Family Practice Exam Family Practice Exam 4 — Questions and Answers
Question 1: A 55-year-old woman with a 10-year history of rheumatoid arthritis on long-term prednisone 7.5 mg/day presents for a routine visit. Her DEXA scan shows a T-score of -1.8. What is the most appropriate intervention?
- Start oral bisphosphonate therapy (e.g., alendronate) (Correct answer)
- Recommend calcium and vitamin D supplementation only
- Repeat DEXA in 5 years without treatment
- Stop prednisone immediately to prevent further bone loss
Correct answer: Start oral bisphosphonate therapy (e.g., alendronate)
Patients on long-term glucocorticoids at any dose with osteopenia should receive bisphosphonate therapy per ACR guidelines to prevent glucocorticoid-induced osteoporosis.
Question 2: A 3-year-old boy is brought in for evaluation of bow-leggedness. His legs have been bowed since he began walking. His growth curve is normal. X-rays show cupping and fraying of the distal femur metaphysis. What is the most likely diagnosis?
- Rickets (Correct answer)
- Physiologic genu varum
- Blount disease
- Osteogenesis imperfecta
Correct answer: Rickets
Metaphyseal cupping and fraying on X-ray are hallmark radiographic findings of rickets, caused by defective bone mineralization due to vitamin D deficiency.
Question 3: A 60-year-old man presents with 3 months of fatigue, 15-lb weight loss, and microcytic anemia. Colonoscopy reveals a mass in the ascending colon. CEA is elevated. What is the most likely stage if CT shows no distant metastases and the mass invades through the muscularis propria into pericolorectal tissues with 2 positive lymph nodes?
- Stage III (T3 N1 M0) (Correct answer)
- Stage I (T1 N0 M0)
- Stage II (T3 N0 M0)
- Stage IV (any T, any N, M1)
Correct answer: Stage III (T3 N1 M0)
T3 (invasion through muscularis propria) with N1 (1–3 positive lymph nodes) and no distant metastasis is classified as Stage III colorectal cancer.
Question 4: A 19-year-old college student presents with 2 days of severe sore throat, fever, anterior cervical lymphadenopathy, and tonsillar exudates but NO cough. His Centor score is 4. What is the best approach?
- Perform rapid strep test; treat with penicillin if positive (Correct answer)
- Empirically treat with amoxicillin without testing
- Prescribe azithromycin for 5 days empirically
- Order throat culture and wait for results before any treatment
Correct answer: Perform rapid strep test; treat with penicillin if positive
With a Centor score of 4, guidelines recommend rapid antigen testing before treatment to confirm GAS pharyngitis and avoid unnecessary antibiotic use.
Question 5: A 48-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH is 8.2 mIU/L and free T4 is low. What is the most appropriate treatment?
- Levothyroxine with dose titrated to normalize TSH (Correct answer)
- Liothyronine (T3) alone
- Combined T3/T4 desiccated thyroid extract
- Repeat TSH in 6 months before initiating treatment
Correct answer: Levothyroxine with dose titrated to normalize TSH
Levothyroxine (T4) is the standard first-line treatment for hypothyroidism, dosed to normalize TSH within the reference range.
Question 6: A 34-year-old woman is 8 weeks pregnant and has a BMI of 36. She asks about gestational weight gain. Per IOM guidelines, how much total weight gain is recommended during her pregnancy?
- 11–20 lbs (5–9 kg) (Correct answer)
- 25–35 lbs (11–16 kg)
- 28–40 lbs (13–18 kg)
- No weight gain is recommended
Correct answer: 11–20 lbs (5–9 kg)
IOM guidelines recommend 11–20 lbs of total gestational weight gain for women with a pre-pregnancy BMI ≥30 (obese).
Question 7: A 65-year-old man with stable coronary artery disease and an aspirin allergy presents for cardioprotective antiplatelet therapy. What is the most appropriate alternative?
- Clopidogrel 75 mg daily (Correct answer)
- Warfarin with target INR 2–3
- Ticagrelor 90 mg twice daily
- Dipyridamole alone
Correct answer: Clopidogrel 75 mg daily
Clopidogrel 75 mg daily is the recommended antiplatelet alternative for stable CAD in patients with true aspirin allergy.
Family Practice Exam Family Practice Exam 4
A 55-year-old woman with a 10-year history of rheumatoid arthritis on long-term prednisone 7.5 mg/day presents for a routine visit.
Her DEXA scan shows a T-score of -1.8.
What is the most appropriate intervention?