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

Question 1: What is the first-line treatment for acute otitis media (AOM) in children?

Ceftriaxone
Clindamycin
Azithromycin
Amoxicillin (Correct answer)

Correct answer: Amoxicillin

Amoxicillin is the first-line treatment for acute otitis media (AOM) in children due to its effectiveness against common bacterial causes and its favorable safety profile. It is typically prescribed for 5-10 days, depending on the child's age and severity of infection. While other antibiotics may be used for penicillin-allergic patients or treatment failures, amoxicillin remains the initial drug of choice.

Question 2: What defines severe preeclampsia apart from hypertension?

Edema of the ankles
Severe-range BP (≥160/110) plus end-organ damage (Correct answer)
Mild proteinuria only
Weight gain of 2 lb/week

Correct answer: Severe-range BP (≥160/110) plus end-organ damage

Severe preeclampsia is defined by BP ≥160/110 mmHg or evidence of end-organ damage (renal, hepatic, neurologic, hematologic).

Question 3: Which medication is used to treat postpartum hemorrhage due to uterine atony as first-line?

Carboprost
Tranexamic acid
Oxytocin (Correct answer)
Misoprostol

Correct answer: Oxytocin

IV oxytocin is the first-line uterotonic agent for postpartum hemorrhage due to uterine atony.

Question 4: Which functional assessment tool evaluates basic activities of daily living (ADLs) in older adults?

MMSE
Tinetti Scale
Katz Index (Correct answer)
Geriatric Depression Scale

Correct answer: Katz Index

The Katz Index of Independence in Activities of Daily Living assesses bathing, dressing, toileting, transferring, continence, and feeding.

Question 5: Which of the following is the most appropriate initial management for a simple febrile seizure in a 2-year-old?

Initiate anticonvulsant therapy
Supportive care and fever management (Correct answer)
Immediate CT head
Lumbar puncture

Correct answer: Supportive care and fever management

Simple febrile seizures are self-limiting and benign; supportive care and antipyretics are appropriate without neuroimaging or anticonvulsants.

Question 6: Which electrolyte abnormality is most commonly associated with prolonged QT interval on ECG?

Hypokalemia (Correct answer)
Hyponatremia
Hyperkalemia
Hypernatremia

Correct answer: Hypokalemia

Hypokalemia prolongs the QT interval and increases the risk of life-threatening arrhythmias including torsades de pointes.

Question 7: A patient develops a pruritic, erythematous vesicular rash on the wrists after wearing a new metal watch. The most likely diagnosis is:

Irritant contact dermatitis
Allergic contact dermatitis (Correct answer)
Atopic dermatitis
Nummular eczema

Correct answer: Allergic contact dermatitis

Allergic contact dermatitis from nickel (common in metal watches) is a Type IV hypersensitivity reaction presenting with pruritic vesicular rash confined to the contact area.

Question 8: Which auscultatory finding is most characteristic of aortic stenosis?

Holosystolic murmur at the apex
Diastolic murmur at the left sternal border
Fixed split S2
Crescendo-decrescendo systolic murmur at the right upper sternal border (Correct answer)

Correct answer: Crescendo-decrescendo systolic murmur at the right upper sternal border

Aortic stenosis produces a harsh crescendo-decrescendo systolic ejection murmur best heard at the right upper sternal border with radiation to the carotids.

Question 9: A patient on ACE inhibitor therapy develops a dry, persistent cough. What is the most appropriate management?

Continue therapy and reassure
Add a short-acting bronchodilator
Add an antihistamine
Switch to an ARB (Correct answer)

Correct answer: Switch to an ARB

ACE inhibitor-induced cough is a class effect due to bradykinin accumulation; switching to an ARB eliminates the cough while maintaining cardiovascular benefit.

Question 10: Which preventive measure is recommended to reduce the risk of cardiovascular disease in adults with a high cardiovascular risk?

Daily sugar consumption
Daily multivitamin use
Regular physical activity (Correct answer)
Routine use of antibiotics

Correct answer: Regular physical activity

Regular physical activity is a cornerstone preventive measure highly recommended to reduce the risk of cardiovascular disease (CVD) in adults with high cardiovascular risk. Engaging in moderate-intensity aerobic activity for at least 150 minutes per week can significantly improve blood pressure, cholesterol levels, and glucose metabolism. These physiological benefits collectively lower the overall risk of heart attacks, strokes, and other CVD events.

Question 11: A patient presents with heel pain that is worst with the first steps in the morning. The most likely diagnosis is:

Achilles tendinopathy
Plantar fasciitis (Correct answer)
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 12: A patient presents with suspected deep vein thrombosis. Which scoring system should be applied before ordering imaging?

CHADS2 score
CURB-65 score
Wells criteria (Correct answer)
Ottawa rules

Correct answer: Wells criteria

The Wells criteria stratify pretest probability for DVT and guide the decision to perform D-dimer testing or duplex ultrasound.

Question 13: A 30-year-old develops widespread urticaria, throat tightness, and hypotension minutes after taking ibuprofen. The immediate first-line treatment is:

Oral cetirizine 10 mg
IV methylprednisolone 125 mg
Epinephrine 0.3 mg IM in the anterolateral thigh (Correct answer)
Diphenhydramine 50 mg IV

Correct answer: Epinephrine 0.3 mg IM in the anterolateral thigh

Epinephrine IM is the first-line treatment for anaphylaxis because it rapidly reverses bronchoconstriction, vasoconstriction, and urticaria through alpha and beta-adrenergic effects.

Question 14: A patient presents with acute monoarthritis of the first MTP joint with overlying erythema and severe pain. Synovial fluid shows negatively birefringent crystals. The diagnosis is:

Pseudogout
Gout (Correct answer)
Rheumatoid arthritis
Septic arthritis

Correct answer: Gout

Gout is caused by monosodium urate crystals, which appear needle-shaped and negatively birefringent under polarized light microscopy.

Question 15: 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)
Oral valacyclovir 1 g TID for 7 days
Topical acyclovir cream twice daily

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 16: A 35-year-old female presents with right lower quadrant pain, nausea, and fever. The Alvarado score is 8. What is the next step?

Urgent surgical consultation (Correct answer)
Abdominal X-ray
Discharge with oral antibiotics
Repeat exam in 4 hours

Correct answer: Urgent surgical consultation

An Alvarado score of 7–10 indicates high likelihood of appendicitis and warrants urgent surgical consultation.

Question 17: Which screening test is recommended at 24–28 weeks gestation to detect gestational diabetes?

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

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 18: A patient presents with greasy, yellowish scales on the scalp, eyebrows, and nasolabial folds with underlying erythema. The most likely diagnosis is:

Scalp psoriasis
Seborrheic dermatitis (Correct answer)
Atopic dermatitis
Tinea capitis

Correct answer: Seborrheic dermatitis

Seborrheic dermatitis characteristically involves sebaceous gland-rich areas (scalp, eyebrows, nasolabial folds) with greasy, yellowish scales on an erythematous base.

Question 19: A patient with an ejection fraction of 35% and NYHA Class II symptoms is started on an ARNI. Which medication is this?

Lisinopril
Losartan
Spironolactone
Sacubitril/valsartan (Correct answer)

Correct answer: Sacubitril/valsartan

Sacubitril/valsartan (Entresto) is an ARNI (angiotensin receptor-neprilysin inhibitor) shown to reduce cardiovascular death in HFrEF compared to enalapril.

Question 20: A pregnant woman at 36 weeks is found to have GBS colonization on vaginal-rectal culture. What is the appropriate management?

Cesarean delivery
IV penicillin G during labor (Correct answer)
Oral amoxicillin started immediately
No treatment required

Correct answer: IV penicillin G during labor

Intrapartum IV penicillin G is given to GBS-positive mothers during labor to prevent neonatal early-onset GBS disease.

Question 21: A patient presents with anaphylaxis after a bee sting. What is the first-line treatment?

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

Correct answer: Epinephrine 0.3 mg IM

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

Question 22: A 75-year-old patient is found to have an ABI (ankle-brachial index) of 0.65. What does this indicate?

Venous insufficiency
Normal peripheral circulation
Mild peripheral arterial disease
Moderate-to-severe peripheral arterial disease (Correct answer)

Correct answer: Moderate-to-severe peripheral arterial disease

An ABI of 0.4–0.69 indicates moderate-to-severe peripheral arterial disease with significant arterial occlusion.

Question 23: A 45-year-old male presents with sudden onset crushing chest pain radiating to the left arm. Which initial diagnostic test is most critical?

12-lead ECG (Correct answer)
Chest X-ray
Troponin level
Echocardiogram

Correct answer: 12-lead ECG

A 12-lead ECG is the first-line diagnostic tool for suspected acute MI and should be obtained within 10 minutes of presentation.

Question 24: Which seronegative spondyloarthropathy is strongly associated with HLA-B27 and causes inflammatory back pain in young adults?

Ankylosing spondylitis (Correct answer)
Reactive arthritis
Psoriatic arthritis
Gout

Correct answer: Ankylosing spondylitis

Ankylosing spondylitis is most strongly associated with HLA-B27 and presents as chronic inflammatory back pain and stiffness in young men.

Question 25: Which finding on urinalysis is most consistent with a diagnosis of nephrolithiasis in a patient with acute flank pain?

Hematuria (Correct answer)
Proteinuria
Pyuria
Glucosuria

Correct answer: Hematuria

Hematuria is present in approximately 85% of nephrolithiasis cases and is the hallmark urinalysis finding.

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%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds