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