SPEX Family Medicine 2 — Questions and Answers
Question 1: A 55-year-old woman presents with a TSH of 8.5 mIU/L and free T4 of 0.9 ng/dL. She reports fatigue and mild constipation. What is the most appropriate next step?
- Initiate levothyroxine therapy (Correct answer)
- Repeat TSH in 3 months
- Order thyroid ultrasound
- Refer to endocrinology immediately
Correct answer: Initiate levothyroxine therapy
Overt hypothyroidism (elevated TSH with low-normal free T4) with symptoms warrants levothyroxine therapy.
Question 2: Which of the following is the first-line pharmacologic treatment for essential tremor?
- Primidone
- Propranolol (Correct answer)
- Levodopa
- Gabapentin
Correct answer: Propranolol
Propranolol is the first-line treatment for essential tremor, along with primidone.
Question 3: A 45-year-old man with obesity and snoring reports excessive daytime sleepiness. His Epworth Sleepiness Scale score is 16. What is the most appropriate next diagnostic step?
- Overnight polysomnography
- Multiple sleep latency test
- Home sleep apnea test (Correct answer)
- Actigraphy
Correct answer: Home sleep apnea test
Home sleep apnea testing is recommended as an appropriate initial test for patients with high pretest probability of obstructive sleep apnea without comorbidities.
Question 4: A 70-year-old man develops confusion, restlessness, and tremor 48 hours after being admitted for hip fracture. Vital signs show HR 110, BP 160/95, temp 37.9°C. What is the most likely diagnosis?
- Delirium tremens (Correct answer)
- Wernicke encephalopathy
- Hospital-acquired delirium
- Septic encephalopathy
Correct answer: Delirium tremens
Autonomic instability with tremor and altered consciousness 48 hours after admission strongly suggests alcohol withdrawal delirium (delirium tremens).
Question 5: A 28-year-old woman presents with recurrent episodes of severe unilateral headache with photophobia and nausea lasting 6–18 hours. She has no aura. She uses ibuprofen frequently. What is the best preventive strategy?
- Daily topiramate (Correct answer)
- Daily sumatriptan
- Increase ibuprofen dose
- Ergotamine on demand
Correct answer: Daily topiramate
Topiramate is an FDA-approved preventive agent for migraine, indicated when attacks are frequent or disabling.
Question 6: A 62-year-old man with type 2 diabetes, CKD stage 3 (eGFR 42), and heart failure with reduced ejection fraction is being optimized. Which diabetes medication has demonstrated cardiovascular and renal benefits in this clinical profile?
- Glipizide
- Pioglitazone
- Empagliflozin (Correct answer)
- Sitagliptin
Correct answer: Empagliflozin
SGLT2 inhibitors like empagliflozin have proven cardiovascular and nephroprotective benefits in patients with HFrEF and CKD.
Question 7: According to USPSTF guidelines, at what age should average-risk adults begin colorectal cancer screening?
- 40 years
- 45 years (Correct answer)
- 50 years
- 55 years
Correct answer: 45 years
The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.
SPEX Family Medicine 2
A 55-year-old woman presents with a TSH of 8.5 mIU/L and free T4 of 0.9 ng/dL.
She reports fatigue and mild constipation.
What is the most appropriate next step?