Family Medicine Exam Flashcards

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?

Answer: ACE inhibitor

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

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?

Answer: Thyroglossal duct cyst

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

Which finding on urinalysis is most specific for a urinary tract infection caused by Escherichia coli?

Answer: Nitrites

Nitrites are produced when gram-negative bacteria (like E. coli) convert urinary nitrates, making it specific for gram-negative UTIs.

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

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.

A 45-year-old male smoker presents with a chronic productive cough for at least 3 months per year for 2 consecutive years. What is the diagnosis?

Answer: Chronic bronchitis

Chronic bronchitis is defined clinically by a productive cough for at least 3 months per year for 2 consecutive years.

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?

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.

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

Answer: MMR

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

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?

Answer: Right coronary artery

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

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

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.

A 65-year-old man presents with hematuria and a 15-pound weight loss over 3 months. Urinalysis shows RBCs but no casts. What is the next best step?

Answer: CT urography

Painless gross hematuria with constitutional symptoms in an older patient warrants urgent CT urography to evaluate for urothelial malignancy.

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

Answer: Streptococcus pneumoniae

Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia across all age groups.

A 34-year-old woman presents with fatigue, cold intolerance, constipation, and weight gain. TSH is 12 mIU/L and free T4 is low. What is the most appropriate treatment?

Answer: Levothyroxine (T4)

Levothyroxine (synthetic T4) is the standard first-line treatment for primary hypothyroidism.

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?

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.

A 19-year-old college student presents with fever, severe sore throat, and posterior cervical lymphadenopathy. Monospot test is positive. Which complication requires activity restriction?

Answer: Splenic rupture

Splenomegaly in infectious mononucleosis raises the risk of splenic rupture with contact sports or strenuous activity, requiring 3–4 weeks of restriction.

A 6-year-old boy is brought in for bed-wetting at night. He has been dry during the day since age 3. No urinary symptoms or polyuria. What is the most appropriate initial management?

Answer: Behavioral interventions and bed alarm

Primary nocturnal enuresis is managed initially with behavioral interventions including fluid restriction at night and moisture alarms, which are most effective.

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?

Answer: Accelerated bone loss

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

A 30-year-old man presents with sudden onset severe unilateral headache described as 'the worst headache of my life.' Neurological exam is normal. What is the next step?

Answer: Non-contrast CT head

A thunderclap headache requires immediate non-contrast CT head to evaluate for subarachnoid hemorrhage before any other management.

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

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.

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?

Answer: Epiglottitis

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

A 25-year-old woman presents with a butterfly-shaped rash across her cheeks and nose, joint pain, and fatigue. ANA is positive with anti-dsDNA antibodies. What is the diagnosis?

Answer: Systemic lupus erythematosus

The malar rash, arthralgia, positive ANA, and anti-dsDNA antibodies (highly specific) confirm systemic lupus erythematosus.