site.

Question 15: For patients with type 2 diabetes, what is the target HbA1c level recommended by most guidelines?

<7.5%
<6.5%
<7.0% (Correct answer)
<6.0%

Correct answer: <7.0%

For most non-pregnant adults with type 2 diabetes, the target HbA1c level recommended by major guidelines, such as those from the American Diabetes Association (ADA), is <7.0%. This target aims to reduce the risk of microvascular complications like retinopathy and nephropathy. Individualized targets may vary based on factors like age, comorbidities, and risk of hypoglycemia, but <7.0% serves as a general goal for many patients.

Question 16: Which feature of a pigmented skin lesion is MOST concerning for malignant melanoma?

A smooth, raised papule with well-defined margins
Diameter less than 3 mm
Irregular border with multiple colors (tan, brown, black) (Correct answer)
Symmetric shape with uniform tan color

Correct answer: Irregular border with multiple colors (tan, brown, black)

Irregular borders and multiple colors are hallmark ABCDE criteria for melanoma, reflecting uncontrolled, asymmetric tumor cell proliferation.

Question 17: Which contraceptive method has the highest typical-use failure rate?

Copper IUD
Combined oral contraceptives
Diaphragm
Male condom (Correct answer)

Correct answer: Male condom

Male condoms have a typical-use failure rate of approximately 13% per year due to inconsistent and incorrect use.

Question 18: A patient presents with anaphylaxis after a bee sting. What is the first-line treatment?

Diphenhydramine IV
Epinephrine 0.3 mg IM (Correct answer)
Methylprednisolone IV
Albuterol inhaler

Correct answer: Epinephrine 0.3 mg IM

Intramuscular epinephrine in the anterolateral thigh is the first-line and life-saving treatment for anaphylaxis.

Question 19: A 68-year-old presents with a painful vesicular eruption along a dermatomal distribution on the left chest wall. Which of the following antiviral regimens is appropriate for treatment within 72 hours?

Oral famciclovir 500 mg TID for 7 days
Either oral valacyclovir or oral famciclovir is appropriate (Correct answer)
Topical acyclovir cream twice daily
Oral valacyclovir 1 g TID for 7 days

Correct answer: Either oral valacyclovir or oral famciclovir is appropriate

Both valacyclovir and famciclovir are FDA-approved oral antivirals for herpes zoster with superior bioavailability compared to acyclovir; either is an appropriate first-line choice.

Question 20: What is the first-line pharmacological treatment for managing hypertension in adults according to current guidelines?

ACE inhibitors
Calcium channel blockers
Beta-blockers
Thiazide diuretics (Correct answer)

Correct answer: Thiazide diuretics

According to current guidelines, including those from the American College of Cardiology/American Heart Association (ACC/AHA) and the Eighth Joint National Committee (JNC 8), thiazide diuretics are recommended as first-line pharmacological treatment for managing hypertension in most adults. They are effective, well-tolerated, and have been shown to reduce cardiovascular morbidity and mortality. Other classes like ACE inhibitors, ARBs, and calcium channel blockers are also considered first-line options, but thiazide diuretics are often preferred initially.

Question 21: A 65-year-old presents with a firm, indurated nodule with overlying crust on the lower lip and palpable cervical lymphadenopathy. The most likely diagnosis is:

Sebaceous cyst
Squamous cell carcinoma (Correct answer)
Basal cell carcinoma
Keratoacanthoma

Correct answer: Squamous cell carcinoma

Squamous cell carcinoma on the lip (a high-risk sun-exposed site) can metastasize to regional lymph nodes, unlike basal cell carcinoma which rarely metastasizes.

Question 22: What is the first-line pharmacologic treatment for moderate-to-severe menopausal vasomotor symptoms in a woman without contraindications?

SSRIs
Gabapentin
Clonidine
Hormone therapy (estrogen ± progesterone) (Correct answer)

Correct answer: Hormone therapy (estrogen ± progesterone)

Hormone therapy remains the most effective treatment for menopausal vasomotor symptoms in appropriate candidates.

Question 23: Which intervention is most effective in preventing pressure ulcers in bedridden elderly patients?

Regular repositioning every 2 hours (Correct answer)
Daily vitamin C supplementation
Moisture barrier creams alone
Prophylactic antibiotics

Correct answer: Regular repositioning every 2 hours

Repositioning every 2 hours relieves sustained pressure and is the most evidence-based intervention for pressure ulcer prevention.

Question 24: A patient presents with heel pain that is worst with the first steps in the morning. The most likely diagnosis is:

Plantar fasciitis (Correct answer)
Achilles tendinopathy
Tarsal tunnel syndrome
Calcaneal stress fracture

Correct answer: Plantar fasciitis

Plantar fasciitis causes pain at the calcaneal insertion of the plantar fascia, characteristically worst with the first steps after rest.

Question 25: A 60-year-old male smoker presents with progressive dyspnea and chronic cough. Spirometry shows FEV1/FVC of 0.58. What is the diagnosis?

Congestive heart failure
Pulmonary fibrosis
COPD (Correct answer)
Asthma

Correct answer: COPD

COPD is confirmed by post-bronchodilator FEV1/FVC <0.70 in a patient with relevant exposure history and symptoms.

Family Medicine Certification Longitudinal Assessment (FMCLA)

The FMCLA is a continuous board recertification assessment administered by the ABFM, delivering 25 open-book clinical questions per quarter that span acute care, chronic disease management, emergent care, and preventive medicine domains.

Questions

30 min

Time Limit

70%

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