Family Practice Exam Family Medicine Exam — Questions and Answers
Question 1: 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?
- Beta-blocker
- ACE inhibitor (Correct answer)
- Calcium channel blocker
- Alpha-blocker
Correct answer: ACE inhibitor
ACE inhibitors (or ARBs) are preferred first-line antihypertensives in diabetic patients due to their nephroprotective effects.
Question 2: 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?
- Lymph node
- Thyroglossal duct cyst (Correct answer)
- Branchial cleft cyst
- Lipoma
Correct answer: Thyroglossal duct cyst
A midline neck mass that elevates with swallowing or tongue protrusion is characteristic of a thyroglossal duct cyst.
Question 3: Which finding on urinalysis is most specific for a urinary tract infection caused by Escherichia coli?
- Proteinuria
- Nitrites (Correct answer)
- Ketones
- Bilirubin
Correct answer: Nitrites
Nitrites are produced when gram-negative bacteria (like E. coli) convert urinary nitrates, making it specific for gram-negative UTIs.
Question 4: A 70-year-old woman is started on alendronate for osteoporosis. What is the most important instruction to give her?
- Take it with a full meal
- Remain upright for 30 minutes after taking it (Correct answer)
- Take it at bedtime
- Crush the tablet if needed
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 5: 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?
- Asthma
- Emphysema
- Chronic bronchitis (Correct answer)
- Bronchiectasis
Correct answer: Chronic bronchitis
Chronic bronchitis is defined clinically by a productive cough for at least 3 months per year for 2 consecutive years.
Question 6: 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
- Weight loss greater than 5% of pre-pregnancy weight (Correct answer)
- Vomiting in the morning
- 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 7: Which vaccine is contraindicated in a patient who is immunocompromised due to HIV with a CD4 count of 150 cells/μL?
- Influenza (inactivated)
- Hepatitis B
- MMR (Correct answer)
- Pneumococcal (PPSV23)
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 8: 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 anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
Inferior wall ST elevations (II, III, aVF) are characteristic of right coronary artery occlusion.
Question 9: A 40-year-old woman with hypothyroidism is well controlled on levothyroxine. She becomes pregnant. How should her levothyroxine dose be adjusted?
- Decrease dose by 25%
- Maintain the same dose
- Increase dose by 25–30% (Correct answer)
- Discontinue until after delivery
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 10: 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?
- Urine culture
- Repeat urinalysis in 6 weeks
- CT urography (Correct answer)
- Renal biopsy
Correct answer: CT urography
Painless gross hematuria with constitutional symptoms in an older patient warrants urgent CT urography to evaluate for urothelial malignancy.
Question 11: Which of the following is the most common cause of community-acquired pneumonia in healthy adults?
- Haemophilus influenzae
- Streptococcus pneumoniae (Correct answer)
- Legionella pneumophila
- Mycoplasma pneumoniae
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae remains the most common cause of community-acquired pneumonia across all age groups.
Question 12: 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?
- Liothyronine (T3)
- Levothyroxine (T4) (Correct answer)
- Methimazole
- Radioactive iodine
Correct answer: Levothyroxine (T4)
Levothyroxine (synthetic T4) is the standard first-line treatment for primary hypothyroidism.
Question 13: 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?
- Administer IV vitamin K 10 mg
- Hold warfarin and give oral vitamin K 1–2.5 mg (Correct answer)
- Administer fresh frozen plasma
- Continue warfarin and recheck INR in 1 week
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 14: 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?
- Hepatitis
- Splenic rupture (Correct answer)
- Airway compromise
- Hemolytic anemia
Correct 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.
Question 15: 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?
- Desmopressin
- Behavioral interventions and bed alarm (Correct answer)
- Oxybutynin
- Renal ultrasound
Correct 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.
Question 16: 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?
- Increased risk of ovarian cancer
- Accelerated bone loss (Correct answer)
- Increased risk of breast 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 17: 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?
- Start sumatriptan immediately
- Non-contrast CT head (Correct answer)
- Lumbar puncture only
- MRI brain with gadolinium
Correct answer: Non-contrast CT head
A thunderclap headache requires immediate non-contrast CT head to evaluate for subarachnoid hemorrhage before any other management.
Question 18: 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 19: 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?
- Croup
- Epiglottitis (Correct answer)
- Peritonsillar abscess
- Foreign body aspiration
Correct answer: Epiglottitis
Epiglottitis presents with the classic tripod position, drooling, dysphagia, and high fever and requires emergent airway management.
Question 20: 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?
- Rosacea
- Systemic lupus erythematosus (Correct answer)
- Dermatomyositis
- Rheumatoid arthritis
Correct answer: Systemic lupus erythematosus
The malar rash, arthralgia, positive ANA, and anti-dsDNA antibodies (highly specific) confirm systemic lupus erythematosus.
Question 21: 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
- Alzheimer's disease (Correct answer)
- Normal pressure hydrocephalus
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.
