Family Practice Exam Family Practice Exam 5

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?

Accepted Answer

Asthma

Answer

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?

Accepted Answer

Advise that she should stop driving and report to the DMV per state law, assist family in arranging alternatives

Answer

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?

Accepted Answer

Lumbar puncture to evaluate for xanthochromia

Answer

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?

Accepted Answer

Referral for tympanostomy tube placement

Answer

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?

Accepted Answer

Primary syphilis (chancre)

Answer

Primary syphilis presents as a single, painless, indurated ulcer (chancre) caused by Treponema pallidum; herpes and chancroid are typically painful.

Family Practice Exam Practice Test

Family Practice Exam Practice Test

Family Practice Exam Family Practice Exam 5