Family Practice Exam Family Practice Exam MCQ 4 — Questions and Answers
Question 1: A 75-year-old man presents with urinary urgency, frequency, nocturia, and a weak stream. DRE shows a smooth, symmetrically enlarged prostate. PSA is 2.1 ng/mL. What is the most likely diagnosis?
- Benign prostatic hyperplasia (Correct answer)
- Prostate cancer
- Prostatitis
- Urinary tract infection
Correct answer: Benign prostatic hyperplasia
Smooth symmetric prostate enlargement with obstructive and irritative voiding symptoms and normal PSA in an elderly man is classic for BPH.
Question 2: A 28-year-old woman presents with a 3-day history of green vaginal discharge, cervical motion tenderness, and adnexal tenderness. Temperature is 38.2°C. What is the recommended outpatient treatment?
- Ceftriaxone IM + doxycycline + metronidazole (Correct answer)
- Azithromycin 1g single dose
- Amoxicillin-clavulanate for 14 days
- Ciprofloxacin for 7 days
Correct answer: Ceftriaxone IM + doxycycline + metronidazole
CDC guidelines for outpatient PID recommend ceftriaxone plus doxycycline plus metronidazole for 14 days to cover gonorrhea, chlamydia, and anaerobes.
Question 3: A 50-year-old man presents with fatigue, arthralgia, bronze-colored skin, and elevated liver enzymes. Serum ferritin is 1200 ng/mL and transferrin saturation is 68%. What is the most likely diagnosis?
- Hereditary hemochromatosis (Correct answer)
- Wilson's disease
- Alcoholic liver disease
- Non-alcoholic fatty liver disease
Correct answer: Hereditary hemochromatosis
The classic triad of bronze skin, liver disease, and arthralgia with markedly elevated ferritin and transferrin saturation points to hereditary hemochromatosis.
Question 4: A 6-year-old boy is noted to have a harsh systolic ejection murmur at the upper left sternal border that radiates to the back. Femoral pulses are diminished. What is the most likely diagnosis?
- Coarctation of the aorta (Correct answer)
- Ventricular septal defect
- Atrial septal defect
- Pulmonary stenosis
Correct answer: Coarctation of the aorta
Coarctation of the aorta presents with upper extremity hypertension, diminished femoral pulses, and a systolic murmur radiating to the back.
Question 5: A 65-year-old smoker presents with a new persistent cough, hemoptysis, and a 15-lb weight loss over 3 months. Chest X-ray shows a 3 cm hilar mass. Which investigation is most critical next?
- CT chest with contrast and PET scan (Correct answer)
- Sputum cytology
- Spirometry
- Bronchodilator trial
Correct answer: CT chest with contrast and PET scan
CT of the chest with contrast and PET scan are used together for staging workup of suspected lung malignancy before tissue biopsy planning.
Question 6: A 30-year-old woman presents with recurrent episodes of palpitations, sweating, weight loss, and diarrhea. Thyroid exam reveals a diffusely enlarged, non-tender gland and a bruit. TSH is undetectable. What is the most likely diagnosis?
- Graves' disease (Correct answer)
- Toxic multinodular goiter
- Hashimoto's thyroiditis
- Thyroid adenoma
Correct answer: Graves' disease
Diffuse goiter with thyroid bruit, hyperthyroidism, and associated ophthalmopathy or dermopathy is classic for Graves' disease, an autoimmune condition.
Question 7: Which of the following patients should receive aspirin for primary prevention of cardiovascular disease according to current USPSTF guidelines?
- A 55-year-old with a 10-year ASCVD risk of 12% and no bleeding risk (Correct answer)
- A 40-year-old with a 5% 10-year ASCVD risk
- A 70-year-old with no prior cardiovascular events
- A 50-year-old currently taking NSAIDs regularly
Correct answer: A 55-year-old with a 10-year ASCVD risk of 12% and no bleeding risk
USPSTF recommends low-dose aspirin for primary prevention in adults 40-59 with a 10-year ASCVD risk ≥ 10% who are not at increased bleeding risk.
Family Practice Exam Family Practice Exam MCQ 4
A 75-year-old man presents with urinary urgency, frequency, nocturia, and a weak stream.
DRE shows a smooth, symmetrically enlarged prostate.
PSA is 2.1 ng/mL.
What is the most likely diagnosis?