Family Practice Exam Family Medicine Exam 3 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
Family Practice Exam Family Medicine Exam 3
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?