Free Family Practice Exam Question and Answers — Questions and Answers
Question 1: If a patient with low back pain exhibits any of the following symptoms:
- Herniated nucleus pulposus (HNP) with major muscle weakness
- Recurrent back pain
- Chronic sciatica for 6 or more weeks or new or progressive neurologic deficit
- All of the above (Correct answer)
Correct answer: All of the above
All the listed symptoms are 'red flags' in patients with low back pain, indicating a need for further evaluation or specialist referral. Herniated nucleus pulposus (HNP) with major muscle weakness suggests significant nerve compression, while chronic sciatica or new neurological deficits point to ongoing or worsening nerve involvement. Recurrent back pain, especially with these other symptoms, warrants a thorough investigation to rule out serious underlying conditions.
Question 2: A patient is admitted with whiplash. The patient exhibits paresthesia along the spine when the neck is flexed, according to the examination. This is advantageous:
- Spurling test
- Blocker, beggar, kisser, grabber, Spock sign
- Lhermitte sign (Correct answer)
- Lachman test
Correct answer: Lhermitte sign
The Lhermitte sign is a neurological finding characterized by an electric shock-like sensation that radiates down the spine and into the extremities upon neck flexion. This sign is indicative of cervical spinal cord dysfunction or demyelination, often seen in conditions like whiplash, multiple sclerosis, or cervical spondylosis. Its presence suggests potential spinal cord irritation or damage.
Question 3: Symptoms of mild acne in a 17-year-old girl include papules, pustules, and a few nodules. Benzoyl peroxide purchased over the counter, which she had been using, is no longer effective. Which line treatment works the best?
- Topical erythromycin 3% + 5% benzoyl peroxide (Correct answer)
- 5% benzoyl peroxide
- Oral once-daily minocycline
- Isotretinoin
Correct answer: Topical erythromycin 3% + 5% benzoyl peroxide
For mild acne that is no longer responding to over-the-counter benzoyl peroxide, combining a topical antibiotic like erythromycin with benzoyl peroxide is an effective next step. The antibiotic targets the bacteria (P. acnes) contributing to inflammation, while benzoyl peroxide helps unclog pores and has additional antimicrobial effects. This combination often reduces antibiotic resistance and improves treatment outcomes for moderate acne.
Question 4: With a patient with stage 3 chronic renal disease, how should hypertension be treated?
- Use calcium channel blockers
- Use angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), and loop diuretics in combination (Correct answer)
- Use diuretics, as they are the best treatment of this stage
- Advise the patient to decrease their protein, sodium, and alcohol intake to control their hypertension
Correct answer: Use angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), and loop diuretics in combination
In patients with Stage 3 chronic renal disease and hypertension, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) are crucial for blood pressure control and renoprotection. Loop diuretics are often necessary to manage fluid balance and hypertension as kidney function declines. Combining these agents helps achieve target blood pressure and slow the progression of kidney disease.
Question 5: A patient with severe right upper quadrant (RUQ) pain presents. Which imaging test should be used to evaluate this patient?
- Plain films
- Endoscopy
- Ultrasound (US) (Correct answer)
- Abdominal computed tomography (CT)
Correct answer: Ultrasound (US)
For a patient presenting with severe right upper quadrant (RUQ) pain, an ultrasound (US) is the initial imaging modality of choice. It is non-invasive, readily available, and highly effective at visualizing the gallbladder, bile ducts, and liver. This makes it ideal for diagnosing common causes of RUQ pain such as gallstones, cholecystitis, or liver abnormalities.
Question 6: A 44-year-old patient with hypertension has an electrocardiogram (ECG) ordered by the doctor. Left ventricular hypertrophy is visible on the ECG (LVH). Which of these results might the doctor be anticipating from this ECG?
- A predominant R wave in V1, a deep S in V6, inverted T waves in V2 and V3, and left axis deviation
- A tall R in V6, a deep S in V1, inverted T waves in V5 and V6, and right axis deviation
- A tall R wave in V6, a deep S in V1, inverted T waves in V5 and V6, and left axis deviation (Correct answer)
- A predominant R wave in V1, a deep S in V6, inverted T waves in V2 and V3, and right axis deviation
Correct answer: A tall R wave in V6, a deep S in V1, inverted T waves in V5 and V6, and left axis deviation
Left Ventricular Hypertrophy (LVH) on an ECG is typically characterized by increased voltage criteria, such as a tall R wave in left-sided leads (V5, V6) and a deep S wave in right-sided leads (V1, V2). Additionally, repolarization abnormalities like inverted T waves in V5 and V6 (often called a 'strain pattern') and left axis deviation are common findings associated with LVH due to the increased muscle mass.
Question 7: The fasting lipid profile of a 46-year-old male reveals a total cholesterol level of 238 mg/dL and an HDL-C level of 185. He has smoked for 100 pack-years. He falls into the moderately high risk category (10-year risk = 10-20%), according to the Framingham Coronary Risk Calculator. Less LDL cholesterol is the desired value for this patient.
- 130 mg/dL (Correct answer)
- 70 mg/dL
- 160 mg/dL
- 100 mg/dL
Correct answer: 130 mg/dL
For a patient with a moderately high risk (10-year risk = 10-20%) of coronary heart disease, as determined by the Framingham Coronary Risk Calculator, the desired LDL cholesterol target is typically less than 130 mg/dL. This target aims to reduce their cardiovascular risk, especially given their significant smoking history and elevated total cholesterol. More aggressive targets are usually reserved for higher-risk individuals.
