SPEX Family Medicine 2

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?

Accepted Answer

Initiate levothyroxine therapy

Answer

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?

Accepted Answer

Propranolol

Answer

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?

Accepted Answer

Home sleep apnea test

Answer

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?

Accepted Answer

Delirium tremens

Answer

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?

Accepted Answer

Daily topiramate

Answer

Topiramate is an FDA-approved preventive agent for migraine, indicated when attacks are frequent or disabling.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Family Medicine 2