Family Practice Exam Family Practice Exam 3 — Questions and Answers
Question 1: A 9-year-old boy is brought in for a well-child visit. His BMI is at the 97th percentile. Fasting glucose is 112 mg/dL and fasting triglycerides are 185 mg/dL. What is the most appropriate initial intervention?
- Intensive lifestyle counseling targeting diet and physical activity (Correct answer)
- Initiate metformin immediately
- Refer to bariatric surgery evaluation
- Recheck labs in 6 months without intervention
Correct answer: Intensive lifestyle counseling targeting diet and physical activity
Lifestyle modification is the cornerstone of initial management for pediatric obesity with metabolic abnormalities before pharmacotherapy is considered.
Question 2: A 50-year-old woman presents with hot flashes, night sweats, and irregular periods for 8 months. FSH is elevated. She has no contraindications. What is the most effective treatment for her vasomotor symptoms?
- Hormone therapy (estrogen ± progestogen) (Correct answer)
- Venlafaxine
- Black cohosh supplement
- Gabapentin
Correct answer: Hormone therapy (estrogen ± progestogen)
Hormone therapy remains the most effective treatment for menopausal vasomotor symptoms in women without contraindications.
Question 3: A 67-year-old man with COPD and FEV1 of 38% predicted has two exacerbations requiring oral steroids in the past year. He is on a LABA/LAMA combination. What is the best next step?
- Add an inhaled corticosteroid (ICS) to form a triple therapy regimen (Correct answer)
- Switch to oral theophylline
- Start long-term oral prednisone
- Refer for lung volume reduction surgery immediately
Correct answer: Add an inhaled corticosteroid (ICS) to form a triple therapy regimen
Adding ICS to LABA/LAMA (triple therapy) reduces exacerbation frequency in GOLD group E COPD patients with elevated eosinophils or frequent exacerbations.
Question 4: A 25-year-old woman with no significant past medical history presents with a 2-week history of fatigue, diffuse lymphadenopathy, sore throat, and a positive heterophile antibody test. What is the most important complication to counsel her about?
- Splenic rupture (Correct answer)
- Bacterial meningitis
- Autoimmune hemolytic anemia requiring immediate transfusion
- Permanent immunodeficiency
Correct answer: Splenic rupture
Splenic rupture, though rare, is the most dangerous complication of infectious mononucleosis, and patients should avoid contact sports for at least 3–4 weeks.
Question 5: A 38-year-old man presents with a painless, firm testicular mass. Scrotal ultrasound confirms a solid intratesticular lesion. What is the next most appropriate step?
- Urgent referral for radical orchiectomy and tumor markers (AFP, β-hCG, LDH) (Correct answer)
- Fine-needle aspiration biopsy of the mass
- CT-guided biopsy
- Watchful waiting with repeat ultrasound in 3 months
Correct answer: Urgent referral for radical orchiectomy and tumor markers (AFP, β-hCG, LDH)
A solid intratesticular mass is presumed malignant; radical inguinal orchiectomy provides both diagnosis and treatment, while biopsy via scrotal approach risks lymphatic spread.
Question 6: A 72-year-old woman reports she has fallen twice in the past 3 months. She takes amlodipine, atorvastatin, and temazepam. Which medication is the highest-priority target for deprescribing?
- Temazepam (Correct answer)
- Amlodipine
- Atorvastatin
- None — falls are unrelated to her medications
Correct answer: Temazepam
Benzodiazepines like temazepam are on the Beers Criteria as high-risk in older adults and significantly increase fall and fracture risk.
Question 7: A 44-year-old woman with no prior cardiac history presents with palpitations. ECG shows a delta wave, short PR interval, and widened QRS. What is the diagnosis?
- Wolff-Parkinson-White syndrome (Correct answer)
- Left bundle branch block
- Brugada syndrome
- First-degree AV block
Correct answer: Wolff-Parkinson-White syndrome
Wolff-Parkinson-White syndrome is characterized by a delta wave (slurred QRS upstroke), shortened PR interval, and widened QRS due to ventricular pre-excitation via an accessory pathway.
Family Practice Exam Family Practice Exam 3
A 9-year-old boy is brought in for a well-child visit.
His BMI is at the 97th percentile.
Fasting glucose is 112 mg/dL and fasting triglycerides are 185 mg/dL.
What is the most appropriate initial intervention?