Family Practice Exam Family Medicine Exam 5 — Questions and Answers
Question 1: 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?
- Omeprazole alone for 8 weeks
- Triple therapy (PPI + clarithromycin + amoxicillin) for 14 days (Correct answer)
- H2 blocker for 4 weeks
- Immediate upper endoscopy
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 2: A 16-year-old girl presents with primary amenorrhea, normal secondary sexual characteristics, and a blind-ending vaginal pouch. Karyotype is 46,XY. What is the diagnosis?
- Turner syndrome
- Congenital adrenal hyperplasia
- Androgen insensitivity syndrome (Correct answer)
- Müllerian agenesis
Correct answer: Androgen insensitivity syndrome
Complete androgen insensitivity syndrome (46,XY) presents with female phenotype, absent uterus, blind vaginal pouch, and undescended testes.
Question 3: A 60-year-old woman with a history of breast cancer is started on tamoxifen. Which adverse effect requires gynecological monitoring?
- Ovarian cysts
- Endometrial cancer (Correct answer)
- Cervical dysplasia
- Vaginal atrophy
Correct answer: Endometrial cancer
Tamoxifen acts as a partial estrogen agonist in the uterus, increasing the risk of endometrial hyperplasia and endometrial cancer.
Question 4: 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 5: 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?
- Lifestyle modification only
- Low-intensity statin
- High-intensity statin (Correct answer)
- Fibrate therapy
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 6: A 3-year-old child is brought in with a barking cough, inspiratory stridor, and low-grade fever that worsens at night. X-ray shows a 'steeple sign.' What is the most appropriate treatment for moderate croup?
- Inhaled albuterol
- Oral or IM dexamethasone (Correct answer)
- IV ampicillin
- Nebulized ipratropium
Correct answer: Oral or IM dexamethasone
Dexamethasone (oral or IM, single dose) reduces subglottic edema and is the standard treatment for moderate-to-severe croup.
Question 7: A 38-year-old woman presents with fatigue, pallor, and a smooth beefy-red tongue. Labs show MCV 108 fL, hypersegmented neutrophils, and low serum B12. She has a history of total gastrectomy. What is the underlying mechanism?
- Dietary deficiency of B12
- Lack of intrinsic factor (Correct answer)
- Folate deficiency
- Chronic hemolysis
Correct answer: Lack of intrinsic factor
Total gastrectomy removes parietal cells that produce intrinsic factor, which is required for B12 absorption in the terminal ileum.
Family Practice Exam Family Medicine Exam 5
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?