Family Practice Exam Family Practice Exam MCQ 5 — Questions and Answers
Question 1: A 16-year-old male athlete presents with anterior knee pain that worsens with activity and is associated with a tender bony prominence just below the patella. What is the most likely diagnosis?
- Osgood-Schlatter disease (Correct answer)
- Patellofemoral pain syndrome
- Patellar tendon rupture
- Prepatellar bursitis
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is a traction apophysitis at the tibial tubercle common in active adolescents, presenting with localized tenderness and swelling.
Question 2: A 52-year-old woman presents with hot flashes, night sweats, and vaginal dryness. Her LMP was 14 months ago. She has no personal or family history of breast cancer or VTE. What is the most effective treatment for her vasomotor symptoms?
- Hormone replacement therapy (estrogen + progestin) (Correct answer)
- SSRIs
- Gabapentin
- Black cohosh supplement
Correct answer: Hormone replacement therapy (estrogen + progestin)
Hormone therapy remains the most effective treatment for menopausal vasomotor symptoms in healthy women without contraindications.
Question 3: A 45-year-old man with a BMI of 38 and newly diagnosed type 2 diabetes asks about medications. Which agent is associated with significant weight loss in addition to glucose lowering?
- Semaglutide (Correct answer)
- Glipizide
- Pioglitazone
- Sitagliptin
Correct answer: Semaglutide
GLP-1 receptor agonists like semaglutide produce significant weight loss (often >10-15%) alongside substantial glucose lowering.
Question 4: A 62-year-old man presents with sudden-onset severe headache he describes as 'the worst headache of my life.' He is alert with no focal neurologic deficits. CT head is negative. What is the next critical step?
- Lumbar puncture for xanthochromia (Correct answer)
- MRI brain with gadolinium
- Start sumatriptan for migraine
- Discharge with follow-up in 24 hours
Correct answer: Lumbar puncture for xanthochromia
A thunderclap headache with negative CT requires lumbar puncture to detect xanthochromia, which indicates subarachnoid hemorrhage in up to 3% of cases.
Question 5: A 78-year-old nursing home resident develops fever, confusion, and productive cough. Chest X-ray shows a right lower lobe infiltrate. What pathogen should empiric treatment most specifically cover that is often seen in this population?
- Gram-negative enteric bacilli and anaerobes (Correct answer)
- Mycoplasma pneumoniae
- Streptococcus pneumoniae alone
- Legionella pneumophila
Correct answer: Gram-negative enteric bacilli and anaerobes
Healthcare-associated pneumonia in nursing home residents requires broader coverage including gram-negative bacilli and anaerobes due to aspiration risk and resistant organisms.
Question 6: A 38-year-old woman presents with a 6-month history of fatigue, joint pain, malar rash, and photosensitivity. Labs show positive ANA (1:320), anti-dsDNA antibodies, and proteinuria. What is the most likely diagnosis?
- Systemic lupus erythematosus (Correct answer)
- Rheumatoid arthritis
- Mixed connective tissue disease
- Dermatomyositis
Correct answer: Systemic lupus erythematosus
The combination of malar rash, photosensitivity, arthritis, renal involvement, positive ANA, and anti-dsDNA antibodies meets SLE classification criteria.
Question 7: A 10-year-old child presents with a target-like skin lesion (erythema migrans) measuring 8 cm following a camping trip in Connecticut. Which treatment is most appropriate?
- Doxycycline for 10-14 days
- Amoxicillin for 21 days
- Doxycycline for 21 days (Correct answer)
- Observation without antibiotics
Correct answer: Doxycycline for 21 days
Lyme disease presenting with erythema migrans is treated with doxycycline 100 mg twice daily for 10-21 days; 21 days is preferred for children ≥8 years with EM.
Family Practice Exam Family Practice Exam MCQ 5
A 16-year-old male athlete presents with anterior knee pain that worsens with activity and is associated with a tender bony prominence just below the patella.
What is the most likely diagnosis?