ABFM Family Medicine Certification Examination (FMCE) — Questions and Answers

Question 1: Which antihypertensive medication is contraindicated in a patient who also has gout?

Hydrochlorothiazide (Correct answer)
Lisinopril
Losartan
Amlodipine

Correct answer: Hydrochlorothiazide

Thiazide diuretics reduce renal uric acid excretion by competing at the proximal tubule, raising serum urate and precipitating gout attacks.

Question 2: Which spirometry pattern is diagnostic of COPD?

Peak expiratory flow rate below 70% predicted
Post-bronchodilator FEV1/FVC ratio less than 0.70 (Correct answer)
FEV1 below 80% predicted with normal FVC
FVC below 80% predicted with normal FEV1/FVC

Correct answer: Post-bronchodilator FEV1/FVC ratio less than 0.70

COPD is confirmed by a post-bronchodilator FEV1/FVC ratio less than 0.70, indicating irreversible airflow obstruction.

Question 3: Which approach to acute care is considered best practice in current Family Practice Exam standards?

One-size-fits-all protocols
Evidence-based, individualized interventions (Correct answer)
Traditional methods exclusively
The least expensive option

Correct answer: Evidence-based, individualized interventions

Evidence-based, individualized interventions combine the best available research with patient-specific factors for optimal outcomes.

Question 4: A patient presents with weakness, hyperkalemia (K+ 7.2 mEq/L), and peaked T-waves on ECG. What is the first medication to administer?

Sodium bicarbonate
Calcium gluconate (Correct answer)
Furosemide
Kayexalate

Correct answer: Calcium gluconate

Calcium gluconate stabilizes the cardiac membrane and is the first-line treatment to prevent life-threatening arrhythmias in severe hyperkalemia.

Question 5: A patient with heart failure with reduced ejection fraction (HFrEF) is already on ACE inhibitor and beta-blocker. Which additional drug class has been shown to reduce mortality?

Mineralocorticoid receptor antagonist (spironolactone) (Correct answer)
Calcium channel blocker (amlodipine)
Digoxin as first add-on
Loop diuretic (furosemide)

Correct answer: Mineralocorticoid receptor antagonist (spironolactone)

Aldosterone antagonists such as spironolactone reduce mortality in HFrEF when added to ACE inhibitor and beta-blocker therapy, as shown in the RALES trial.

Question 6: A 70-year-old man presents with acute onset of severe low back pain after lifting. X-ray shows a vertebral compression fracture at L2. What is the most important underlying condition to evaluate?

Osteoporosis (Correct answer)
Lumbar spinal stenosis
Paget's disease
Multiple myeloma

Correct answer: Osteoporosis

Vertebral compression fractures in elderly patients most commonly result from osteoporosis and warrant DEXA scanning and fracture risk assessment.

Question 7: In Family Practice Exam practice, when should a patient's condition be reassessed?

Once per week
Only at admission and discharge
At regular intervals and when status changes (Correct answer)
Only when the patient requests it

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 8: A 70-year-old male who smoked 25 pack-years and quit 20 years ago presents for a health maintenance visit. Should he receive USPSTF low-dose CT lung cancer screening?

No, because he is over 80
No, because he quit more than 15 years ago (Correct answer)
Yes, if he has any respiratory symptoms
Yes, because he is 70 and ever smoked

Correct answer: No, because he quit more than 15 years ago

USPSTF criteria require quitting within the past 15 years; since this patient quit 20 years ago, he no longer meets eligibility for lung cancer screening.

Question 9: What is the first priority in mental health for Family Practice Exam practitioners?

Completing documentation
Ensuring patient safety and well-being (Correct answer)
Following insurance requirements
Meeting productivity targets

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 10: Which approach best demonstrates mastery of preventive medicine in Family Practice Exam practice?

Avoiding complex scenarios
Applying principles to novel situations with sound judgment (Correct answer)
Relying entirely on technology
Following procedures without understanding

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 11: A 52-year-old woman presents with hot flashes, night sweats, and vaginal dryness. Her LMP was 14 months ago. She has no personal or family history of breast cancer or VTE. What is the most effective treatment for her vasomotor symptoms?

Hormone replacement therapy (estrogen + progestin) (Correct answer)
Black cohosh supplement
SSRIs
Gabapentin

Correct answer: Hormone replacement therapy (estrogen + progestin)

Hormone therapy remains the most effective treatment for menopausal vasomotor symptoms in healthy women without contraindications.

Question 12: A physician notices a patient is making a fist and gritting teeth during the interview. This nonverbal observation is best described as a sign of:

Agitation or anger (Correct answer)
Psychomotor retardation
Catatonia
Tardive dyskinesia

Correct answer: Agitation or anger

Clenching fists and gritting teeth are nonverbal cues indicating agitation or suppressed anger.

Question 13: A 55-year-old male presents with sudden-onset tearing chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm. What is the most likely diagnosis?

Pulmonary embolism
Esophageal rupture
Acute MI
Aortic dissection (Correct answer)

Correct answer: Aortic dissection

Aortic dissection classically presents with tearing chest pain radiating to the back and BP differential between arms.

Question 14: Which OTC analgesic is safest for pain management in a patient with stage 3 chronic kidney disease?

Aspirin
Naproxen
Acetaminophen (Correct answer)
Ibuprofen

Correct answer: Acetaminophen

Acetaminophen is preferred over NSAIDs in CKD because it does not inhibit renal prostaglandins or further reduce glomerular filtration rate.

Question 15: Which cognitive domain is primarily impaired early in Alzheimer's disease?

Episodic memory (Correct answer)
Procedural memory
Semantic memory for remote events
Implicit memory

Correct answer: Episodic memory

Episodic memory (new learning and recent recall) is the earliest and most prominently affected domain in Alzheimer's disease.

Question 16: Which of the following is the most common cause of acute pancreatitis in the United States?

Hypertriglyceridemia
Medication-induced
Alcohol use
Gallstones (Correct answer)

Correct answer: Gallstones

Gallstones account for approximately 40–70% of acute pancreatitis cases, as a stone obstructing the common bile duct can impair pancreatic enzyme drainage.

Question 17: A 4-week-old boy presents with non-bilious projectile vomiting after every feeding. What is the best next step?

Abdominal ultrasound (Correct answer)
Upper GI series
Trial of hydrolyzed formula
Stool culture

Correct answer: Abdominal ultrasound

Pyloric stenosis is the likely diagnosis; abdominal ultrasound is the gold standard for confirming hypertrophic pylorus in neonates.

Question 18: What is the most important professional competency for Family Practice Exam certification in preventive medicine?

Ability to work alone exclusively
Deep knowledge combined with practical application skills (Correct answer)
Speed of task completion
Memorization of all reference materials

Correct answer: Deep knowledge combined with practical application skills

Professional competency requires both deep knowledge of the subject matter and the ability to apply that knowledge in practical situations.

Question 19: A 27-year-old lady laments having trouble becoming pregnant. She observes a dramatic increase in weight, erratic menstruation cycles, acne, and hirsutism. Which of the following conditions should the doctor be on the lookout for?

Addison's disease
Hyperparathyroidism
Graves disease
Cushing syndrome (Correct answer)

Correct answer: Cushing syndrome

The constellation of symptoms described—dramatic weight gain, erratic menstruation, acne, and hirsutism—is highly suggestive of Cushing syndrome. This condition results from prolonged exposure to high levels of cortisol, leading to characteristic features like central obesity, menstrual irregularities, skin changes, and often infertility. These symptoms differentiate it from other endocrine disorders.

Question 20: A 26-year-old woman presents with dysuria and urinary frequency. Urinalysis shows positive nitrites and leukocyte esterase. She is not pregnant and has no fever. What is the most appropriate management?

Trimethoprim-sulfamethoxazole for 3 days (Correct answer)
Nitrofurantoin for 5 days
Ciprofloxacin for 7 days
Obtain urine culture before any treatment

Correct answer: Trimethoprim-sulfamethoxazole for 3 days

TMP-SMX for 3 days is effective first-line therapy for uncomplicated cystitis in women; nitrofurantoin is also acceptable but typically given for 5 days.

Question 21: According to Rome IV criteria, which of the following is NOT a diagnostic criterion for irritable bowel syndrome (IBS)?

Pain related to defecation
Pain associated with a change in stool frequency or form
Unintentional weight loss >10 lbs (Correct answer)
Recurrent abdominal pain at least 1 day per week for 3 months

Correct answer: Unintentional weight loss >10 lbs

Unintentional weight loss is a red-flag symptom suggesting organic disease and is not part of the Rome IV IBS criteria; its presence warrants further workup.

Question 22: A 35-year-old woman presents with fatigue, cold intolerance, weight gain, and constipation. TSH is 12 mIU/L and free T4 is low. What is the appropriate next step?

Repeat TSH in 6 weeks
Order thyroid ultrasound
Start levothyroxine (Correct answer)
Refer to endocrinology

Correct answer: Start levothyroxine

Overt hypothyroidism (elevated TSH + low free T4) with symptoms warrants starting levothyroxine replacement therapy.

Question 23: A patient has a blood pressure of 165/95 mmHg on two separate office visits. According to ACC/AHA 2017 guidelines, what is the diagnosis?

Normal blood pressure
Elevated blood pressure
Stage 2 hypertension (Correct answer)
Stage 1 hypertension

Correct answer: Stage 2 hypertension

ACC/AHA 2017 guidelines define Stage 2 hypertension as BP ≥140/90 mmHg on repeated measurements.

Question 24: A 32-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic pain. Urinalysis shows pyuria and bacteriuria. She has no fever or flank pain. What is the most appropriate treatment?

Ciprofloxacin for 14 days
Nitrofurantoin for 5 days
IV ceftriaxone for 7 days
Trimethoprim-sulfamethoxazole for 3 days only if local resistance <20% (Correct answer)

Correct answer: Trimethoprim-sulfamethoxazole for 3 days only if local resistance <20%

TMP-SMX for 3 days is first-line for uncomplicated UTI if local E. coli resistance is below 20%; otherwise nitrofurantoin or fosfomycin are preferred alternatives.

Question 25: A 28-year-old traveler returns from Central America with 4 days of watery, non-bloody diarrhea and mild cramping but no fever. What is the most appropriate initial management?

Stool culture and ova and parasite exam before any treatment
Oral rehydration therapy and supportive care (Correct answer)
Empiric ciprofloxacin for 3 days
Empiric metronidazole for Giardia

Correct answer: Oral rehydration therapy and supportive care

Mild traveler's diarrhea without fever, bloody stools, or systemic symptoms is self-limiting; oral rehydration and supportive care are sufficient management.

Question 26: A 45-year-old presents with salmon-colored plaques with silvery scales on the elbows and knees. Nail pitting is also noted. What is the most likely diagnosis?

Psoriasis vulgaris (Correct answer)
Pityriasis rosea
Lichen planus
Seborrheic dermatitis

Correct answer: Psoriasis vulgaris

Psoriasis vulgaris presents with well-demarcated salmon-pink plaques with silvery scales on extensor surfaces, and nail pitting is a classic associated finding.

Question 27: The USPSTF recommends depression screening for adults. What is the essential prerequisite for implementing population-wide screening?

Patient history of prior depressive episodes
Age ≥ 40 years
Adequate staff and systems in place to ensure diagnosis and treatment (Correct answer)
Presence of a mental health specialist in the practice

Correct answer: Adequate staff and systems in place to ensure diagnosis and treatment

USPSTF specifies that screening for depression is indicated only when adequate systems are in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.

Question 28: Which of the following best describes the recommended monitoring interval for diabetic nephropathy screening in a patient with type 2 diabetes and normal renal function?

Only if symptomatic proteinuria develops
Annual urine albumin-to-creatinine ratio and serum creatinine (Correct answer)
Every 6 months regardless of risk factors
Every 5 years if baseline is normal

Correct answer: Annual urine albumin-to-creatinine ratio and serum creatinine

Annual screening with urine albumin-to-creatinine ratio and eGFR is recommended starting at diagnosis for type 2 diabetes to detect early nephropathy.

Question 29: A 62-year-old woman with a 40 pack-year smoking history is being screened for lung cancer. Which imaging modality is recommended?

Chest X-ray annually
Low-dose CT of the chest annually (Correct answer)
PET scan every 2 years
High-resolution CT every 3 years

Correct answer: Low-dose CT of the chest annually

USPSTF recommends annual low-dose CT (LDCT) for adults aged 50–80 with a 20 pack-year history who currently smoke or quit within 15 years.

Question 30: A patient with HFrEF on lisinopril develops a persistent dry cough. What is the best medication change?

Discontinue all heart failure medications
Switch to a different ACE inhibitor
Add a beta-blocker
Switch to an ARB (Correct answer)

Correct answer: Switch to an ARB

ARBs provide equivalent cardiovascular benefits to ACE inhibitors without causing bradykinin-mediated cough.

Question 31: Which blood pressure target is recommended for a 72-year-old patient with hypertension but no diabetes or CKD, according to current ACC/AHA guidelines?

Less than 140/90 mmHg
Less than 150/90 mmHg
Less than 130/80 mmHg (Correct answer)
Less than 160/90 mmHg

Correct answer: Less than 130/80 mmHg

The 2017 ACC/AHA guidelines recommend a BP target of less than 130/80 mmHg for most adults, including older patients who can tolerate treatment.

Question 32: Which primary prevention strategy most effectively reduces the incidence of skin cancer in fair-skinned adults?

Vitamin D supplementation
Daily broad-spectrum sunscreen use and sun-protective clothing (Correct answer)
Annual full-body skin examination by a dermatologist
Avoidance of all outdoor activities

Correct answer: Daily broad-spectrum sunscreen use and sun-protective clothing

Daily use of broad-spectrum SPF 15+ sunscreen combined with protective clothing and shade significantly reduces UV exposure and skin cancer risk.

Question 33: A 45-year-old patient reports heartburn and regurgitation occurring at least twice weekly for 6 months. What is the most appropriate first-line pharmacological treatment?

Surgical fundoplication referral
Proton pump inhibitor (e.g., omeprazole) (Correct answer)
H2 receptor antagonist (e.g., famotidine)
Calcium-based antacid

Correct answer: Proton pump inhibitor (e.g., omeprazole)

PPIs provide superior acid suppression compared to H2 blockers and are the first-line pharmacological therapy for chronic GERD.

Question 34: A 72-year-old man on warfarin for atrial fibrillation has an INR of 6.8 but no active bleeding. What is the most appropriate management?

Continue warfarin and recheck INR in 1 week
Administer IV vitamin K 10 mg
Administer fresh frozen plasma
Hold warfarin and give oral vitamin K 1–2.5 mg (Correct answer)

Correct answer: Hold warfarin and give oral vitamin K 1–2.5 mg

For supratherapeutic INR without bleeding, holding warfarin and giving low-dose oral vitamin K is recommended per CHEST guidelines.

Question 35: Which of the following is the first-line treatment regimen for H. pylori eradication?

Triple therapy (PPI + amoxicillin + clarithromycin) (Correct answer)
Metronidazole monotherapy for 14 days
PPI monotherapy for 8 weeks
Bismuth quadruple therapy alone

Correct answer: Triple therapy (PPI + amoxicillin + clarithromycin)

Triple therapy with a PPI, amoxicillin, and clarithromycin for 14 days is the standard first-line regimen for H. pylori eradication in areas with low clarithromycin resistance.

Question 36: Which electrolyte abnormality most increases the risk of digoxin toxicity?

Hypernatremia
Hypermagnesemia
Hypokalemia (Correct answer)
Hyperkalemia

Correct answer: Hypokalemia

Hypokalemia increases digoxin binding affinity to Na/K-ATPase, potentiating its toxic effects on cardiac automaticity and conduction.

Question 37: A patient presents with an intense fear of gaining weight, BMI of 16, and absence of menstruation for 6 months. Which lab finding is most expected?

Low cortisol
Elevated LH
Low LH and FSH (Correct answer)
Elevated FSH

Correct answer: Low LH and FSH

Anorexia nervosa causes hypothalamic suppression, leading to low LH and FSH with resulting amenorrhea.

Question 38: A 25-year-old man has annular, scaly, pruritic plaques on the trunk with central clearing. KOH preparation shows hyphae. What is the first-line treatment?

Oral griseofulvin for 6 weeks
Topical mupirocin
Systemic prednisone
Topical clotrimazole for 2-4 weeks (Correct answer)

Correct answer: Topical clotrimazole for 2-4 weeks

Tinea corporis is treated with topical antifungals such as clotrimazole for 2-4 weeks for localized disease.

Question 39: In Family Practice Exam practice, what is the best approach to quality improvement in dermatology?

Wait for problems to occur before acting
Use data-driven methods with measurable outcomes (Correct answer)
Make changes without measuring results
Copy what other organizations do without analysis

Correct answer: Use data-driven methods with measurable outcomes

Data-driven quality improvement with measurable outcomes ensures that changes actually produce the intended improvements and can be verified.

Question 40: A 4-year-old child is brought in with fever, drooling, and sitting in a tripod position with neck hyperextended. What is the most likely diagnosis?

Epiglottitis (Correct answer)
Foreign body aspiration
Peritonsillar abscess
Croup

Correct answer: Epiglottitis

Epiglottitis presents with the classic tripod position, drooling, dysphagia, and high fever and requires emergent airway management.

Question 41: What is the recommended approach when managing conflicting priorities in Family Practice Exam?

Delegate all decisions upward
Prioritize based on impact and urgency (Correct answer)
Address them in alphabetical order
Ignore lower-priority items

Correct answer: Prioritize based on impact and urgency

Prioritizing based on impact and urgency ensures the most critical issues receive attention first while maintaining progress on other goals.

Question 42: According to current USPSTF guidelines, at what age should average-risk asymptomatic adults begin colorectal cancer screening?

55 years
40 years
45 years (Correct answer)
50 years

Correct answer: 45 years

In 2021, the USPSTF updated its recommendation to begin colorectal cancer screening at age 45 for average-risk adults due to rising incidence in younger populations.

Question 43: Which immunization series requires 3 doses and provides protection against cervical cancer caused by HPV types 16 and 18?

Cervarix given at any age
Gardasil 9 given before age 15
Recombivax given in adolescence
Gardasil 9 given at 15 or older (Correct answer)

Correct answer: Gardasil 9 given at 15 or older

When HPV vaccination is started at age 15 or older, a 3-dose schedule is required; starting before age 15 requires only 2 doses.

Question 44: A 45-year-old presents with abdominal pain, vomiting, and serum lipase of 1,200 U/L. CT shows peripancreatic fat stranding. Which finding would indicate severe acute pancreatitis requiring ICU care?

Persistent organ failure for >48 hours (Correct answer)
Fever >38.5°C on day 1
Serum lipase >3x normal
BMI >30

Correct answer: Persistent organ failure for >48 hours

Persistent (>48 hours) single or multi-organ failure defines severe acute pancreatitis with high morbidity and mortality requiring ICU-level care.

Question 45: A patient on ciprofloxacin develops Achilles tendon pain. What is the most serious complication to warn about?

Tendon rupture (Correct answer)
Reactive arthritis
Septic arthritis
Bursitis

Correct answer: Tendon rupture

Fluoroquinolones carry an FDA black-box warning for tendinitis and tendon rupture, most commonly affecting the Achilles tendon.

Question 46: A 28-year-old woman presents 6 weeks postpartum with persistent sadness, inability to bond with her newborn, and passive thoughts of self-harm. She is breastfeeding. What is the safest first-line pharmacologic option?

Venlafaxine
Paroxetine
Sertraline (Correct answer)
Bupropion

Correct answer: Sertraline

Sertraline is considered first-line for postpartum depression in breastfeeding women due to minimal transfer into breast milk and established safety data.

Question 47: Which ethical principle requires Family Practice Exam professionals to act in the patient's best interest?

Fidelity
Beneficence (Correct answer)
Autonomy
Justice

Correct answer: Beneficence

Beneficence is the ethical principle that obligates healthcare professionals to act in ways that promote the well-being and best interests of the patient.

Question 48: A patient presents with sudden palpitations, HR 158 bpm, and an irregularly irregular rhythm on exam. What is the most likely diagnosis?

Sinus tachycardia
Ventricular tachycardia
Atrial fibrillation (Correct answer)
Supraventricular tachycardia

Correct answer: Atrial fibrillation

An irregularly irregular rhythm at a rapid rate is the hallmark clinical finding of atrial fibrillation.

Question 49: A 72-year-old man presents with symmetric proximal muscle weakness and difficulty rising from a chair. ESR is 85 mm/hr. Creatine kinase is normal. What is the most likely diagnosis?

Hypothyroid myopathy
Amyotrophic lateral sclerosis
Polymyositis
Polymyalgia rheumatica (PMR) (Correct answer)

Correct answer: Polymyalgia rheumatica (PMR)

PMR classically presents in patients over 50 with proximal muscle pain/stiffness, elevated ESR, and normal CK, distinguishing it from inflammatory myopathies.

Question 50: A 45-year-old with known COPD presents with worsening dyspnea, decreased breath sounds on the left, and tracheal deviation to the right. What is the immediate intervention?

Needle decompression (Correct answer)
Administer bronchodilators
Start BiPAP
Obtain chest X-ray

Correct answer: Needle decompression

Tension pneumothorax with hemodynamic compromise requires immediate needle decompression without waiting for imaging.

Question 51: Which ethical principle requires Family Practice Exam professionals to act in the patient's best interest?

Beneficence (Correct answer)
Autonomy
Fidelity
Justice

Correct answer: Beneficence

Beneficence is the ethical principle that obligates healthcare professionals to act in ways that promote the well-being and best interests of the patient.

Question 52: A 10-year-old boy with asthma uses his albuterol inhaler more than 2 days per week. How should his asthma be classified?

Intermittent asthma
Mild persistent asthma (Correct answer)
Moderate persistent asthma
Severe persistent asthma

Correct answer: Mild persistent asthma

Symptoms more than 2 days per week but not daily, with nighttime awakenings 3-4 times per month, classify asthma as mild persistent per NAEPP guidelines.

Question 53: A 35-year-old woman on combined oral contraceptives presents with sudden severe headache and left-sided weakness. Which OCP-related risk is most concerning?

Increased risk of ovarian cyst rupture
Dopamine suppression from ethinyl estradiol
Progesterone-induced hypertensive crisis
Estrogen-related thromboembolic stroke (Correct answer)

Correct answer: Estrogen-related thromboembolic stroke

Combined OCPs containing estrogen increase the risk of venous and arterial thromboembolism, including ischemic stroke, particularly in women with migraines with aura.

Question 54: With a patient with stage 3 chronic renal disease, how should hypertension be treated?

Advise the patient to decrease their protein, sodium, and alcohol intake to control their hypertension
Use diuretics, as they are the best treatment of this stage
Use calcium channel blockers
Use angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), and loop diuretics in combination (Correct answer)

Correct answer: Use angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), and loop diuretics in combination

In patients with Stage 3 chronic renal disease and hypertension, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) are crucial for blood pressure control and renoprotection. Loop diuretics are often necessary to manage fluid balance and hypertension as kidney function declines. Combining these agents helps achieve target blood pressure and slow the progression of kidney disease.

Question 55: A 50-year-old woman presents with hot flashes, night sweats, and irregular periods. FSH is elevated. Which long-term risk is most important to counsel her about?

Accelerated bone loss (Correct answer)
Increased risk of breast cancer
Increased risk of ovarian cancer
Decreased cardiovascular risk

Correct answer: Accelerated bone loss

Menopause leads to estrogen deficiency, which accelerates bone resorption and significantly increases the risk of osteoporosis and fractures.

Question 56: A 32-year-old female 20 weeks pregnant presents with BP 160/110 mmHg, headache, and 3+ proteinuria. What is the drug of choice for acute blood pressure management?

Oral nifedipine XL
IV labetalol or hydralazine (Correct answer)
ACE inhibitor
Furosemide

Correct answer: IV labetalol or hydralazine

IV labetalol or hydralazine is first-line for acute severe hypertension in pregnancy; ACE inhibitors are contraindicated.

Question 57: Which drug class is preferred for hypertension management in a patient with diabetes and microalbuminuria?

Beta-blocker
Alpha-1 blocker
ACE inhibitor or ARB (Correct answer)
Thiazide diuretic as monotherapy

Correct answer: ACE inhibitor or ARB

ACE inhibitors and ARBs are preferred in diabetic patients with microalbuminuria because they reduce intraglomerular pressure and slow progression of nephropathy beyond blood pressure control.

Question 58: A 38-year-old woman presents with a 6-month history of fatigue, joint pain, malar rash, and photosensitivity. Labs show positive ANA (1:320), anti-dsDNA antibodies, and proteinuria. What is the most likely diagnosis?

Dermatomyositis
Systemic lupus erythematosus (Correct answer)
Mixed connective tissue disease
Rheumatoid arthritis

Correct answer: Systemic lupus erythematosus

The combination of malar rash, photosensitivity, arthritis, renal involvement, positive ANA, and anti-dsDNA antibodies meets SLE classification criteria.

Question 59: A patient presents with multiple flesh-colored, dome-shaped papules with central umbilication on the trunk and arms. The patient is immunocompetent. What is the natural course without treatment?

Malignant transformation in 5% of cases
Progressive spread requiring systemic antiviral therapy
Self-resolution within 6-12 months (Correct answer)
Permanent scarring

Correct answer: Self-resolution within 6-12 months

Molluscum contagiosum in immunocompetent individuals is self-limiting and typically resolves spontaneously within 6-18 months without treatment.

Question 60: A patient stabilized on warfarin begins eating large daily servings of leafy green vegetables. What change in INR would you expect?

Decrease in INR (Correct answer)
Increase in INR
No significant change
Unpredictable change

Correct answer: Decrease in INR

Leafy greens are high in vitamin K, which replenishes clotting factor activity and counteracts warfarin's anticoagulant effect, lowering the INR.

Question 61: Which of the following best characterizes the pharmacokinetic changes of aging that affect drug dosing in elderly patients?

Decreased hepatic blood flow reduces first-pass metabolism, increasing bioavailability of some drugs (Correct answer)
Increased first-pass metabolism increases drug bioavailability
Increased renal clearance requires higher doses
Decreased body fat reduces volume of distribution of lipophilic drugs

Correct answer: Decreased hepatic blood flow reduces first-pass metabolism, increasing bioavailability of some drugs

Aging reduces hepatic blood flow and CYP enzyme activity, decreasing first-pass metabolism and increasing oral bioavailability of drugs such as propranolol and morphine.

Question 62: A 38-year-old woman with episodic right upper quadrant pain after fatty meals has an ultrasound confirming cholelithiasis. She has no fever, jaundice, or signs of acute cholecystitis. What is the definitive treatment?

Dietary fat restriction as sole management
Long-term ursodeoxycholic acid to dissolve stones
Elective laparoscopic cholecystectomy (Correct answer)
Urgent cholecystectomy within 24 hours

Correct answer: Elective laparoscopic cholecystectomy

Symptomatic cholelithiasis is definitively treated with elective laparoscopic cholecystectomy, which eliminates the risk of future complications including acute cholecystitis and gallstone pancreatitis.

Question 63: A 45-year-old man with no prior cardiac history presents with crushing substernal chest pain radiating to the left arm for 30 minutes. ECG shows ST elevation in leads V1-V4. What is the most critical next step?

Activate the cardiac catheterization lab (Correct answer)
Administer IV morphine
Start IV heparin and admit to telemetry
Order a chest X-ray

Correct answer: Activate the cardiac catheterization lab

STEMI management priority is immediate reperfusion via percutaneous coronary intervention (PCI); door-to-balloon time under 90 minutes is the standard.

Question 64: Which finding on urinalysis is most consistent with early diabetic nephropathy?

Gross hematuria with RBC casts
Microalbuminuria (30–300 mg albumin/g creatinine) (Correct answer)
Heavy proteinuria greater than 3.5 g/day
Leukocyte esterase with nitrites

Correct answer: Microalbuminuria (30–300 mg albumin/g creatinine)

Microalbuminuria is the earliest marker of diabetic nephropathy, reflecting early glomerular damage before overt proteinuria develops.

Question 65: A 60-year-old woman with a history of long-term corticosteroid use is found to have a T-score of -2.7 on DEXA scan. What is the most appropriate next step?

Start estrogen replacement therapy
Refer for parathyroidectomy
Initiate bisphosphonate therapy (Correct answer)
Calcium and vitamin D supplementation only

Correct answer: Initiate bisphosphonate therapy

A T-score of -2.5 or below indicates osteoporosis, and bisphosphonates (e.g., alendronate) are first-line pharmacologic treatment.

Question 66: A 29-year-old woman presents with amenorrhea for 3 months, galactorrhea, and headaches. Serum prolactin is 180 ng/mL. What is the most appropriate next step?

Begin combined OCPs to restore cycles
Start bromocriptine empirically
Order an MRI of the pituitary gland
Perform pregnancy test and thyroid function tests first (Correct answer)

Correct answer: Perform pregnancy test and thyroid function tests first

Before MRI, exclude pregnancy (most common cause of amenorrhea-galactorrhea) and hypothyroidism (causes elevated prolactin) to avoid unnecessary imaging.

Question 67: A 70-year-old man presents with acute monoarthritis of the first MTP joint. Arthrocentesis shows negatively birefringent, needle-shaped crystals. What is the treatment of choice for acute flare?

Hydroxychloroquine
Indomethacin or colchicine (Correct answer)
Probenecid
Allopurinol

Correct answer: Indomethacin or colchicine

Acute gout flares are treated with NSAIDs (e.g., indomethacin), colchicine, or corticosteroids.

Question 68: A 16-year-old male presents with insidious onset of low back pain and morning stiffness that improves with exercise. HLA-B27 is positive. What is the most likely diagnosis?

Ankylosing spondylitis (Correct answer)
Lumbar disc herniation
Reactive arthritis
Psoriatic arthritis

Correct answer: Ankylosing spondylitis

Ankylosing spondylitis presents in young males with inflammatory back pain, morning stiffness, and strong HLA-B27 association.

Question 69: A 34-year-old woman is 8 weeks pregnant and has a BMI of 36. She asks about gestational weight gain. Per IOM guidelines, how much total weight gain is recommended during her pregnancy?

28–40 lbs (13–18 kg)
No weight gain is recommended
11–20 lbs (5–9 kg) (Correct answer)
25–35 lbs (11–16 kg)

Correct answer: 11–20 lbs (5–9 kg)

IOM guidelines recommend 11–20 lbs of total gestational weight gain for women with a pre-pregnancy BMI ≥30 (obese).

Question 70: A 55-year-old male presents with crushing chest pain radiating to the left arm. What is the first-line diagnostic test?

Chest X-ray
ECG (Correct answer)
Echocardiogram
Troponin levels

Correct answer: ECG

An ECG is the first-line test in suspected acute MI because it can rapidly identify ST-elevation changes at the bedside.

Question 71: A 68-year-old presents with sudden onset of atrial fibrillation with RVR (HR 145 bpm) and is hemodynamically stable. What is the preferred acute rate-control agent?

Adenosine IV push
Atropine IV
Diltiazem IV (Correct answer)
Digoxin IV

Correct answer: Diltiazem IV

IV diltiazem (calcium channel blocker) provides rapid rate control in hemodynamically stable atrial fibrillation with rapid ventricular response.

Question 72: A 71-year-old woman presents with pain in both hips and shoulders for 3 months, morning stiffness lasting over 1 hour, and ESR of 72 mm/hr. CK is normal. She responds dramatically to prednisone 15 mg/day. What should now be monitored most closely?

Blood glucose, blood pressure, and bone density (for steroid side effects) (Correct answer)
Temporal artery biopsy annually
Monthly CBC to monitor for aplastic anemia
Serum ACE levels for treatment response

Correct answer: Blood glucose, blood pressure, and bone density (for steroid side effects)

Long-term corticosteroid therapy for PMR requires monitoring for steroid-induced complications including hyperglycemia, hypertension, osteoporosis, and adrenal suppression.

Question 73: A patient with schizophrenia shows flat affect, alogia, and avolition with intact thought organization. These symptoms are best described as:

Negative symptoms (Correct answer)
Cognitive symptoms
Disorganized symptoms
Positive symptoms

Correct answer: Negative symptoms

Flat affect, alogia, and avolition are negative symptoms reflecting diminution of normal functions.

Question 74: Which of the following is the most appropriate initial treatment for a patient with generalized anxiety disorder (GAD)?

Propranolol alone
Clonazepam plus quetiapine
Lorazepam long-term
Buspirone or an SSRI plus CBT (Correct answer)

Correct answer: Buspirone or an SSRI plus CBT

First-line treatment for GAD is an SSRI or buspirone combined with CBT; benzodiazepines are not recommended for long-term use.

Question 75: A patient with a serum acetaminophen level of 250 mcg/mL at 4 hours post-ingestion plots above the Rumack-Matthew nomogram treatment line. What is the antidote?

Naloxone
Flumazenil
N-acetylcysteine (NAC) (Correct answer)
Activated charcoal only

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine replenishes glutathione and is the antidote for acetaminophen toxicity when levels exceed the treatment threshold.

Question 76: A patient with severe right upper quadrant (RUQ) pain presents. Which imaging test should be used to evaluate this patient?

Endoscopy
Abdominal computed tomography (CT)
Plain films
Ultrasound (US) (Correct answer)

Correct answer: Ultrasound (US)

For a patient presenting with severe right upper quadrant (RUQ) pain, an ultrasound (US) is the initial imaging modality of choice. It is non-invasive, readily available, and highly effective at visualizing the gallbladder, bile ducts, and liver. This makes it ideal for diagnosing common causes of RUQ pain such as gallstones, cholecystitis, or liver abnormalities.

Question 77: A 60-year-old postmenopausal woman is started on alendronate for osteoporosis. Which instruction is most important to prevent esophageal injury?

Crush the tablet and dissolve in juice for easier swallowing
Take with a full glass of milk to protect the esophagus
Take at bedtime to maximize overnight absorption
Remain upright for at least 30 minutes after taking the tablet (Correct answer)

Correct answer: Remain upright for at least 30 minutes after taking the tablet

Bisphosphonates must be taken with a full glass of plain water and the patient must remain upright for ≥30 minutes to prevent esophageal ulceration.

Question 78: A 38-year-old female presents with pleuritic chest pain, dyspnea, and unilateral leg swelling after a long flight. D-dimer is elevated. What imaging is the gold standard for diagnosis?

V/Q scan
Chest X-ray
CT pulmonary angiography (Correct answer)
Doppler ultrasound of the leg

Correct answer: CT pulmonary angiography

CT pulmonary angiography (CTPA) is the gold standard for diagnosing pulmonary embolism, offering high sensitivity and specificity.

Question 79: A 65-year-old man with stable coronary artery disease and an aspirin allergy presents for cardioprotective antiplatelet therapy. What is the most appropriate alternative?

Ticagrelor 90 mg twice daily
Dipyridamole alone
Clopidogrel 75 mg daily (Correct answer)
Warfarin with target INR 2–3

Correct answer: Clopidogrel 75 mg daily

Clopidogrel 75 mg daily is the recommended antiplatelet alternative for stable CAD in patients with true aspirin allergy.

Question 80: What role does collaboration play in dermatology for Family Practice Exam professionals?

It slows down work unnecessarily
It enhances outcomes through diverse perspectives and shared expertise (Correct answer)
It reduces individual accountability
It is only needed in emergencies

Correct answer: It enhances outcomes through diverse perspectives and shared expertise

Collaboration leverages diverse perspectives and combined expertise to achieve better outcomes than any individual could alone.

Question 81: Which of the following best differentiates delirium from dementia?

Memory impairment
Acute onset with fluctuating consciousness (Correct answer)
Language difficulties
Presence of hallucinations

Correct answer: Acute onset with fluctuating consciousness

Delirium is distinguished from dementia by its acute onset, fluctuating course, and disturbance in attention and consciousness.

Question 82: A patient presents with high fever, altered mental status, muscle rigidity, and autonomic instability after starting haloperidol. What is the diagnosis?

Serotonin syndrome
Malignant hyperthermia
Anticholinergic toxicity
Neuroleptic malignant syndrome (Correct answer)

Correct answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is caused by antipsychotic agents and presents with hyperthermia, rigidity, altered consciousness, and autonomic instability.

Question 83: Which psychological therapy has the strongest evidence base for treating bulimia nervosa?

Cognitive behavioral therapy (CBT) (Correct answer)
Dialectical behavior therapy (DBT)
Psychodynamic therapy
Exposure and response prevention

Correct answer: Cognitive behavioral therapy (CBT)

CBT is the gold-standard psychotherapy for bulimia nervosa with the strongest evidence for reducing binge-purge cycles.

Question 84: Which of the following is the most common cause of small bowel obstruction in adults in developed countries?

Intra-abdominal adhesions from prior surgery (Correct answer)
Small bowel neoplasm
External hernias
Crohn's disease strictures

Correct answer: Intra-abdominal adhesions from prior surgery

Post-surgical intra-abdominal adhesions account for approximately 60–75% of small bowel obstructions, making them by far the most common etiology in patients with prior abdominal surgery.

Question 85: Which physical exam finding is most specific for heart failure with reduced ejection fraction?

Bilateral crackles
Jugular venous distension
S3 gallop (Correct answer)
Peripheral edema

Correct answer: S3 gallop

An S3 gallop (third heart sound) is highly specific for ventricular volume overload and reduced ejection fraction in heart failure.

Question 86: A 60-year-old man presents with sudden-onset confusion, fever, muscle rigidity, and autonomic instability after starting haloperidol. The most likely diagnosis is:

Anticholinergic toxicity
Neuroleptic malignant syndrome (Correct answer)
Serotonin syndrome
Malignant hyperthermia

Correct answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) presents with the tetrad of fever, rigidity, altered consciousness, and autonomic instability after antipsychotic exposure.

Question 87: Which laboratory finding most strongly indicates the need to initiate statin therapy in a patient without known cardiovascular disease?

LDL of 110 mg/dL in a 30-year-old with no risk factors
10-year ASCVD risk ≥7.5% with LDL ≥70 mg/dL (Correct answer)
Triglycerides of 180 mg/dL with normal LDL
HDL of 55 mg/dL in an otherwise healthy adult

Correct answer: 10-year ASCVD risk ≥7.5% with LDL ≥70 mg/dL

ACC/AHA guidelines recommend initiating statin therapy for primary prevention when the 10-year ASCVD risk is ≥7.5% and LDL is ≥70 mg/dL.

Question 88: A 30-year-old woman presents with recurrent episodes of palpitations, sweating, weight loss, and diarrhea. Thyroid exam reveals a diffusely enlarged, non-tender gland and a bruit. TSH is undetectable. What is the most likely diagnosis?

Hashimoto's thyroiditis
Graves' disease (Correct answer)
Thyroid adenoma
Toxic multinodular goiter

Correct answer: Graves' disease

Diffuse goiter with thyroid bruit, hyperthyroidism, and associated ophthalmopathy or dermopathy is classic for Graves' disease, an autoimmune condition.

Question 89: An 85-year-old man is being discharged after hip fracture repair. Which intervention has the strongest evidence for preventing delirium in postoperative elderly patients?

Benzodiazepine sedation for nighttime agitation
Prophylactic haloperidol administration
Placement in a private room with minimal stimulation
Early mobilization and reorientation protocols (Correct answer)

Correct answer: Early mobilization and reorientation protocols

Multicomponent non-pharmacologic interventions including early mobilization, reorientation, sleep hygiene, and hydration are the most evidence-based strategies for delirium prevention.

Question 90: A 16-year-old presents with primary amenorrhea. She has normal breast development but no pubic/axillary hair. Testosterone is in the male range. What is the most likely diagnosis?

Mullerian agenesis (Mayer-Rokitansky syndrome)
Complete androgen insensitivity syndrome (CAIS) (Correct answer)
Congenital adrenal hyperplasia
Turner syndrome (45,X)

Correct answer: Complete androgen insensitivity syndrome (CAIS)

CAIS presents with female phenotype, normal breast development, absent pubic/axillary hair, and male-range testosterone (46,XY karyotype).

Question 91: A child in your practice has not received any vaccines due to parental refusal. Now at age 11, the parents consent to vaccination. Which vaccine combination is MOST important to administer at this visit?

Rotavirus + PCV15 + hepatitis A
MMR + varicella + IPV
HPV + Tdap + meningococcal conjugate (MenACWY) (Correct answer)
Hepatitis B + DTaP + Hib

Correct answer: HPV + Tdap + meningococcal conjugate (MenACWY)

The 11–12-year-old platform includes HPV series initiation, Tdap booster, and meningococcal conjugate vaccine as the highest-priority catch-up vaccines at this age.

Question 92: A 2-year-old presents with a barky cough, stridor, and low-grade fever. What is the most likely diagnosis?

Pertussis
Bronchiolitis
Croup (laryngotracheobronchitis) (Correct answer)
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

Croup is characterized by a seal-like barky cough and inspiratory stridor, typically caused by parainfluenza virus in children under 5.

Question 93: A 28-year-old woman at 10 weeks gestation reports nausea and vomiting. She cannot keep any fluids down. Which finding would indicate hyperemesis gravidarum rather than normal morning sickness?

Nausea before meals
Vomiting in the morning
Weight loss greater than 5% of pre-pregnancy weight (Correct answer)
Mild fatigue

Correct answer: Weight loss greater than 5% of pre-pregnancy weight

Hyperemesis gravidarum is characterized by severe vomiting with more than 5% weight loss, dehydration, and ketonuria.

Question 94: What is the recommended initial antihypertensive agent in a diabetic patient with microalbuminuria?

Thiazide diuretic
Calcium channel blocker
Beta-blocker
ACE inhibitor (Correct answer)

Correct answer: ACE inhibitor

ACE inhibitors are first-line in diabetic patients with microalbuminuria due to proven nephroprotective effects beyond blood pressure lowering.

Question 95: Which peripheral vascular sign is characteristic of severe aortic regurgitation?

Pulsus paradoxus
Malar flush
Pulsus alternans
Corrigan pulse (water-hammer pulse) (Correct answer)

Correct answer: Corrigan pulse (water-hammer pulse)

Aortic regurgitation causes a bounding, rapidly collapsing Corrigan pulse due to the wide pulse pressure from diastolic backflow into the left ventricle.

Question 96: Which complication of hepatic cirrhosis is defined by spontaneous infection of ascitic fluid with >250 neutrophils/mm³ in the absence of a surgical intra-abdominal source?

Hepatic encephalopathy
Hepatorenal syndrome
Spontaneous bacterial peritonitis (SBP) (Correct answer)
Secondary bacterial peritonitis

Correct answer: Spontaneous bacterial peritonitis (SBP)

SBP is diagnosed when ascitic fluid PMN count exceeds 250 cells/mm³ without evidence of a surgically treatable intra-abdominal infection; it most commonly occurs in cirrhotic patients with low ascitic protein.

Question 97: Which vaccine is contraindicated in a 32-year-old woman who is 10 weeks pregnant?

MMR vaccine (Correct answer)
Hepatitis B vaccine
Tdap vaccine
Inactivated influenza vaccine

Correct answer: MMR vaccine

MMR is a live attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection; it should be given postpartum.

Question 98: A 45-year-old man presents with intermittent epigastric pain relieved by eating, positive H. pylori breath test, and no alarm symptoms. What is the most appropriate initial treatment?

Immediate upper endoscopy
Triple therapy (PPI + clarithromycin + amoxicillin) for 14 days (Correct answer)
H2 blocker for 4 weeks
Omeprazole alone for 8 weeks

Correct answer: Triple therapy (PPI + clarithromycin + amoxicillin) for 14 days

H. pylori eradication with triple therapy (PPI + clarithromycin + amoxicillin) for 14 days is first-line treatment for H. pylori-associated peptic ulcer disease.

Question 99: A 50-year-old construction worker presents with gradual numbness and tingling in the thumb, index, and middle fingers, worst at night. Tinel's and Phalen's signs are positive. What is the first-line treatment?

Physical therapy
Wrist splinting at night (Correct answer)
Surgical carpal tunnel release
Corticosteroid injection

Correct answer: Wrist splinting at night

Nocturnal wrist splinting in a neutral position is the first-line conservative treatment for mild to moderate carpal tunnel syndrome.

Question 100: Which of the following symptoms is used to identify Parkinson's disease?

Bradykinesia, intentional tremor, muscular instability, and dyskinesia
Hyperkinesia, resting tremor, muscular rigidity, and postural
Bradykinesia, resting tremor, muscular rigidity, and postural instability (Correct answer)
Hyperkinesia, resting tremor, myoclonus, and dyskinesia

Correct answer: Bradykinesia, resting tremor, muscular rigidity, and postural instability

Parkinson's disease is primarily identified by four cardinal motor symptoms: bradykinesia (slowness of movement), a resting tremor (tremor that occurs at rest), muscular rigidity (stiffness), and postural instability (impaired balance and coordination). These symptoms arise from the degeneration of dopamine-producing neurons in the brain. Understanding these key features is essential for diagnosis.

Question 101: Which hepatitis B serologic pattern indicates immunity due to vaccination (not prior infection)?

HBsAg positive with anti-HBc IgM positive
Anti-HBc positive with anti-HBs positive
Anti-HBs positive only (HBsAg negative, anti-HBc negative) (Correct answer)
Anti-HBe positive with HBsAg positive

Correct answer: Anti-HBs positive only (HBsAg negative, anti-HBc negative)

Vaccination generates anti-HBs without anti-HBc, because vaccines contain only surface antigen; natural infection also produces anti-HBc.

Question 102: A 50-year-old presents with a pigmented lesion with asymmetry, border irregularity, multiple colors (black, brown, red), and a diameter of 8 mm. What is the next best step?

Shave biopsy
Topical imiquimod and watchful waiting
Punch biopsy of darkest area only
Excisional biopsy with 1-2 mm margins (Correct answer)

Correct answer: Excisional biopsy with 1-2 mm margins

Excisional biopsy with narrow margins is the preferred approach for lesions suspicious for melanoma to allow complete pathologic evaluation.

Question 103: What is the first priority in acute care for Family Practice Exam practitioners?

Ensuring patient safety and well-being (Correct answer)
Following insurance requirements
Meeting productivity targets
Completing documentation

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 104: Which vaccine is recommended for all adults aged 19–64 who smoke cigarettes, regardless of other indications?

Hepatitis A vaccine
Pneumococcal vaccine (PCV15 or PCV20) (Correct answer)
Varicella vaccine
Meningococcal vaccine

Correct answer: Pneumococcal vaccine (PCV15 or PCV20)

Current smokers aged 19–64 are at increased risk for invasive pneumococcal disease and should receive pneumococcal vaccination.

Question 105: A 55-year-old male with a 30 pack-year smoking history who currently smokes should receive which cancer screening?

CT colonography annually
Low-dose CT chest annually (Correct answer)
Chest X-ray annually
Sputum cytology every 3 years

Correct answer: Low-dose CT chest annually

USPSTF recommends annual low-dose CT of the chest for adults aged 50–80 with a 20+ pack-year history who currently smoke or quit within 15 years.

Question 106: A patient with HIV presents with violaceous papules and plaques on the skin and oral mucosa. Biopsy shows spindle cell proliferation. What is the diagnosis?

Bacillary angiomatosis
Secondary syphilis
Lymphoma cutis
Kaposi sarcoma (Correct answer)

Correct answer: Kaposi sarcoma

Kaposi sarcoma in HIV patients presents as violaceous lesions on skin and mucosa; biopsy shows spindle cell proliferation with vascular channels and is associated with HHV-8.

Question 107: A 22-year-old college student reports recurrent binge eating followed by self-induced vomiting. Which electrolyte abnormality is most expected?

Hypokalemic metabolic alkalosis (Correct answer)
Hyponatremia
Hyperchloremic metabolic acidosis
Hyperkalemia

Correct answer: Hypokalemic metabolic alkalosis

Recurrent purging causes loss of hydrochloric acid and potassium, resulting in hypokalemic metabolic alkalosis.

Question 108: A 14-year-old male presents with knee pain worsened by activity. There is tenderness over the tibial tubercle with a visible prominence. What is the most likely diagnosis?

Osteosarcoma
Osgood-Schlatter disease (Correct answer)
Patellar tendinopathy
Septic arthritis of the knee

Correct answer: Osgood-Schlatter disease

Osgood-Schlatter disease is a traction apophysitis at the tibial tubercle, common in active adolescents during growth spurts, causing anterior knee pain and a bony prominence.

Question 109: A 75-year-old man presents with urinary urgency, frequency, nocturia, and a weak stream. DRE shows a smooth, symmetrically enlarged prostate. PSA is 2.1 ng/mL. What is the most likely diagnosis?

Prostatitis
Benign prostatic hyperplasia (Correct answer)
Prostate cancer
Urinary tract infection

Correct answer: Benign prostatic hyperplasia

Smooth symmetric prostate enlargement with obstructive and irritative voiding symptoms and normal PSA in an elderly man is classic for BPH.

Question 110: A 55-year-old farmer presents with a verrucous, slowly enlarging plaque on the dorsum of the hand that developed at a minor trauma site. Biopsy reveals pseudoepitheliomatous hyperplasia and suppurative granulomas with dark-walled fungal cells. What is the diagnosis?

Blastomycosis
Chromoblastomycosis (Correct answer)
Cutaneous leishmaniasis
Sporotrichosis

Correct answer: Chromoblastomycosis

Chromoblastomycosis presents as verrucous plaques with Medlar (sclerotic) bodies (dark-walled cells) on biopsy, typically in agricultural workers after traumatic inoculation.

Question 111: A 25-year-old female presents with a tender, soft lump over the dorsum of her wrist that transilluminates. It has been present for months and fluctuates in size. What is the most appropriate management?

Urgent biopsy
MRI with contrast
Immediate surgical excision
Aspiration or observation (Correct answer)

Correct answer: Aspiration or observation

Ganglion cysts are benign synovial fluid-filled cysts; observation or aspiration is appropriate as many resolve spontaneously.

Question 112: A 44-year-old patient with hypertension has an electrocardiogram (ECG) ordered by the doctor. Left ventricular hypertrophy is visible on the ECG (LVH). Which of these results might the doctor be anticipating from this ECG?

A predominant R wave in V1, a deep S in V6, inverted T waves in V2 and V3, and right axis deviation
A tall R wave in V6, a deep S in V1, inverted T waves in V5 and V6, and left axis deviation (Correct answer)
A tall R in V6, a deep S in V1, inverted T waves in V5 and V6, and right axis deviation
A predominant R wave in V1, a deep S in V6, inverted T waves in V2 and V3, and left axis deviation

Correct answer: A tall R wave in V6, a deep S in V1, inverted T waves in V5 and V6, and left axis deviation

Left Ventricular Hypertrophy (LVH) on an ECG is typically characterized by increased voltage criteria, such as a tall R wave in left-sided leads (V5, V6) and a deep S wave in right-sided leads (V1, V2). Additionally, repolarization abnormalities like inverted T waves in V5 and V6 (often called a 'strain pattern') and left axis deviation are common findings associated with LVH due to the increased muscle mass.

Question 113: Which intervention has the strongest evidence for improving liver histology in non-alcoholic fatty liver disease (NAFLD)?

Metformin therapy in non-diabetic patients
High-dose vitamin E supplementation in all patients
Ursodeoxycholic acid (UDCA) long-term therapy
Weight loss of 7–10% of body weight through diet and exercise (Correct answer)

Correct answer: Weight loss of 7–10% of body weight through diet and exercise

Lifestyle modification achieving 7–10% weight loss is the most effective intervention for NAFLD, consistently improving steatosis, inflammation, and fibrosis on histology.

Question 114: A 25-year-old woman with no significant past medical history presents with a 2-week history of fatigue, diffuse lymphadenopathy, sore throat, and a positive heterophile antibody test. What is the most important complication to counsel her about?

Splenic rupture (Correct answer)
Autoimmune hemolytic anemia requiring immediate transfusion
Permanent immunodeficiency
Bacterial meningitis

Correct answer: Splenic rupture

Splenic rupture, though rare, is the most dangerous complication of infectious mononucleosis, and patients should avoid contact sports for at least 3–4 weeks.

Question 115: Barrett's esophagus is best defined as which of the following histological changes?

Dysplastic change within existing squamous epithelium
Adenocarcinoma arising in the distal esophagus
Replacement of columnar epithelium with squamous epithelium
Replacement of normal squamous epithelium with intestinal-type columnar epithelium (Correct answer)

Correct answer: Replacement of normal squamous epithelium with intestinal-type columnar epithelium

Barrett's esophagus is a metaplastic change where normal esophageal squamous epithelium is replaced by specialized intestinal columnar epithelium, typically from chronic gastric acid reflux.

Question 116: A 70-year-old woman develops bilateral leg edema after starting amlodipine for hypertension. What is the most appropriate management?

Switch to a different antihypertensive class such as an ACE inhibitor (Correct answer)
Add a loop diuretic to manage the edema
Order echocardiogram to rule out heart failure
Reassure her that this is harmless and continue amlodipine

Correct answer: Switch to a different antihypertensive class such as an ACE inhibitor

Calcium channel blocker-induced leg edema is due to precapillary vasodilation and does not respond to diuretics; switching to an alternative antihypertensive is the appropriate response.

Question 117: Which of the following best describes the management of anaphylaxis as the first-line treatment?

Inhaled albuterol
IV diphenhydramine
IM epinephrine to the lateral thigh (Correct answer)
IV corticosteroids

Correct answer: IM epinephrine to the lateral thigh

IM epinephrine to the lateral thigh is the first and most critical intervention in anaphylaxis due to its rapid onset and dual alpha/beta effects.

Question 118: A 22-year-old woman presents with thick, white, cottage-cheese-like vaginal discharge with vulvar pruritus and no odor. KOH prep shows pseudohyphae. What is the treatment?

Azithromycin 1g PO single dose
Metronidazole 500 mg PO twice daily for 7 days
Clindamycin vaginal cream for 7 days
Fluconazole 150 mg PO single dose (Correct answer)

Correct answer: Fluconazole 150 mg PO single dose

Vulvovaginal candidiasis is treated with oral fluconazole 150 mg single dose or topical antifungals; pseudohyphae on KOH confirms Candida.

Question 119: What role does collaboration play in musculoskeletal for Family Practice Exam professionals?

It reduces individual accountability
It enhances outcomes through diverse perspectives and shared expertise (Correct answer)
It is only needed in emergencies
It slows down work unnecessarily

Correct answer: It enhances outcomes through diverse perspectives and shared expertise

Collaboration leverages diverse perspectives and combined expertise to achieve better outcomes than any individual could alone.

Question 120: A 62-year-old with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the recommended management?

Oral anticoagulation (Correct answer)
No antithrombotic therapy
Aspirin only
Cardioversion only

Correct answer: Oral anticoagulation

A CHA2DS2-VASc score ≥2 in males warrants long-term oral anticoagulation to reduce ischemic stroke risk.

Question 121: A 72-year-old man presents with low back and hip pain, worsened with walking and relieved when leaning forward (e.g., shopping cart sign). What is the most likely diagnosis?

Hip osteoarthritis
Peripheral artery disease
Lumbar spinal stenosis (Correct answer)
Piriformis syndrome

Correct answer: Lumbar spinal stenosis

Neurogenic claudication from lumbar spinal stenosis is relieved by flexion (leaning forward) which opens the spinal canal, unlike vascular claudication.

Question 122: A 55-year-old presents with a solitary, firm, brown-red papule on the leg that dimples inward when pinched laterally (positive dimple sign). What is the diagnosis?

Melanoma
Blue nevus
Kaposi sarcoma
Dermatofibroma (Correct answer)

Correct answer: Dermatofibroma

Dermatofibroma is characterized by the positive dimple sign (lateral compression causes central dimpling) and is a benign fibrous histiocytoma.

Question 123: False or True. Depression is frequently treated with citalopram.

False
True (Correct answer)

Correct answer: True

True. Citalopram (Celexa) is a selective serotonin reuptake inhibitor (SSRI) and is a commonly prescribed medication for the treatment of depression. SSRIs are often considered first-line agents due to their efficacy in improving mood and their generally favorable side effect profile compared to older classes of antidepressants.

Question 124: Which medication is CONTRAINDICATED in a patient presenting with acute decompensated heart failure and cardiogenic shock?

IV furosemide
Dobutamine
Nitroglycerin
Metoprolol (Correct answer)

Correct answer: Metoprolol

Beta-blockers like metoprolol are contraindicated in cardiogenic shock because they reduce cardiac output further.

Question 125: At what blood pressure level does the JNC/ACC-AHA define Stage 2 hypertension?

≥160 / ≥100 mmHg
130–139 / 80–89 mmHg
≥140 / ≥90 mmHg (Correct answer)
120–129 / <80 mmHg

Correct answer: ≥140 / ≥90 mmHg

The 2017 ACC/AHA guidelines define Stage 2 hypertension as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg.

Question 126: Which antibody test is the preferred initial screening test for celiac disease in patients with adequate IgA levels?

Anti-endomysial IgM
Anti-tissue transglutaminase IgA (anti-tTG IgA) (Correct answer)
Anti-gliadin IgG
Anti-deamidated gliadin peptide IgM

Correct answer: Anti-tissue transglutaminase IgA (anti-tTG IgA)

Anti-tTG IgA is the single best screening test for celiac disease due to its high sensitivity (>95%) and specificity (~95%) and is recommended by all major guidelines.

Question 127: A 77-year-old man with COPD and heart failure is found to have a serum sodium of 128 mEq/L. He is asymptomatic and euvolemic. What is the most appropriate next step?

Administer 3% hypertonic saline immediately
Restrict free water intake and review medications (Correct answer)
Initiate hemodialysis
Give a bolus of normal saline

Correct answer: Restrict free water intake and review medications

Asymptomatic euvolemic hyponatremia in an elderly patient is often medication-related (e.g., thiazides, SSRIs) or SIADH; fluid restriction and medication review are the initial steps.

Question 128: A 40-year-old woman presents with pain and swelling over the radial aspect of the wrist, worsened by thumb movement. Finkelstein's test is positive. What is the diagnosis?

Carpal tunnel syndrome
De Quervain tenosynovitis (Correct answer)
Dupuytren contracture
Trigger finger

Correct answer: De Quervain tenosynovitis

De Quervain tenosynovitis involves the abductor pollicis longus and extensor pollicis brevis tendons, diagnosed by a positive Finkelstein test.

Question 129: A COPD patient with frequent exacerbations (≥2/year) and severe airflow limitation is best treated with which maintenance regimen?

ICS monotherapy
LABA monotherapy
SABA alone as needed
LABA + LAMA + ICS triple therapy (Correct answer)

Correct answer: LABA + LAMA + ICS triple therapy

Patients with frequent exacerbations and severe COPD benefit most from triple therapy combining LABA, LAMA, and inhaled corticosteroids to reduce exacerbation risk.

Question 130: Which medication on the list below is a beta blocker?

Carvedilol
All of the above (Correct answer)
Atenolol
Metoprolol

Correct answer: All of the above

Beta blockers are a class of medications that block beta-adrenergic receptors, primarily used to treat cardiovascular conditions like hypertension, angina, and arrhythmias. Metoprolol, Atenolol, and Carvedilol are all well-known and commonly prescribed beta-blockers, each with specific receptor selectivity and pharmacokinetic properties. Therefore, all listed medications fall under the beta-blocker category.

Question 131: A 58-year-old man with type 2 diabetes has a blood pressure of 148/92 mmHg on two separate visits. Which antihypertensive class is preferred as first-line therapy?

Alpha-blocker
ACE inhibitor (Correct answer)
Beta-blocker
Calcium channel blocker

Correct answer: ACE inhibitor

ACE inhibitors (or ARBs) are preferred first-line antihypertensives in diabetic patients due to their nephroprotective effects.

Question 132: A 17-year-old is brought in after being found with a suicide note but denies current intent. What is the most appropriate next step?

Initiate outpatient CBT only
Reassure the parents and discharge
Refer for inpatient psychiatric evaluation (Correct answer)
Prescribe an antidepressant and follow up in 2 weeks

Correct answer: Refer for inpatient psychiatric evaluation

A suicide note represents a serious attempt indicator requiring inpatient psychiatric evaluation regardless of current denial of intent.

Question 133: A patient with multiple chronic conditions asks about the recommended frequency of comprehensive medication reviews to prevent polypharmacy harm. What is the standard recommendation?

Every 5 years if medications are stable
When the patient reports side effects only
Only when a new specialist is involved
At least annually or with any significant change in health status (Correct answer)

Correct answer: At least annually or with any significant change in health status

Annual medication reconciliation and comprehensive review, or review with each major health change, is recommended to identify drug interactions, duplications, and deprescribing opportunities in polypharmacy.

Question 134: Which of the following best describes the Lachman test?

Anterior tibial translation with knee at 90° flexion
Lateral tibial rotation with knee extension
Medial tibial translation with valgus stress
Anterior tibial translation with knee at 20-30° flexion (Correct answer)

Correct answer: Anterior tibial translation with knee at 20-30° flexion

The Lachman test assesses ACL integrity by applying anterior force to the tibia with the knee at 20-30° of flexion, and is more sensitive than the anterior drawer test.

Question 135: A 55-year-old woman presents with a 2-week history of epigastric pain, early satiety, and unintentional 10-lb weight loss. She denies dysphagia. What is the most appropriate next step?

Upper endoscopy (Correct answer)
Barium swallow
PPI trial for 4 weeks
H. pylori breath test

Correct answer: Upper endoscopy

Alarm symptoms (age >45, unintentional weight loss, early satiety) mandate prompt upper endoscopy to rule out malignancy.

Question 136: Which of the following is the leading cause of death in children ages 1-18 in the United States?

Homicide
Unintentional injuries (Correct answer)
Congenital anomalies
Cancer

Correct answer: Unintentional injuries

Unintentional injuries (primarily motor vehicle accidents, drowning, and falls) are the single leading cause of death in children ages 1-18 in the US.

Question 137: A 45-year-old woman with no family history has a routine Pap smear with HPV co-test. Her result is HPV-negative with normal cytology. What is the recommended rescreening interval?

3 years
10 years
1 year
5 years (Correct answer)

Correct answer: 5 years

Women aged 30–65 who undergo co-testing (Pap + HPV) with both results negative may be screened every 5 years per ACS/USPSTF guidelines.

Question 138: What is the most important factor in effective communication with patients regarding mental health?

Using medical jargon to appear professional
Using clear, understandable language and confirming understanding (Correct answer)
Providing written instructions only
Speaking quickly to save time

Correct answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

Question 139: What is the first-line regimen for Helicobacter pylori eradication in the United States?

Bismuth quadruple therapy only
Metronidazole monotherapy
Dual therapy with amoxicillin and PPI
Clarithromycin triple therapy (PPI + clarithromycin + amoxicillin) (Correct answer)

Correct answer: Clarithromycin triple therapy (PPI + clarithromycin + amoxicillin)

Clarithromycin-based triple therapy (PPI + clarithromycin + amoxicillin for 14 days) remains the standard first-line H. pylori regimen in regions with low clarithromycin resistance.

Question 140: What is the recommended screening interval for cervical cancer in a 25-year-old woman with no prior abnormal results?

No screening until age 30
Annual Pap smear alone
Pap smear every 3 years (Correct answer)
Co-testing every 5 years

Correct answer: Pap smear every 3 years

Women aged 21–29 should have a Pap smear every 3 years; HPV co-testing is not recommended in this age group.

Question 141: Which ECG finding is the earliest sign of hyperkalemia?

ST depression
Peaked T waves (Correct answer)
Prolonged PR interval
U waves

Correct answer: Peaked T waves

Peaked (tall, narrow, symmetric) T waves are the earliest ECG manifestation of hyperkalemia before QRS widening occurs.

Question 142: A 48-year-old man presents with morning heel pain that is worst with the first steps after rest. It improves after walking a few minutes. Where is the tenderness localized?

Medial calcaneal tuberosity (plantar fascia origin) (Correct answer)
Lateral ankle ligament
Achilles tendon insertion
Peroneal tendon

Correct answer: Medial calcaneal tuberosity (plantar fascia origin)

Plantar fasciitis classically causes heel pain maximal at the medial calcaneal tuberosity, worst with first steps in the morning.

Question 143: A patient with liver cirrhosis presents with fever, abdominal pain, and ascites with PMN count >250 cells/mm³ on paracentesis. What is the first-line treatment?

IV cefotaxime (Correct answer)
IV vancomycin
Oral metronidazole
Observation only

Correct answer: IV cefotaxime

Spontaneous bacterial peritonitis is treated with IV cefotaxime (third-generation cephalosporin) as first-line therapy.

Question 144: Which intervention has the strongest evidence for reducing cardiovascular mortality in a patient with newly diagnosed hypertension and no other comorbidities?

Potassium supplementation
Stress reduction counseling
Sodium restriction alone
Antihypertensive pharmacotherapy plus lifestyle modification (Correct answer)

Correct answer: Antihypertensive pharmacotherapy plus lifestyle modification

Combined antihypertensive drug therapy and lifestyle modification (diet, exercise, weight loss) provides the greatest reduction in cardiovascular events.

Question 145: A 62-year-old man with a 40 pack-year history presents for a preventive visit. He currently smokes. Per USPSTF guidelines, which screening is indicated?

Annual low-dose CT of the chest for lung cancer screening (Correct answer)
Sputum cytology every 6 months
No lung cancer screening is indicated
Annual chest X-ray for lung cancer screening

Correct answer: Annual low-dose CT of the chest for lung cancer screening

USPSTF recommends annual low-dose CT for adults 50–80 years old with a 20+ pack-year history who currently smoke or quit within the past 15 years.

Question 146: A 40-year-old presents with fever, productive cough, and right lower lobe infiltrate on CXR. She is tachycardic and hypotensive. According to CURB-65, what score warrants ICU admission consideration?

Score of 2
Score of 5 only
Score of 3 or higher (Correct answer)
Score of 1

Correct answer: Score of 3 or higher

A CURB-65 score of 3 or higher indicates severe community-acquired pneumonia and warrants consideration of ICU-level care.

Question 147: In Family Practice Exam practice, when should a patient's condition be reassessed?

Only when the patient requests it
Once per week
At regular intervals and when status changes (Correct answer)
Only at admission and discharge

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 148: A 48-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH is 8.2 mIU/L and free T4 is low. What is the most appropriate treatment?

Liothyronine (T3) alone
Repeat TSH in 6 months before initiating treatment
Combined T3/T4 desiccated thyroid extract
Levothyroxine with dose titrated to normalize TSH (Correct answer)

Correct answer: Levothyroxine with dose titrated to normalize TSH

Levothyroxine (T4) is the standard first-line treatment for hypothyroidism, dosed to normalize TSH within the reference range.

Question 149: Which agent is used to immediately reverse opioid-induced respiratory depression in the emergency setting?

Atropine
Flumazenil
Physostigmine
Naloxone (Correct answer)

Correct answer: Naloxone

Naloxone is a competitive opioid receptor antagonist that rapidly reverses respiratory depression, sedation, and miosis from opioid overdose.

Question 150: Which screening test is recommended for abdominal aortic aneurysm (AAA) in primary care according to USPSTF guidelines?

Annual CT angiography in all men over 60
Abdominal ultrasound in all adults over 65
One-time abdominal ultrasound in men aged 65-75 who have ever smoked (Correct answer)
One-time ultrasound in women aged 65-75 with smoking history

Correct answer: One-time abdominal ultrasound in men aged 65-75 who have ever smoked

USPSTF recommends a one-time abdominal ultrasound screening for AAA in men aged 65–75 who have ever smoked (at least 100 cigarettes lifetime).

Question 151: What is the most common cause of secondary hypertension in adults under 40 years old?

Cushing syndrome
Pheochromocytoma
Primary aldosteronism
Renovascular hypertension (Correct answer)

Correct answer: Renovascular hypertension

Renovascular hypertension from renal artery stenosis (often fibromuscular dysplasia in young adults) is the most common cause of secondary hypertension in patients under 40.

Question 152: A 50-year-old with a history of alcohol use presents with tremors, diaphoresis, and visual hallucinations 36 hours after his last drink. What is the treatment of choice?

Propranolol
Benzodiazepines (Correct answer)
Haloperidol
Phenobarbital alone

Correct answer: Benzodiazepines

Benzodiazepines are first-line for alcohol withdrawal delirium and seizure prevention by cross-reacting at GABA receptors.

Question 153: A patient with known CAD develops new-onset dyspnea and orthopnea. Which test best evaluates cardiac function?

Exercise stress test
Chest X-ray
Echocardiogram (Correct answer)
BNP level

Correct answer: Echocardiogram

Echocardiography directly evaluates ejection fraction, wall motion abnormalities, and valve function to determine the cardiac etiology of dyspnea.

Question 154: A 55-year-old diabetic woman presents with shoulder pain and severely limited range of motion in all planes for 4 months. X-ray is normal. What is the most likely diagnosis?

Subacromial bursitis
Glenohumeral osteoarthritis
Adhesive capsulitis (Correct answer)
Rotator cuff tear

Correct answer: Adhesive capsulitis

Adhesive capsulitis (frozen shoulder) causes global shoulder motion restriction and is more common in diabetics.

Question 155: In Family Practice Exam practice, what is the primary purpose of strategic planning?

To satisfy external auditors
To reduce workforce
To create paperwork
To align resources with goals and anticipate challenges (Correct answer)

Correct answer: To align resources with goals and anticipate challenges

Strategic planning aligns organizational resources with goals and helps anticipate challenges before they become critical issues.

Question 156: Which lipid-lowering drug class is first-line for primary prevention of cardiovascular disease in high-risk patients?

Statins (Correct answer)
Niacin
Bile acid sequestrants
Fibrates

Correct answer: Statins

Statins are first-line for cardiovascular risk reduction due to robust evidence showing reduced mortality and major adverse cardiac events.

Question 157: A 6-year-old boy is noted to have a harsh systolic ejection murmur at the upper left sternal border that radiates to the back. Femoral pulses are diminished. What is the most likely diagnosis?

Pulmonary stenosis
Ventricular septal defect
Atrial septal defect
Coarctation of the aorta (Correct answer)

Correct answer: Coarctation of the aorta

Coarctation of the aorta presents with upper extremity hypertension, diminished femoral pulses, and a systolic murmur radiating to the back.

Question 158: A 45-year-old man with a BMI of 38 and newly diagnosed type 2 diabetes asks about medications. Which agent is associated with significant weight loss in addition to glucose lowering?

Glipizide
Semaglutide (Correct answer)
Pioglitazone
Sitagliptin

Correct answer: Semaglutide

GLP-1 receptor agonists like semaglutide produce significant weight loss (often >10-15%) alongside substantial glucose lowering.

Question 159: The fasting lipid profile of a 46-year-old male reveals a total cholesterol level of 238 mg/dL and an HDL-C level of 185. He has smoked for 100 pack-years. He falls into the moderately high risk category (10-year risk = 10-20%), according to the Framingham Coronary Risk Calculator. Less LDL cholesterol is the desired value for this patient.

130 mg/dL (Correct answer)
160 mg/dL
70 mg/dL
100 mg/dL

Correct answer: 130 mg/dL

For a patient with a moderately high risk (10-year risk = 10-20%) of coronary heart disease, as determined by the Framingham Coronary Risk Calculator, the desired LDL cholesterol target is typically less than 130 mg/dL. This target aims to reduce their cardiovascular risk, especially given their significant smoking history and elevated total cholesterol. More aggressive targets are usually reserved for higher-risk individuals.

Question 160: Aspirin use for primary prevention of cardiovascular disease in adults aged 40–59 with ≥10% 10-year CVD risk is classified as which USPSTF grade?

Grade D — recommended against
Grade C — individualized decision (Correct answer)
Grade A — strongly recommended
Grade B — recommended

Correct answer: Grade C — individualized decision

USPSTF gives a Grade C recommendation for aspirin in adults 40–59 with ≥10% CVD risk, meaning clinicians should offer it selectively based on individual patient circumstances.

Question 161: A 60-year-old presents with yellow, thickened, crumbling toenails with subungual debris. KOH of nail scrapings shows hyphae. What is the most appropriate treatment?

Topical clotrimazole cream
Surgical nail avulsion alone
Oral fluconazole single dose
Oral terbinafine for 12 weeks (Correct answer)

Correct answer: Oral terbinafine for 12 weeks

Onychomycosis requires systemic antifungals; oral terbinafine for 12 weeks (toenails) achieves the highest cure rates due to poor nail penetration of topical agents.

Question 162: A 32-year-old woman at 10 weeks gestation asks about prenatal vitamins. Which supplement is most important to prevent neural tube defects when started before conception?

Calcium 1000 mg daily
Folic acid 400-800 mcg daily (Correct answer)
Vitamin D 600 IU daily
Iron 30 mg daily

Correct answer: Folic acid 400-800 mcg daily

Folic acid supplementation before conception and through the first trimester reduces the risk of neural tube defects such as spina bifida.

Question 163: A patient presents with fever, nuchal rigidity, and photophobia. Lumbar puncture shows CSF with elevated protein, low glucose, and predominantly neutrophils. What is the most appropriate initial antibiotic?

Vancomycin alone
Metronidazole plus gentamicin
Ceftriaxone plus vancomycin (Correct answer)
Ampicillin alone

Correct answer: Ceftriaxone plus vancomycin

Bacterial meningitis requires broad coverage with ceftriaxone plus vancomycin to cover resistant organisms including S. pneumoniae.

Question 164: A 35-year-old runner presents with lateral hip pain radiating down the thigh, worsened by stairs and lying on that side. Palpation over the greater trochanter is tender. What is the most likely diagnosis?

Hip osteoarthritis
Piriformis syndrome
Meralgia paresthetica
Greater trochanteric pain syndrome (Correct answer)

Correct answer: Greater trochanteric pain syndrome

Greater trochanteric pain syndrome (formerly trochanteric bursitis) causes lateral hip pain with tenderness directly over the greater trochanter.

Question 165: Which of the following best describes the role of the SGLT-2 inhibitor empagliflozin in chronic disease management beyond glycemic control?

Indicated only when GLP-1 agonists fail
Primarily used for weight loss without cardiovascular benefit
Reduces cardiovascular mortality and hospitalizations for heart failure in type 2 diabetes (Correct answer)
Provides renal protection but no cardiac benefit

Correct answer: Reduces cardiovascular mortality and hospitalizations for heart failure in type 2 diabetes

The EMPA-REG OUTCOME trial demonstrated that empagliflozin significantly reduces cardiovascular death and heart failure hospitalizations in type 2 diabetes patients with established CVD.

Question 166: Which of the following best describes the ego defense mechanism 'projection'?

Channeling impulses into socially acceptable activities
Reverting to childhood behaviors under stress
Refusing to acknowledge a painful reality
Attributing one's own unacceptable feelings to another person (Correct answer)

Correct answer: Attributing one's own unacceptable feelings to another person

Projection involves attributing one's own unwanted thoughts or feelings to someone else.

Question 167: Which of the following is the most important modifiable risk factor for slowing progression of diabetic retinopathy?

Lipid-lowering therapy with statins
Blood pressure control alone
Annual dilated fundus exam frequency
Tight glycemic control (HbA1c <7%) (Correct answer)

Correct answer: Tight glycemic control (HbA1c <7%)

The DCCT and UKPDS trials demonstrated that tight glycemic control is the most powerful intervention for preventing and slowing progression of diabetic retinopathy.

Question 168: Which approach best demonstrates mastery of dermatology in Family Practice Exam practice?

Applying principles to novel situations with sound judgment (Correct answer)
Avoiding complex scenarios
Following procedures without understanding
Relying entirely on technology

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 169: A 52-year-old man is found to have a total cholesterol of 240 mg/dL, LDL 165 mg/dL, and HDL 38 mg/dL. He has diabetes and hypertension. His 10-year ASCVD risk is 18%. What is the most appropriate treatment?

Fibrate therapy
High-intensity statin (Correct answer)
Lifestyle modification only
Low-intensity statin

Correct answer: High-intensity statin

Patients with diabetes and a 10-year ASCVD risk ≥7.5–10% qualify for high-intensity statin therapy per ACC/AHA guidelines.

Question 170: A 70-year-old diabetic presents with confusion, polyuria, and blood glucose of 850 mg/dL. Serum ketones are absent. What is the diagnosis?

Hyperosmolar hyperglycemic state (Correct answer)
Hypoglycemia
Lactic acidosis
Diabetic ketoacidosis

Correct answer: Hyperosmolar hyperglycemic state

Hyperosmolar hyperglycemic state features markedly elevated glucose without significant ketosis, common in type 2 diabetics.

Question 171: Which endoscopic finding is more characteristic of Crohn's disease than ulcerative colitis?

Pseudopolyp formation limited to the sigmoid colon
Skip lesions with areas of normal intervening mucosa (Correct answer)
Isolated rectal disease without proximal extension
Continuous mucosal involvement from the rectum proximally

Correct answer: Skip lesions with areas of normal intervening mucosa

Crohn's disease characteristically produces patchy, discontinuous 'skip lesions,' whereas ulcerative colitis shows continuous mucosal inflammation extending proximally from the rectum.

Question 172: Which approach to geriatric care is considered best practice in current Family Practice Exam standards?

One-size-fits-all protocols
Traditional methods exclusively
Evidence-based, individualized interventions (Correct answer)
The least expensive option

Correct answer: Evidence-based, individualized interventions

Evidence-based, individualized interventions combine the best available research with patient-specific factors for optimal outcomes.

Question 173: The USPSTF recommends that clinicians screen for unhealthy alcohol use in adults 18 and older using which validated tool?

PHQ-9
CAGE questionnaire
AUDIT-C (Correct answer)
DAST-10

Correct answer: AUDIT-C

The AUDIT-C (Alcohol Use Disorders Identification Test – Consumption) is a validated 3-item screen recommended by USPSTF for unhealthy alcohol use in primary care.

Question 174: A 6-year-old presents with inspiratory stridor, barking cough, and low-grade fever. Which treatment is most appropriate?

Immediate intubation
Heliox only
IV antibiotics
Nebulized racemic epinephrine and dexamethasone (Correct answer)

Correct answer: Nebulized racemic epinephrine and dexamethasone

Croup (viral laryngotracheobronchitis) is treated with dexamethasone and nebulized epinephrine for moderate-to-severe cases.

Question 175: Hepatitis C screening is recommended by USPSTF for all adults in which age range, regardless of risk factors?

18–79 years (Correct answer)
25–65 years
40–75 years
18–49 years

Correct answer: 18–79 years

USPSTF recommends hepatitis C virus screening for all adults aged 18–79 years, reflecting high prevalence in birth cohorts beyond just 1945–1965.

Question 176: Which ECG criterion is most commonly used to diagnose left ventricular hypertrophy?

Peaked T waves in V1-V4
QTc >450 ms
Tall R waves in V1-V2
S in V1 + R in V5 >35 mm (Sokolow-Lyon) (Correct answer)

Correct answer: S in V1 + R in V5 >35 mm (Sokolow-Lyon)

The Sokolow-Lyon criterion (SV1 + RV5 or RV6 >35 mm) is the most widely used voltage-based ECG criterion for diagnosing left ventricular hypertrophy.

Question 177: A 55-year-old male presents with acute onset of severe flank pain radiating to the groin with hematuria. What is the most likely diagnosis?

Ectopic pregnancy
Appendicitis
Nephrolithiasis (Correct answer)
Aortic aneurysm

Correct answer: Nephrolithiasis

Colicky flank pain radiating to the groin with hematuria is classic for ureteral calculi (kidney stones).

Question 178: Which counseling intervention does the USPSTF recommend as part of primary prevention for sexually active adolescents and adults at increased risk for STIs?

Mandatory STI testing every 6 months
Pelvic exam annually
Prophylactic antibiotics before sexual activity
Intensive behavioral counseling (Correct answer)

Correct answer: Intensive behavioral counseling

USPSTF recommends intensive behavioral counseling for all sexually active adolescents and adults at increased risk for STIs to reduce infection rates.

Question 179: A 25-year-old woman presents with mucopurulent cervical discharge, cervical motion tenderness, and uterine tenderness. She is afebrile. What is the most appropriate treatment?

Ceftriaxone 500 mg IM plus doxycycline 100 mg PO BID for 14 days (Correct answer)
Ciprofloxacin 500 mg PO BID for 14 days
Azithromycin 1g PO single dose only
Metronidazole 500 mg PO BID for 7 days alone

Correct answer: Ceftriaxone 500 mg IM plus doxycycline 100 mg PO BID for 14 days

Outpatient PID treatment per CDC guidelines is ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 14 days (with or without metronidazole).

Question 180: A 60-year-old man presents with a pearly, rolled-border nodule with telangiectasias on the nose that has grown slowly over two years. What is the most likely diagnosis?

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

Correct answer: Basal cell carcinoma

Basal cell carcinoma classically appears as a pearly papule or nodule with rolled borders and telangiectasias, most often on sun-exposed areas like the nose.

Question 181: Which of the following is important to know when treating influenza?

All of the above are true
Treatment must be started within 48 hours or it won's benefit the patient at all
Both oseltamivir and zanamivir are effective against both influenza type 1 and 2 (Correct answer)
Influenza A includes H1N1 and H3N2, which can be treated with antivirals (Correct answer)

Correct answer: Both oseltamivir and zanamivir are effective against both influenza type 1 and 2

Influenza A is a common type of flu virus, including strains like H1N1 and H3N2, which are responsible for seasonal epidemics. Antiviral medications such as oseltamivir (Tamiflu) and zanamivir (Relenza) are effective against both influenza A and B viruses. While treatment is most effective when started within 48 hours, it can still offer some benefit beyond this window, especially in high-risk patients.

Question 182: What is the most important factor in effective communication with patients regarding acute care?

Speaking quickly to save time
Providing written instructions only
Using medical jargon to appear professional
Using clear, understandable language and confirming understanding (Correct answer)

Correct answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

Question 183: A patient on digoxin presents with nausea, yellow-green visual disturbances (xanthopsia), and bradycardia. What is the most likely diagnosis?

Digoxin toxicity (Correct answer)
Drug-induced allergy
Viral gastroenteritis
Hyponatremia

Correct answer: Digoxin toxicity

The classic triad of GI symptoms, xanthopsia (yellow-green vision), and bradyarrhythmias is pathognomonic for digoxin toxicity.

Question 184: What is the most important factor in effective communication with patients regarding women health?

Using medical jargon to appear professional
Providing written instructions only
Using clear, understandable language and confirming understanding (Correct answer)
Speaking quickly to save time

Correct answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

Question 185: A 31-year-old woman at 10 weeks gestation is found to have a TSH of 6.8 mIU/L and low free T4. She is asymptomatic. What is the appropriate management?

Start methimazole to suppress TSH
Recheck thyroid function in the second trimester
No treatment needed as TSH rises normally in pregnancy
Start levothyroxine to achieve TSH <2.5 mIU/L (Correct answer)

Correct answer: Start levothyroxine to achieve TSH <2.5 mIU/L

Overt hypothyroidism in pregnancy (elevated TSH + low free T4) requires levothyroxine to maintain TSH <2.5 mIU/L to prevent adverse fetal outcomes.

Question 186: A 6-year-old girl presents with recurrent urinary tract infections. What is the most important evaluation to consider?

CT abdomen with contrast
Renal ultrasound and voiding cystourethrogram (VCUG) (Correct answer)
Cystoscopy under general anesthesia
Urine culture alone

Correct answer: Renal ultrasound and voiding cystourethrogram (VCUG)

Recurrent UTIs in young children warrant evaluation for vesicoureteral reflux (VUR) with renal ultrasound and VCUG to prevent renal scarring.

Question 187: Which breast cancer risk factor is considered the strongest independent predictor of lifetime risk?

Nulliparity
Combined oral contraceptive use
First-degree relative with postmenopausal breast cancer
BRCA1 or BRCA2 mutation (Correct answer)

Correct answer: BRCA1 or BRCA2 mutation

BRCA1/2 mutations confer up to 70–85% lifetime risk of breast cancer, making them the strongest independent genetic risk factor.

Question 188: A 55-year-old man presents with crushing substernal chest pain radiating to the left arm for 30 minutes. ECG shows ST elevations in leads II, III, and aVF. Which coronary artery is most likely occluded?

Left circumflex artery
Right coronary artery (Correct answer)
Left anterior descending artery
Left main coronary artery

Correct answer: Right coronary artery

Inferior wall ST elevations (II, III, aVF) are characteristic of right coronary artery occlusion.

Question 189: Which vaccine is contraindicated in a patient who is immunocompromised due to HIV with a CD4 count of 150 cells/μL?

MMR (Correct answer)
Pneumococcal (PPSV23)
Hepatitis B
Influenza (inactivated)

Correct answer: MMR

MMR is a live attenuated vaccine contraindicated in severely immunocompromised patients (CD4 <200 cells/μL) due to risk of vaccine-strain infection.

Question 190: Which antihypertensive drug class is absolutely contraindicated in the second and third trimesters of pregnancy?

Beta-blockers
ACE inhibitors (Correct answer)
Methyldopa
Calcium channel blockers

Correct answer: ACE inhibitors

ACE inhibitors cause fetal renal dysgenesis, oligohydramnios, and neonatal renal failure when used in the second or third trimester.

Question 191: A 70-year-old patient with COPD has a resting oxygen saturation of 87% on room air. What is the appropriate oxygen therapy recommendation?

Nocturnal oxygen only without daytime supplementation
Long-term supplemental oxygen to maintain SpO₂ ≥90% (Correct answer)
No oxygen unless SpO₂ falls below 80%
Oxygen only during exercise, not at rest

Correct answer: Long-term supplemental oxygen to maintain SpO₂ ≥90%

Long-term oxygen therapy is indicated when resting SpO₂ is ≤88%, as it has been shown to improve survival in severe hypoxemic COPD.

Question 192: Which medication class is most commonly associated with falls in elderly patients due to orthostatic hypotension?

ACE inhibitors
Thiazide diuretics
Beta-blockers
Alpha-1 blockers (Correct answer)

Correct answer: Alpha-1 blockers

Alpha-1 blockers (e.g., terazosin, doxazosin) cause significant orthostatic hypotension, making them a leading pharmacologic fall risk in elderly men often prescribed them for BPH.

Question 193: A patient with heart failure presents with worsening dyspnea and bilateral lower extremity edema. Current medications include carvedilol and lisinopril. What should be added?

Increase carvedilol dose as first step
Nonsteroidal anti-inflammatory drug for comfort
Loop diuretic (furosemide) to relieve congestion (Correct answer)
Calcium channel blocker for afterload reduction

Correct answer: Loop diuretic (furosemide) to relieve congestion

Loop diuretics are the cornerstone of symptom management for acute decompensation in heart failure, rapidly relieving pulmonary and peripheral congestion.

Question 194: A 55-year-old woman presents with thumb carpometacarpal (CMC) joint pain aggravated by pinching and jar-opening. Grind test is positive. What is the most likely diagnosis?

Basal joint arthritis (Correct answer)
Carpal tunnel syndrome
Trigger thumb
De Quervain tenosynovitis

Correct answer: Basal joint arthritis

Basal joint (CMC) arthritis is the most common form of hand arthritis in women over 50, presenting with pain at the thumb base and a positive grind test.

Question 195: A 50-year-old man presents with progressively worsening memory, personality changes, and myoclonus over 6 months. MRI shows cortical ribboning. The most likely diagnosis is:

Creutzfeldt-Jakob disease (Correct answer)
Frontotemporal dementia
Lewy body dementia
Alzheimer's disease

Correct answer: Creutzfeldt-Jakob disease

Rapidly progressive dementia with myoclonus and cortical ribboning on DWI MRI is classic for Creutzfeldt-Jakob disease (CJD).

Question 196: Which medication class is the first-line pharmacologic treatment for stable angina?

Aspirin
Beta-blockers (Correct answer)
Nitroglycerin
Amlodipine

Correct answer: Beta-blockers

Beta-blockers are first-line for stable angina because they reduce myocardial oxygen demand by lowering heart rate and contractility.

Question 197: A patient with stable chronic heart failure develops a serum potassium of 5.6 mEq/L while on lisinopril and spironolactone. What is the most appropriate action?

Continue all medications and recheck in 3 months
Discontinue all heart failure medications immediately
Reduce or discontinue the mineralocorticoid antagonist and reassess potassium (Correct answer)
Add a potassium-wasting diuretic to counteract hyperkalemia

Correct answer: Reduce or discontinue the mineralocorticoid antagonist and reassess potassium

Hyperkalemia above 5.5 mEq/L in HFrEF patients on dual RAAS blockade requires dose reduction or discontinuation of the aldosterone antagonist to prevent life-threatening arrhythmia.

Question 198: A 3-year-old child has strawberry-red, sharply demarcated perianal erythema with satellite pustules. Culture grows Streptococcus pyogenes. What is the treatment?

Topical hydrocortisone
Topical nystatin
Systemic fluconazole
Oral penicillin for 10 days (Correct answer)

Correct answer: Oral penicillin for 10 days

Perianal streptococcal dermatitis caused by Group A Strep is treated with oral penicillin or amoxicillin for 10 days.

Question 199: Which of the following is the MOST appropriate management for a 30-year-old woman who presents with a 3 cm simple ovarian cyst found incidentally on ultrasound?

CA-125 measurement and repeat ultrasound in 8–12 weeks
Start combined OCPs to suppress the cyst
Immediate laparoscopic cystectomy
Reassurance and repeat ultrasound in 8–12 weeks (Correct answer)

Correct answer: Reassurance and repeat ultrasound in 8–12 weeks

A simple cyst ≤5 cm in a premenopausal woman is almost always benign; reassurance with follow-up ultrasound in 8–12 weeks is appropriate.

Question 200: A 62-year-old otherwise healthy patient is diagnosed with uncomplicated acute diverticulitis (no abscess, no perforation, mild symptoms). What is the most appropriate management?

Emergent surgical consultation for resection
Intravenous antibiotics with hospital admission
Outpatient treatment with oral antibiotics and liquid diet (Correct answer)
Urgent colonoscopy within 24 hours

Correct answer: Outpatient treatment with oral antibiotics and liquid diet

Uncomplicated diverticulitis in immunocompetent patients with mild symptoms can be safely managed outpatient with oral antibiotics and dietary modification.

Question 201: A 65-year-old man has a hyperkeratotic, scaly, erythematous plaque on the dorsum of the hand that has been present for 2 years. Biopsy shows full-thickness epidermal dysplasia. What is the diagnosis?

Merkel cell carcinoma
Squamous cell carcinoma in situ (Bowen disease) (Correct answer)
Basal cell carcinoma
Actinic keratosis

Correct answer: Squamous cell carcinoma in situ (Bowen disease)

Bowen disease (SCC in situ) shows full-thickness epidermal dysplasia on biopsy and presents as a persistent, slowly enlarging scaly plaque.

Question 202: A patient on an SSRI for depression reports easy bruising. What is the most likely pharmacologic mechanism?

Vitamin K deficiency
Thrombocytopenia
Coagulation factor deficiency
Platelet dysfunction (Correct answer)

Correct answer: Platelet dysfunction

SSRIs inhibit serotonin reuptake in platelets, impairing serotonin-mediated platelet aggregation and increasing bruising risk.

Question 203: A patient receiving heparin develops a platelet count drop from 280,000 to 85,000 on day 8 of therapy. What is the most appropriate next step?

Switch to low-molecular-weight heparin
Stop heparin and start argatroban (Correct answer)
Increase heparin dose
Transfuse platelets

Correct answer: Stop heparin and start argatroban

Heparin-induced thrombocytopenia (HIT) requires immediate cessation of all heparin products and initiation of a direct thrombin inhibitor like argatroban.

Question 204: Which finding is most consistent with iron deficiency anemia in a 12-month-old?

High MCV with low B12 level
Elevated MCV with hypersegmented neutrophils
Normal MCV with low reticulocyte count
Low MCV with low ferritin and high TIBC (Correct answer)

Correct answer: Low MCV with low ferritin and high TIBC

Iron deficiency anemia presents with microcytic (low MCV), hypochromic anemia, low ferritin, and elevated TIBC reflecting low iron stores.

Question 205: A 24-year-old male presents with periumbilical pain that migrated to the right lower quadrant over 12 hours, accompanied by nausea, low-grade fever, and leukocytosis. Which physical exam finding is most classic for acute appendicitis?

Psoas sign (RLQ pain with right hip extension)
Rovsing's sign (RLQ pain with LLQ palpation)
Murphy's sign (inspiratory arrest with RUQ palpation)
Rebound tenderness at McBurney's point (Correct answer)

Correct answer: Rebound tenderness at McBurney's point

Rebound tenderness at McBurney's point—located one-third the distance from the right anterior superior iliac spine to the umbilicus—is the classic physical finding of peritoneal irritation in acute appendicitis.

Question 206: A 28-year-old woman presents with a 3-day history of green vaginal discharge, cervical motion tenderness, and adnexal tenderness. Temperature is 38.2°C. What is the recommended outpatient treatment?

Amoxicillin-clavulanate for 14 days
Ciprofloxacin for 7 days
Azithromycin 1g single dose
Ceftriaxone IM + doxycycline + metronidazole (Correct answer)

Correct answer: Ceftriaxone IM + doxycycline + metronidazole

CDC guidelines for outpatient PID recommend ceftriaxone plus doxycycline plus metronidazole for 14 days to cover gonorrhea, chlamydia, and anaerobes.

Question 207: Which valve lesion produces a harsh systolic ejection murmur best heard at the right upper sternal border radiating to the carotids?

Tricuspid regurgitation
Mitral regurgitation
Aortic stenosis (Correct answer)
Pulmonic stenosis

Correct answer: Aortic stenosis

Aortic stenosis classically produces a harsh crescendo-decrescendo systolic murmur at the right second intercostal space that radiates to the carotid arteries.

Question 208: Which drug added to ACE inhibitor and beta-blocker therapy reduces mortality in patients with HFrEF and EF ≤35%?

Digoxin
Amlodipine
Furosemide
Spironolactone (Correct answer)

Correct answer: Spironolactone

Aldosterone antagonists like spironolactone have proven mortality benefit in HFrEF when added to standard guideline-directed therapy.

Question 209: A 9-month-old has a fever of 39.5°C, bulging fontanelle, and irritability. Which organism is the most common cause of bacterial meningitis at this age?

Streptococcus pneumoniae (Correct answer)
Listeria monocytogenes
Group B Streptococcus
Neisseria meningitidis

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae is the leading cause of bacterial meningitis in infants older than 3 months and young children.

Question 210: What is the first priority in women health for Family Practice Exam practitioners?

Completing documentation
Ensuring patient safety and well-being (Correct answer)
Following insurance requirements
Meeting productivity targets

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 211: What is the recommended duration of low-dose aspirin for preeclampsia prevention in high-risk pregnant women, per USPSTF?

Entire pregnancy starting at conception
After 12 weeks of gestation until delivery (Correct answer)
12 weeks until delivery
16 weeks until 36 weeks gestation

Correct answer: After 12 weeks of gestation until delivery

USPSTF recommends initiating low-dose aspirin (81 mg/day) after 12 weeks of gestation in women at high risk for preeclampsia and continuing through delivery.

Question 212: A 60-year-old presents with sudden vision loss in one eye described as a 'curtain coming down.' What is the most likely diagnosis?

Vitreous hemorrhage
Retinal detachment (Correct answer)
Central retinal artery occlusion
Acute angle-closure glaucoma

Correct answer: Retinal detachment

Painless monocular vision loss described as a descending curtain is the classic presentation of retinal detachment.

Question 213: A 50-year-old woman presents with hot flashes, night sweats, and irregular periods for 8 months. FSH is elevated. She has no contraindications. What is the most effective treatment for her vasomotor symptoms?

Hormone therapy (estrogen ± progestogen) (Correct answer)
Venlafaxine
Black cohosh supplement
Gabapentin

Correct answer: Hormone therapy (estrogen ± progestogen)

Hormone therapy remains the most effective treatment for menopausal vasomotor symptoms in women without contraindications.

Question 214: A 32-year-old woman presents with a painless, soft, mobile neck lump that moves upward when she swallows. What is the most likely diagnosis?

Branchial cleft cyst
Lipoma
Thyroglossal duct cyst (Correct answer)
Lymph node

Correct answer: Thyroglossal duct cyst

A midline neck mass that elevates with swallowing or tongue protrusion is characteristic of a thyroglossal duct cyst.

Question 215: Which ethical principle requires Family Practice Exam professionals to act in the patient's best interest?

Autonomy
Fidelity
Beneficence (Correct answer)
Justice

Correct answer: Beneficence

Beneficence is the ethical principle that obligates healthcare professionals to act in ways that promote the well-being and best interests of the patient.

Question 216: Which lifestyle intervention has the strongest evidence for reducing cardiovascular mortality in patients with established coronary artery disease?

Sodium restriction to less than 1,000 mg/day
Stress reduction meditation alone
Cardiac rehabilitation program with structured exercise (Correct answer)
Vitamin E supplementation

Correct answer: Cardiac rehabilitation program with structured exercise

Cardiac rehabilitation programs incorporating structured exercise have been shown in multiple trials to reduce cardiovascular mortality and hospitalizations in CAD patients.

Question 217: A 28-year-old woman has recurrent facial flushing, erythema of the cheeks and nose, and papulopustules without comedones. What is the first-line topical treatment?

Metronidazole gel (Correct answer)
Tretinoin cream
Salicylic acid wash
Benzoyl peroxide

Correct answer: Metronidazole gel

Topical metronidazole is first-line therapy for rosacea, reducing papulopustules and erythema.

Question 218: A family physician screens a 16-year-old using the PHQ-A and scores 15. The most appropriate next action is:

Start fluoxetine and follow up in 2 weeks
Refer to psychiatry only after a failed SSRI trial
Combine fluoxetine with CBT referral and monitor closely for suicidality (Correct answer)
Rescreen in 4 weeks

Correct answer: Combine fluoxetine with CBT referral and monitor closely for suicidality

Moderate-to-severe adolescent depression warrants combined SSRI (fluoxetine is FDA-approved for adolescents) plus CBT with close suicidality monitoring.

Question 219: Which skill is most critical for effective chronic disease management?

Individual work preferences
Communication and stakeholder engagement (Correct answer)
Speed of decision-making
Technical expertise alone

Correct answer: Communication and stakeholder engagement

Communication and stakeholder engagement are essential because management success depends on effectively coordinating with and influencing others.

Question 220: Which of the following is the most common cause of new-onset hypothyroidism in elderly patients in the United States?

Surgical thyroidectomy
Hashimoto's thyroiditis (chronic autoimmune thyroiditis) (Correct answer)
Iodine deficiency
Radioactive iodine therapy for prior hyperthyroidism

Correct answer: Hashimoto's thyroiditis (chronic autoimmune thyroiditis)

Hashimoto's thyroiditis is the most common cause of hypothyroidism in iodine-sufficient countries, including in elderly patients.

Question 221: A patient presents with jaundice, generalized pruritus, dark urine, and clay-colored stools. Lab results show markedly elevated direct bilirubin and alkaline phosphatase. What type of jaundice does this pattern represent?

Gilbert syndrome
Cholestatic (obstructive) jaundice (Correct answer)
Hemolytic jaundice
Hepatocellular jaundice

Correct answer: Cholestatic (obstructive) jaundice

Elevated direct (conjugated) bilirubin, alkaline phosphatase, and the clinical features of pruritus, dark urine, and pale stools indicate obstruction of bile flow (cholestatic jaundice).

Question 222: A 19-year-old college student presents with pharyngitis, cervical lymphadenopathy, fatigue, and splenomegaly. Monospot test is positive. What activity restriction is most critical?

No physical activity for 3 months
No contact sports for at least 3-4 weeks (Correct answer)
Strict bed rest for 1 week
No swimming for 2 weeks

Correct answer: No contact sports for at least 3-4 weeks

Patients with infectious mononucleosis should avoid contact sports for at least 3-4 weeks due to risk of splenic rupture.

Question 223: An 82-year-old woman is brought to your office by her daughter who reports the patient has fallen three times in the past month. Which assessment tool is most appropriate to evaluate her fall risk?

Mini-Mental State Examination (MMSE)
Katz Index of Independence
Geriatric Depression Scale
Timed Up and Go (TUG) test (Correct answer)

Correct answer: Timed Up and Go (TUG) test

The Timed Up and Go (TUG) test measures functional mobility and is the standard tool for assessing fall risk in older adults.

Question 224: A 52-year-old patient with chronic constipation has failed dietary fiber supplementation and increased fluid intake. Which pharmacological agent is the most appropriate next step?

Bisacodyl suppository
Senna (stimulant laxative)
Docusate sodium (stool softener)
Polyethylene glycol (osmotic laxative) (Correct answer)

Correct answer: Polyethylene glycol (osmotic laxative)

Polyethylene glycol is the preferred first-line pharmacological agent for chronic constipation, with strong evidence for efficacy and long-term safety.

Question 225: What is the first priority in geriatric care for Family Practice Exam practitioners?

Meeting productivity targets
Completing documentation
Following insurance requirements
Ensuring patient safety and well-being (Correct answer)

Correct answer: Ensuring patient safety and well-being

Patient safety and well-being must always be the first priority in clinical practice, taking precedence over administrative concerns.

Question 226: A 22-year-old presents with fever, purpuric rash, neck stiffness, and shock. What organism is most likely responsible?

Listeria monocytogenes
Neisseria meningitidis (Correct answer)
Streptococcus pneumoniae
Haemophilus influenzae

Correct answer: Neisseria meningitidis

Neisseria meningitidis causes meningococcemia, characterized by purpuric/petechial rash, meningitis, and septic shock.

Question 227: A 70-year-old woman is started on alendronate for osteoporosis. What is the most important instruction to give her?

Crush the tablet if needed
Take it with a full meal
Take it at bedtime
Remain upright for 30 minutes after taking it (Correct answer)

Correct answer: Remain upright for 30 minutes after taking it

Patients must remain upright for at least 30 minutes after taking bisphosphonates to prevent esophageal irritation and ulceration.

Question 228: A 28-year-old presents with annular plaques with raised indurated borders on the extremities and face, central atrophy, and telangiectasia. ANA is positive. What skin finding is most specific for discoid lupus erythematosus?

Butterfly-shaped malar erythema
Photosensitive widespread urticaria
Livedo reticularis
Follicular plugging within the plaques (Correct answer)

Correct answer: Follicular plugging within the plaques

Follicular plugging (dilated, keratin-filled follicles) within discoid lupus plaques is a histological and clinical hallmark that distinguishes DLE from other lupus subtypes.

Question 229: Which diagnostic procedure is the preferred initial evaluation for a patient presenting with hematemesis and hemodynamic stability?

Tagged red blood cell nuclear scan
Esophagogastroduodenoscopy (EGD) (Correct answer)
CT angiography of the abdomen
Upper GI barium series

Correct answer: Esophagogastroduodenoscopy (EGD)

EGD is the gold-standard first-line test for upper GI bleeding because it simultaneously identifies the bleeding source and allows therapeutic intervention (e.g., banding, injection, cautery).

Question 230: What lab test is typically run on a patient taking diabetes medication?

Fasting lipid panel
BUN and Creatinine
Hemoglobin A1c (CMP) (Correct answer)
ALT, AST and Alk Phos

Correct answer: Hemoglobin A1c (CMP)

The Hemoglobin A1c (HbA1c) test measures a person's average blood glucose level over the past 2-3 months. It is the primary lab test used to monitor long-term glycemic control in patients with diabetes and to assess the effectiveness of their diabetes medication regimen. Regular HbA1c testing helps guide treatment adjustments and prevent diabetes complications.

Question 231: A 28-year-old presents with sudden severe headache described as 'the worst headache of my life.' CT head is negative. What is the next best step?

Discharge with analgesics
MRI brain with contrast
Neurology referral in 1 week
Lumbar puncture (Correct answer)

Correct answer: Lumbar puncture

A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture is required to detect xanthochromia or RBCs.

Question 232: A 55-year-old male with type 2 diabetes presents for routine follow-up. His HbA1c is 8.9%. He is currently on metformin 1000 mg twice daily. What is the most appropriate next step?

Increase metformin to 2500 mg/day
Refer to endocrinology before any medication change
Switch to insulin immediately
Add a GLP-1 receptor agonist or SGLT-2 inhibitor (Correct answer)

Correct answer: Add a GLP-1 receptor agonist or SGLT-2 inhibitor

Adding a GLP-1 agonist or SGLT-2 inhibitor is recommended when HbA1c remains above goal on metformin, as both classes offer cardiovascular and renal benefits.

Question 233: Which of the following is the safest antidepressant in pregnancy?

Phenelzine
Amitriptyline
Paroxetine
Sertraline (Correct answer)

Correct answer: Sertraline

Sertraline has the most safety data in pregnancy and is generally considered first-line when antidepressant treatment is needed.

Question 234: A healthy 42-year-old marathon runner has an asymptomatic resting heart rate of 48 bpm and no medications. What is the most likely cause?

Complete heart block
Athletic conditioning (Correct answer)
Sick sinus syndrome
Hypothyroidism

Correct answer: Athletic conditioning

Asymptomatic bradycardia in a healthy, active individual is most commonly due to high vagal tone from aerobic conditioning.

Question 235: Which osteoporosis screening recommendation is consistent with USPSTF guidelines for postmenopausal women?

Screen all women at age 60 regardless of risk
Screen all women beginning at menopause
Screen only women with a prior fragility fracture
Screen women aged 65 and older, and younger postmenopausal women with increased fracture risk (Correct answer)

Correct answer: Screen women aged 65 and older, and younger postmenopausal women with increased fracture risk

USPSTF recommends bone density screening for all women aged ≥65 and for postmenopausal women under 65 whose 10-year fracture risk is equal to or greater than that of a 65-year-old white woman.

Question 236: Which diagnostic lab conducts an annual kidney problem screening for diabetics?

Liver Function Test (LFT)
Basic Metabolic Panel (BMP)
Microalbumin (Correct answer)
C-Reactive Protein (CRP)

Correct answer: Microalbumin

Microalbuminuria, the presence of small amounts of albumin in the urine, is an early indicator of kidney damage in diabetic patients. An annual microalbumin test (urine albumin-to-creatinine ratio) is crucial for screening diabetics for early signs of diabetic nephropathy. Early detection allows for timely intervention to prevent or slow the progression of kidney disease.

Question 237: A 52-year-old man presents with a 3-month history of episodic chest tightness and shortness of breath at night. Spirometry shows FEV1/FVC of 0.85 and a 15% improvement in FEV1 after bronchodilator. What is the most likely diagnosis?

COPD
Vocal cord dysfunction
Asthma (Correct answer)
Cardiac asthma

Correct answer: Asthma

A ≥12% and ≥200 mL improvement in FEV1 after bronchodilator with normal FEV1/FVC (ruling out obstruction at baseline) is consistent with reversible airway disease, i.e., asthma.

Question 238: Which of the following is a Grade B USPSTF recommendation for women who have never been pregnant and are at average risk?

Biennial mammography starting at age 40
Annual mammography starting at age 40
Cervical cancer screening with Pap smear every 5 years starting at age 21
Biennial mammography starting at age 50 (Correct answer)

Correct answer: Biennial mammography starting at age 50

USPSTF gives a Grade B recommendation for biennial mammography screening for women aged 50–74 at average risk for breast cancer.

Question 239: A 65-year-old woman presents with bilateral hand deformity showing ulnar deviation of the fingers and swan-neck deformities. Labs show positive RF and anti-CCP. What joint erosions are expected on X-ray?

Sacroiliac joints
Distal interphalangeal joints
First carpometacarpal joint
Proximal interphalangeal and metacarpophalangeal joints (Correct answer)

Correct answer: Proximal interphalangeal and metacarpophalangeal joints

Rheumatoid arthritis preferentially involves the PIP and MCP joints with periarticular erosions, sparing the DIP joints (which are affected in OA).

Question 240: A 50-year-old man presents with fatigue, arthralgia, bronze-colored skin, and elevated liver enzymes. Serum ferritin is 1200 ng/mL and transferrin saturation is 68%. What is the most likely diagnosis?

Non-alcoholic fatty liver disease
Wilson's disease
Hereditary hemochromatosis (Correct answer)
Alcoholic liver disease

Correct answer: Hereditary hemochromatosis

The classic triad of bronze skin, liver disease, and arthralgia with markedly elevated ferritin and transferrin saturation points to hereditary hemochromatosis.

Question 241: What is the LDL goal for a patient with established atherosclerotic cardiovascular disease (ASCVD)?

Less than 70 mg/dL (Correct answer)
Less than 100 mg/dL
Less than 130 mg/dL
Less than 55 mg/dL

Correct answer: Less than 70 mg/dL

ACC/AHA guidelines recommend an LDL target of <70 mg/dL for patients with established ASCVD due to their very high cardiovascular risk.

Question 242: A 78-year-old woman with moderate Alzheimer's disease and her family ask about driving. Her MMSE score is 14/30. She lives in a rural area with no public transportation. What is the most appropriate response?

Order a formal driving evaluation before making any recommendation
Allow her to continue driving only in familiar areas nearby
Defer the decision to her neurologist
Advise that she should stop driving and report to the DMV per state law, assist family in arranging alternatives (Correct answer)

Correct answer: Advise that she should stop driving and report to the DMV per state law, assist family in arranging alternatives

Moderate dementia poses significant driving safety risks; physicians have both an ethical and (in many states) legal duty to counsel cessation and may need to report to the DMV.

Question 243: A 58-year-old patient with type 2 diabetes has an HbA1c of 9.2% despite metformin monotherapy. What is the most appropriate next step?

Add a second oral agent or injectable therapy (Correct answer)
Switch to insulin monotherapy immediately
Increase metformin to maximum dose only
Recheck HbA1c in 6 months without changes

Correct answer: Add a second oral agent or injectable therapy

When HbA1c remains above target on metformin monotherapy, guidelines recommend adding a second agent such as a GLP-1 agonist, SGLT-2 inhibitor, or sulfonylurea.

Question 244: Which developmental milestone is expected by age 12 months?

Using a pincer grasp (Correct answer)
Walking independently
Speaking 50 words
Drawing a circle

Correct answer: Using a pincer grasp

The pincer grasp (thumb-to-index finger) typically develops by 9-12 months, preceding walking which usually occurs around 12-15 months.

Question 245: A 3-year-old is brought to the ED with drooling, high fever, muffled voice, and appears anxious sitting in the 'sniffing position.' What is the most important next step?

Administer oral amoxicillin
Throat culture
Immediate otolaryngology and anesthesia consultation for airway management (Correct answer)
Lateral neck X-ray only

Correct answer: Immediate otolaryngology and anesthesia consultation for airway management

Epiglottitis is a life-threatening emergency requiring immediate airway securing in a controlled setting with surgical backup.

Question 246: Which is the most appropriate management for a patient with acute ischemic stroke who presents within 4.5 hours of symptom onset and has no contraindications?

Aspirin 325 mg only
Clopidogrel loading dose
Heparin drip
IV alteplase (tPA) (Correct answer)

Correct answer: IV alteplase (tPA)

IV alteplase within 4.5 hours of ischemic stroke onset improves neurological outcomes when no contraindications are present.

Question 247: A 40-year-old woman with hypothyroidism is well controlled on levothyroxine. She becomes pregnant. How should her levothyroxine dose be adjusted?

Increase dose by 25–30% (Correct answer)
Maintain the same dose
Discontinue until after delivery
Decrease dose by 25%

Correct answer: Increase dose by 25–30%

Thyroid hormone requirements increase by approximately 25–50% during pregnancy due to increased TBG, placental hormone metabolism, and fetal needs.

Question 248: An 8-year-old boy presents with a sore throat, sandpaper-like rash, and a strawberry tongue. Rapid strep test is positive. What is the first-line treatment?

Azithromycin for 5 days
Penicillin V or amoxicillin for 10 days (Correct answer)
Trimethoprim-sulfamethoxazole for 7 days
Clindamycin for 5 days

Correct answer: Penicillin V or amoxicillin for 10 days

Group A streptococcal pharyngitis (scarlet fever) is treated with penicillin or amoxicillin for 10 days to prevent rheumatic fever.

Question 249: A patient stabilized on warfarin is started on fluconazole for a fungal infection. What effect will this have on the INR?

Increase INR (Correct answer)
Decrease INR
No effect on INR
Unpredictably alter INR

Correct answer: Increase INR

Fluconazole inhibits CYP2C9, reducing warfarin metabolism and raising plasma levels, which increases the INR and bleeding risk.

Question 250: A patient with chronic kidney disease stage 3 has a hemoglobin of 9.8 g/dL. Iron stores are adequate. What is the most appropriate next step?

No treatment needed until hemoglobin falls below 8 g/dL
Prescribe oral iron supplementation alone
Transfuse packed red blood cells immediately
Initiate erythropoiesis-stimulating agent (ESA) therapy (Correct answer)

Correct answer: Initiate erythropoiesis-stimulating agent (ESA) therapy

Anemia of CKD with adequate iron stores and hemoglobin below 10 g/dL is appropriately treated with ESA therapy to reduce transfusion dependence.

Question 251: Which of the following is a CONTRAINDICATION to breastfeeding in the United States?

Maternal HIV infection (Correct answer)
Maternal cytomegalovirus (CMV) infection
Maternal hepatitis B infection
Maternal mastitis without abscess

Correct answer: Maternal HIV infection

Maternal HIV infection is a contraindication to breastfeeding in the US because safe infant formula is readily available and HIV can be transmitted through breast milk.

Question 252: A 35-year-old develops pruritic, coin-shaped eczematous plaques on the lower legs in winter. What is the most likely diagnosis?

Tinea corporis
Psoriasis
Nummular eczema (Correct answer)
Contact dermatitis

Correct answer: Nummular eczema

Nummular (discoid) eczema presents as coin-shaped, pruritic, eczematous plaques often worse in dry winter conditions.

Question 253: A 25-year-old male is brought in after a motor vehicle accident with BP 80/50, HR 130, and distended neck veins. Breath sounds are equal bilaterally. What is the most likely diagnosis?

Tension pneumothorax
Cardiac tamponade (Correct answer)
Hemothorax
Aortic laceration

Correct answer: Cardiac tamponade

Beck's triad of hypotension, distended neck veins, and muffled heart sounds suggests cardiac tamponade.

Question 254: A 73-year-old man with Parkinson's disease develops visual hallucinations after starting which of the following medications?

Carbidopa-levodopa
Amantadine
Pramipexole (a dopamine agonist) (Correct answer)
Trihexyphenidyl (an anticholinergic)

Correct answer: Pramipexole (a dopamine agonist)

Dopamine agonists like pramipexole and ropinirole are more likely to cause hallucinations, impulse control disorders, and psychosis than levodopa in Parkinson's disease.

Question 255: Which approach to pediatric care is considered best practice in current Family Practice Exam standards?

Traditional methods exclusively
The least expensive option
One-size-fits-all protocols
Evidence-based, individualized interventions (Correct answer)

Correct answer: Evidence-based, individualized interventions

Evidence-based, individualized interventions combine the best available research with patient-specific factors for optimal outcomes.

Question 256: A 22-year-old presents with intensely pruritic linear burrows between the fingers and on the wrists, worse at night. Close contacts are also affected. What is the treatment of choice?

Oral fluconazole
Hydrocortisone cream
Mupirocin ointment
Permethrin 5% cream applied to entire body (Correct answer)

Correct answer: Permethrin 5% cream applied to entire body

Permethrin 5% cream applied to the whole body from neck down and left overnight is the first-line treatment for scabies.

Question 257: A 34-year-old woman with PCOS presents desiring pregnancy. She has anovulatory cycles and a BMI of 32. What is the first-line ovulation induction agent?

Gonadotropin injections (FSH)
Metformin alone
Letrozole (aromatase inhibitor) (Correct answer)
Clomiphene citrate

Correct answer: Letrozole (aromatase inhibitor)

Letrozole is now preferred over clomiphene for ovulation induction in PCOS as it achieves higher live birth rates with less multiple pregnancy risk.

Question 258: Which metric is most useful for evaluating program effectiveness in Family Practice Exam?

Amount of money spent
Outcome-based performance indicators (Correct answer)
Number of meetings held
Number of staff involved

Correct answer: Outcome-based performance indicators

Outcome-based performance indicators directly measure whether the program is achieving its intended results and goals.

Question 259: Which approach to mental health is considered best practice in current Family Practice Exam standards?

The least expensive option
Traditional methods exclusively
One-size-fits-all protocols
Evidence-based, individualized interventions (Correct answer)

Correct answer: Evidence-based, individualized interventions

Evidence-based, individualized interventions combine the best available research with patient-specific factors for optimal outcomes.

Question 260: A young couple comes in to get their 4-year-well-child old's checkup. You do a fluoride test after learning that their well is their main water supply. The test findings indicate 0.4 ppm (parts per million). Which of the following should the doctor tell the parents?

No fluoride treatment is necessary until the child reaches adolescence
A Fluoride supplement should be provided through 16 years old (Correct answer)
No fluoride treatment is necessary unless the child is less than 1 year old
Fluoride should be provided until the child is 6 years old

Correct answer: A Fluoride supplement should be provided through 16 years old

For children living in areas with suboptimal fluoride levels in their drinking water (below 0.6 ppm), fluoride supplementation is recommended to prevent dental caries. A level of 0.4 ppm indicates a need for supplementation, which should typically continue from infancy through age 16. This ensures adequate fluoride exposure during the critical years of tooth development, strengthening enamel and reducing cavity risk.

Question 261: A 77-year-old man with type 2 diabetes has an HbA1c of 9.4%. He lives alone and has had two episodes of hypoglycemia. What is the most appropriate HbA1c target for this patient?

Less than 8.0% (Correct answer)
Less than 7.0%
Less than 6.5%
Less than 9.0%

Correct answer: Less than 8.0%

For older adults with multiple comorbidities, hypoglycemia history, and limited social support, ADA guidelines recommend a less stringent HbA1c target of <8.0% to minimize hypoglycemia risk.

Question 262: Which of the following patients should receive aspirin for primary prevention of cardiovascular disease according to current USPSTF guidelines?

A 55-year-old with a 10-year ASCVD risk of 12% and no bleeding risk (Correct answer)
A 50-year-old currently taking NSAIDs regularly
A 70-year-old with no prior cardiovascular events
A 40-year-old with a 5% 10-year ASCVD risk

Correct answer: A 55-year-old with a 10-year ASCVD risk of 12% and no bleeding risk

USPSTF recommends low-dose aspirin for primary prevention in adults 40-59 with a 10-year ASCVD risk ≥ 10% who are not at increased bleeding risk.

Question 263: Which antidepressant is preferred for a depressed patient who also wants to quit smoking?

Amitriptyline
Citalopram
Fluoxetine
Bupropion (Correct answer)

Correct answer: Bupropion

Bupropion is FDA-approved for both major depressive disorder and smoking cessation.

Question 264: A 78-year-old man presents with gradually progressive memory loss, getting lost in familiar places, and difficulty managing finances for 2 years. MRI shows diffuse cortical atrophy. What is the most likely diagnosis?

Vascular dementia
Lewy body dementia
Normal pressure hydrocephalus
Alzheimer's disease (Correct answer)

Correct answer: Alzheimer's disease

Gradual onset of memory-predominant cognitive decline in an elderly patient with cortical atrophy is most consistent with Alzheimer's disease.

Question 265: A 58-year-old woman with a 20-year history of type 2 diabetes presents with protein-to-creatinine ratio of 380 mg/g and eGFR of 52 mL/min/1.73m². BP is 138/86. She is on metformin and lisinopril. What additional agent most reduces CKD progression?

Calcium channel blocker
SGLT-2 inhibitor (e.g., empagliflozin or dapagliflozin) (Correct answer)
Beta-blocker
Additional ACE inhibitor dose doubling

Correct answer: SGLT-2 inhibitor (e.g., empagliflozin or dapagliflozin)

SGLT-2 inhibitors have demonstrated significant renoprotective benefits in diabetic CKD, reducing progression to ESRD independent of glycemic control.

Question 266: A 75-year-old on warfarin for AFib presents to the ED with an intracerebral hemorrhage. INR is 4.2. What is the most appropriate reversal strategy?

Protamine sulfate
Vitamin K alone
4-factor prothrombin complex concentrate (PCC) plus vitamin K (Correct answer)
Fresh frozen plasma alone

Correct answer: 4-factor prothrombin complex concentrate (PCC) plus vitamin K

4-factor PCC provides rapid, complete reversal of warfarin with smaller volume than FFP, combined with vitamin K for sustained effect.

Question 267: A 3-year-old has a temperature of 40°C and a petechial rash spreading rapidly from the trunk. She appears toxic. What is the most urgent concern?

Immune thrombocytopenic purpura (ITP)
Meningococcemia (Correct answer)
Rocky Mountain spotted fever
Viral exanthem with thrombocytopenia

Correct answer: Meningococcemia

Rapidly spreading petechiae or purpura with high fever and a toxic appearance in a child is meningococcemia until proven otherwise, requiring immediate empiric antibiotics.

Question 268: Which of the following is the MOST appropriate initial imaging for suspected lumbar disc herniation in a patient with 6 weeks of radiculopathy?

Bone scan
Plain X-ray
CT scan without contrast
MRI of the lumbar spine (Correct answer)

Correct answer: MRI of the lumbar spine

MRI is the gold standard for evaluating lumbar disc herniation and nerve root compression.

Question 269: What is the primary mechanism of action of metformin in type 2 diabetes?

Blocks intestinal glucose absorption
Decreases hepatic glucose production (Correct answer)
Increases renal glucose excretion
Increases pancreatic insulin secretion

Correct answer: Decreases hepatic glucose production

Metformin activates AMPK, primarily reducing hepatic gluconeogenesis and decreasing fasting plasma glucose levels.

Question 270: In a patient with CKD stage 3b (eGFR 35 mL/min/1.73m²) and type 2 diabetes, which glucose-lowering agent requires dose adjustment or avoidance?

Empagliflozin
Insulin
Metformin (contraindicated below eGFR 30, use caution 30-45) (Correct answer)
Linagliptin

Correct answer: Metformin (contraindicated below eGFR 30, use caution 30-45)

Metformin requires caution when eGFR is 30–45 mL/min and is contraindicated below 30 mL/min due to lactic acidosis risk, while many other agents are safer in moderate CKD.

Question 271: Which of the following is the MOST common precipitant of delirium in hospitalized elderly patients?

Mild anemia
New antidepressant initiation
Urinary tract infection (Correct answer)
Hip fracture pain

Correct answer: Urinary tract infection

Infection, particularly urinary tract infection, is the most frequently identified precipitant of delirium in hospitalized older adults.

Question 272: A 2-year-old presents with episodes of breath-holding, turning blue, and then losing consciousness briefly. The episodes always follow minor frustration or pain. What is the most appropriate management?

Antiepileptic medication
Parental reassurance and behavioral guidance (Correct answer)
Cardiac monitoring and echocardiogram
EEG and neurology referral

Correct answer: Parental reassurance and behavioral guidance

Cyanotic breath-holding spells in toddlers are benign, self-limited, and triggered by emotional upset; they require only parental education and reassurance as no intervention prevents them.

Question 273: A woman taking rifampin for active TB reports that her oral contraceptive pills may not be working. What is the pharmacologic explanation?

Rifampin is a potent CYP3A4 inducer that accelerates OCP metabolism (Correct answer)
Rifampin degrades hormones in the gut lumen
Rifampin causes malabsorption of hormones
Rifampin blocks estrogen receptors directly

Correct answer: Rifampin is a potent CYP3A4 inducer that accelerates OCP metabolism

Rifampin is a potent CYP3A4 inducer that markedly increases hepatic metabolism of estrogen and progestin, reducing oral contraceptive plasma levels and efficacy.

Question 274: A 14-year-old overweight boy presents with a limp and dull hip pain referred to the knee. X-ray shows posterior and medial displacement of the femoral epiphysis. What is the diagnosis?

Slipped capital femoral epiphysis (Correct answer)
Developmental dysplasia of the hip
Transient synovitis
Legg-Calvé-Perthes disease

Correct answer: Slipped capital femoral epiphysis

SCFE occurs in overweight adolescents and presents with hip or knee pain; surgical pinning is the treatment.

Question 275: A 37-year-old woman with a BRCA1 mutation asks about risk-reducing surgery. At what age is risk-reducing salpingo-oophorectomy (RRSO) generally recommended for BRCA1 carriers?

Only after a first-degree relative develops ovarian cancer
At age 25, regardless of childbearing plans
Between ages 35–40 years, after childbearing is complete (Correct answer)
After age 50, concurrent with menopause

Correct answer: Between ages 35–40 years, after childbearing is complete

For BRCA1 carriers, RRSO is recommended between ages 35–40 after childbearing is complete due to the earlier onset of ovarian cancer risk.

Question 276: Which ECG finding is most specific for hyperacute ST-elevation MI of the anterior wall?

ST elevation in leads I and aVL only
ST elevation in leads V1-V4 (Correct answer)
ST elevation in leads II, III, aVF
Diffuse ST elevation with PR depression

Correct answer: ST elevation in leads V1-V4

ST elevation in the precordial leads V1-V4 indicates LAD territory (anterior wall) MI.

Question 277: What is the key benefit of evidence-based decision making in Family Practice Exam management?

It reduces reliance on data
It eliminates all risk
It speeds up all processes
It improves accuracy and reduces bias in decisions (Correct answer)

Correct answer: It improves accuracy and reduces bias in decisions

Evidence-based decision making uses data and research to improve the accuracy of decisions and reduce the influence of personal bias.

Question 278: Which of the following should be avoided while treating depression in the elderly due to the possibility of cardiotoxic adverse effects?

Venlafaxine
Fluoxetine
Bupropion
Amitriptyline (Correct answer)

Correct answer: Amitriptyline

Amitriptyline is a tricyclic antidepressant (TCA) known for its significant anticholinergic and cardiotoxic side effects, including orthostatic hypotension, arrhythmias, and sedation. These adverse effects are particularly problematic and potentially dangerous in elderly patients, who are more susceptible to falls and cardiac complications. Therefore, TCAs like amitriptyline are generally avoided as first-line treatment for depression in this population.

Question 279: Which vaccine is recommended at 11-12 years as part of the adolescent immunization schedule?

Hepatitis B booster
Varicella booster
Tdap and MenACWY (Correct answer)
MMR booster

Correct answer: Tdap and MenACWY

The 11-12 year visit includes Tdap (tetanus, diphtheria, acellular pertussis) and meningococcal (MenACWY) vaccines per CDC schedule.

Question 280: A 22-year-old female presents with acute onset of a warm, swollen right knee. She denies trauma. She has a new sexual partner and had a pustular skin rash last week. What is the most likely diagnosis?

Septic arthritis from Staphylococcus
Reactive arthritis
Lyme arthritis
Disseminated gonococcal infection (Correct answer)

Correct answer: Disseminated gonococcal infection

Disseminated gonococcal infection is the most common cause of septic arthritis in sexually active young adults and may present with migratory arthritis and pustular skin lesions.

Question 281: A 42-year-old man with obesity (BMI 34) and type 2 diabetes has an HbA1c of 8.2% on metformin monotherapy. Which add-on agent provides both glycemic control and cardiovascular/renal benefit?

SGLT-2 inhibitor (Correct answer)
Sulfonylurea
Acarbose
DPP-4 inhibitor

Correct answer: SGLT-2 inhibitor

SGLT-2 inhibitors (e.g., empagliflozin) reduce HbA1c and have proven cardiovascular and renal protective benefits in T2DM.

Question 282: An infant has vesicles and pustules on the scalp and trunk at birth. Tzanck smear shows multinucleated giant cells. The mother has a history of genital herpes. What is the immediate management?

Intravenous acyclovir (Correct answer)
Watchful waiting with supportive care
Topical acyclovir cream
Oral valacyclovir

Correct answer: Intravenous acyclovir

Neonatal herpes simplex infection is life-threatening and requires immediate intravenous acyclovir therapy regardless of disease extent.

Question 283: Which approach best demonstrates mastery of musculoskeletal in Family Practice Exam practice?

Avoiding complex scenarios
Relying entirely on technology
Following procedures without understanding
Applying principles to novel situations with sound judgment (Correct answer)

Correct answer: Applying principles to novel situations with sound judgment

True mastery involves understanding underlying principles well enough to apply them to new and unfamiliar situations with professional judgment.

Question 284: Which of the following antidepressants is most associated with causing sexual dysfunction?

Venlafaxine
Mirtazapine
Paroxetine (Correct answer)
Bupropion

Correct answer: Paroxetine

Paroxetine has the highest rates of sexual dysfunction among antidepressants, likely due to potent serotonin reuptake inhibition and anticholinergic effects.

Question 285: A 35-year-old presents with erythematous, well-demarcated plaques with fine scaling confined to the hairline, nasolabial folds, eyebrows, and external ears. Which organism plays a pathogenic role?

Malassezia furfur (Correct answer)
Demodex folliculorum
Candida albicans
Staphylococcus epidermidis

Correct answer: Malassezia furfur

Seborrheic dermatitis is associated with an abnormal immune response to Malassezia yeast species colonizing sebaceous-rich skin areas.

Question 286: A patient presents with confusion, fever, jaundice, renal failure, and thrombocytopenia after starting a new antibiotic. What is the most likely diagnosis?

Sepsis
DIC
Thrombotic thrombocytopenic purpura (Correct answer)
Hemolytic uremic syndrome

Correct answer: Thrombotic thrombocytopenic purpura

The pentad of fever, microangiopathic hemolytic anemia, thrombocytopenia, renal failure, and neurological symptoms defines TTP.

Question 287: What is the role of informed consent in geriatric care?

It protects only the provider
It ensures the patient understands and agrees to the plan (Correct answer)
It is only needed for surgery
It is a mere formality

Correct answer: It ensures the patient understands and agrees to the plan

Informed consent ensures patients understand the proposed interventions, alternatives, risks, and benefits before agreeing to proceed.

Question 288: Which of the following does not pose a risk for cataract development?

Poor diet and insufficient vitamin intake (Correct answer)
Glaucoma
Ultraviolet light exposure
Smoking and alcohol use

Correct answer: Poor diet and insufficient vitamin intake

While factors like ultraviolet light exposure, smoking, alcohol use, diabetes, and certain eye conditions (like glaucoma) are established risk factors for cataract development, poor diet and insufficient vitamin intake are generally not considered primary, direct risk factors. The primary mechanisms involve oxidative stress and damage to lens proteins, which are more directly influenced by age, genetics, and specific environmental exposures.

Question 289: A 52-year-old woman is noted to have a BMI of 34, nulliparity, late menopause at age 55, and type 2 diabetes. Which cancer does this cluster of risk factors most increase?

Cervical cancer
Endometrial cancer (Correct answer)
Ovarian cancer
Breast cancer

Correct answer: Endometrial cancer

Obesity, nulliparity, late menopause, and diabetes are classic risk factors for endometrial cancer due to unopposed estrogen exposure.

Question 290: In Family Practice Exam practice, when should a patient's condition be reassessed?

Only at admission and discharge
Only when the patient requests it
At regular intervals and when status changes (Correct answer)
Once per week

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 291: A type 2 diabetic patient on metformin is found to have a GFR of 28 mL/min. What is the appropriate management?

Continue at current dose
Discontinue metformin (Correct answer)
Switch to maximum-dose metformin
Increase the dose

Correct answer: Discontinue metformin

Metformin is contraindicated when GFR falls below 30 mL/min due to impaired renal clearance and the risk of fatal lactic acidosis.

Question 292: A 38-year-old G3P3 woman presents with heavy menstrual bleeding and pelvic pressure. Ultrasound shows a 6 cm intramural fibroid. She desires no future pregnancies. What is the definitive treatment?

Uterine artery embolization
Hysterectomy (Correct answer)
Levonorgestrel IUD for symptom control
GnRH agonist therapy

Correct answer: Hysterectomy

Hysterectomy is the definitive cure for symptomatic uterine fibroids in a woman who has completed childbearing.

Question 293: Which of the following is the most common etiology of peptic ulcer disease in the United States?

Helicobacter pylori infection (Correct answer)
Stress-related mucosal disease
Zollinger-Ellison syndrome
Chronic NSAID use

Correct answer: Helicobacter pylori infection

H. pylori infection is responsible for approximately 70–90% of duodenal ulcers and 60–70% of gastric ulcers, making it the leading cause of peptic ulcer disease.

Question 294: A patient taking valproate for bipolar disorder becomes pregnant. Which fetal risk must be specifically discussed?

Neural tube defects (Correct answer)
Cardiac septal defects
Cleft palate
Limb reduction defects

Correct answer: Neural tube defects

Valproate is associated with a significantly elevated risk of neural tube defects, including spina bifida, in the fetus.

Question 295: What is the most effective approach to chronic disease management in the Family Practice Exam field?

Maintaining the status quo
Following competitors
Reactive problem-solving
Systematic planning and continuous improvement (Correct answer)

Correct answer: Systematic planning and continuous improvement

Systematic planning combined with continuous improvement ensures sustainable success and allows for proactive management of challenges.

Question 296: In Family Practice Exam practice, when should a patient's condition be reassessed?

Once per week
At regular intervals and when status changes (Correct answer)
Only at admission and discharge
Only when the patient requests it

Correct answer: At regular intervals and when status changes

Regular reassessment and reassessment upon status changes ensure that care plans remain appropriate and responsive to the patient's needs.

Question 297: A patient taking a MAO inhibitor for depression is prescribed tramadol for pain. What is the most serious risk?

Serotonin syndrome (Correct answer)
QT prolongation
Acetaminophen hepatotoxicity
Hypertensive urgency

Correct answer: Serotonin syndrome

Tramadol combined with MAOIs can precipitate serotonin syndrome due to additive serotonergic activity, a potentially fatal drug interaction.

Question 298: An 80-year-old patient's laboratory results show a serum creatinine of 1.1 mg/dL. What is the most accurate statement about his kidney function?

His GFR is likely normal since creatinine is within the normal range
His GFR may be significantly reduced due to decreased muscle mass in older adults (Correct answer)
Creatinine is the most reliable marker of GFR in elderly patients
He likely has stage 3 chronic kidney disease

Correct answer: His GFR may be significantly reduced due to decreased muscle mass in older adults

In elderly patients, decreased muscle mass results in lower creatinine production, so serum creatinine can appear normal despite significantly reduced GFR.

Question 299: A 28-year-old woman presents with recurrent, intrusive thoughts about contamination and spends 3+ hours daily washing her hands. Which first-line pharmacotherapy is indicated?

Quetiapine
Sertraline (Correct answer)
Lithium
Alprazolam

Correct answer: Sertraline

SSRIs such as sertraline are first-line pharmacotherapy for obsessive-compulsive disorder (OCD).

Question 300: What is the recommended screening interval for prediabetes and type 2 diabetes screening in asymptomatic adults aged 35–70 who are overweight or obese, per USPSTF?

Annually
Every 5 years
Every 2 years
Every 3 years (Correct answer)

Correct answer: Every 3 years

USPSTF recommends screening every 3 years for prediabetes/type 2 diabetes in overweight or obese adults aged 35–70 when results are normal.

ABFM Family Medicine Certification Examination (FMCE)

The American Board of Family Medicine (ABFM) Family Medicine Certification Examination assesses the knowledge and clinical judgment of physicians seeking board certification or recertification in family medicine across the full scope of primary care.

300

Questions

380 min

Time Limit

70%

To Pass

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