Family Practice Exam Family Practice Exam 5 — Questions and Answers
Question 1: A 52-year-old man presents with a 3-month history of episodic chest tightness and shortness of breath at night. Spirometry shows FEV1/FVC of 0.85 and a 15% improvement in FEV1 after bronchodilator. What is the most likely diagnosis?
- Asthma (Correct answer)
- COPD
- Cardiac asthma
- Vocal cord dysfunction
Correct answer: Asthma
A ≥12% and ≥200 mL improvement in FEV1 after bronchodilator with normal FEV1/FVC (ruling out obstruction at baseline) is consistent with reversible airway disease, i.e., asthma.
Question 2: A 78-year-old woman with moderate Alzheimer's disease and her family ask about driving. Her MMSE score is 14/30. She lives in a rural area with no public transportation. What is the most appropriate response?
- Advise that she should stop driving and report to the DMV per state law, assist family in arranging alternatives (Correct answer)
- Allow her to continue driving only in familiar areas nearby
- Defer the decision to her neurologist
- Order a formal driving evaluation before making any recommendation
Correct answer: Advise that she should stop driving and report to the DMV per state law, assist family in arranging alternatives
Moderate dementia poses significant driving safety risks; physicians have both an ethical and (in many states) legal duty to counsel cessation and may need to report to the DMV.
Question 3: A 40-year-old man presents with sudden-onset severe headache described as 'the worst headache of my life,' with neck stiffness. CT head is negative. What is the next most critical diagnostic step?
- Lumbar puncture to evaluate for xanthochromia (Correct answer)
- Start empiric antibiotics for bacterial meningitis
- MRI brain with gadolinium
- Discharge with analgesics and neurology follow-up
Correct answer: Lumbar puncture to evaluate for xanthochromia
A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture looking for xanthochromia or RBCs is required to exclude SAH in thunderclap headache.
Question 4: A 6-year-old boy has recurrent ear infections. He currently has bilateral otitis media with effusion for 3 months, with a 25 dB hearing loss. He has mild speech delay. What is the most appropriate management?
- Referral for tympanostomy tube placement (Correct answer)
- Watchful waiting for an additional 3 months
- Prolonged antibiotic prophylaxis
- Adenoidectomy alone without tubes
Correct answer: Referral for tympanostomy tube placement
Bilateral OME persisting ≥3 months with documented hearing loss ≥25 dB or developmental delay is an indication for tympanostomy tubes per AAP guidelines.
Question 5: A 30-year-old woman presents with painless, non-pruritic vulvar ulcers that are clean-based with indurated edges. She is sexually active with multiple partners. What is the most likely diagnosis?
- Primary syphilis (chancre) (Correct answer)
- Genital herpes
- Chancroid
- Lymphogranuloma venereum
Correct answer: Primary syphilis (chancre)
Primary syphilis presents as a single, painless, indurated ulcer (chancre) caused by Treponema pallidum; herpes and chancroid are typically painful.
Question 6: A 58-year-old woman with a 20-year history of type 2 diabetes presents with protein-to-creatinine ratio of 380 mg/g and eGFR of 52 mL/min/1.73m². BP is 138/86. She is on metformin and lisinopril. What additional agent most reduces CKD progression?
- SGLT-2 inhibitor (e.g., empagliflozin or dapagliflozin) (Correct answer)
- Calcium channel blocker
- Beta-blocker
- Additional ACE inhibitor dose doubling
Correct answer: SGLT-2 inhibitor (e.g., empagliflozin or dapagliflozin)
SGLT-2 inhibitors have demonstrated significant renoprotective benefits in diabetic CKD, reducing progression to ESRD independent of glycemic control.
Question 7: A 22-year-old man presents with a 2-week history of unilateral eye redness, mucopurulent discharge, and mild photophobia. He is sexually active and does not use protection. Gram stain of discharge shows gram-negative intracellular diplococci. What is the recommended treatment?
- Ceftriaxone 500 mg IM single dose plus doxycycline 100 mg BID for 7 days (Correct answer)
- Azithromycin 1 g single dose alone
- Topical ciprofloxacin eye drops for 7 days
- Oral doxycycline for 14 days
Correct answer: Ceftriaxone 500 mg IM single dose plus doxycycline 100 mg BID for 7 days
Gonococcal conjunctivitis requires systemic ceftriaxone (not topical antibiotics) plus empiric chlamydial co-treatment with doxycycline per CDC STI guidelines.
Family Practice Exam Family Practice Exam 5
A 52-year-old man presents with a 3-month history of episodic chest tightness and shortness of breath at night.
Spirometry shows FEV1/FVC of 0.85 and a 15% improvement in FEV1 after bronchodilator.
What is the most likely diagnosis?