SPEX Family Medicine 3 — Questions and Answers
Question 1: A 35-year-old woman presents with palpitations, heat intolerance, and a 10-lb weight loss over 2 months. Exam reveals a diffusely enlarged thyroid and lid lag. TSH is undetectable. What is the most likely diagnosis?
- Toxic multinodular goiter
- Graves' disease (Correct answer)
- Subacute thyroiditis
- Toxic adenoma
Correct answer: Graves' disease
Diffuse goiter, ophthalmopathy signs, and suppressed TSH in a young woman is classic for Graves' disease.
Question 2: A 50-year-old man with hypertension and gout presents with a serum uric acid of 9.2 mg/dL. He has had 3 gout attacks in the past year. Which medication is most appropriate for urate-lowering therapy?
- Colchicine
- Probenecid
- Allopurinol (Correct answer)
- Indomethacin
Correct answer: Allopurinol
Allopurinol is the first-line urate-lowering therapy for chronic gout, targeting a serum urate below 6 mg/dL.
Question 3: A 68-year-old woman with COPD and FEV1/FVC ratio of 0.58 is symptomatic despite SABA use. What is the most appropriate next step in management?
- Add inhaled corticosteroid
- Add long-acting beta-agonist (LABA)
- Add long-acting muscarinic antagonist (LAMA) (Correct answer)
- Initiate oral prednisone
Correct answer: Add long-acting muscarinic antagonist (LAMA)
GOLD guidelines recommend adding a LAMA (e.g., tiotropium) as maintenance therapy in symptomatic COPD when SABA alone is insufficient.
Question 4: A 25-year-old man presents with fever, pharyngitis, and cervical lymphadenopathy. Monospot test is positive. Which complication should be specifically discussed with this patient?
- Risk of rheumatic fever
- Splenic rupture with contact sports (Correct answer)
- Airway obstruction requiring antibiotics
- Liver failure requiring hospitalization
Correct answer: Splenic rupture with contact sports
Splenomegaly in infectious mononucleosis creates a risk of splenic rupture, so patients must avoid contact sports for at least 3–4 weeks.
Question 5: A 72-year-old woman falls at home and is found to have osteoporosis on DEXA (T-score -2.8). She has no prior fractures. Which treatment is most appropriate?
- Calcium and vitamin D supplementation only
- Alendronate plus calcium and vitamin D (Correct answer)
- Calcitonin nasal spray
- Testosterone therapy
Correct answer: Alendronate plus calcium and vitamin D
Bisphosphonates like alendronate are the first-line pharmacologic treatment for osteoporosis to reduce fracture risk.
Question 6: A 40-year-old man presents with 3 months of epigastric pain relieved by eating. H. pylori testing is positive. What is the recommended treatment?
- Omeprazole alone for 8 weeks
- Triple therapy: omeprazole + clarithromycin + amoxicillin (Correct answer)
- H2 blocker therapy for 4 weeks
- Bismuth quadruple therapy as first-line
Correct answer: Triple therapy: omeprazole + clarithromycin + amoxicillin
Clarithromycin-based triple therapy remains a common first-line regimen for H. pylori eradication in areas of low clarithromycin resistance.
Question 7: A 55-year-old man with a 30 pack-year smoking history and no current symptoms is seen for a routine visit. Per USPSTF guidelines, which screening is recommended?
- Chest X-ray annually
- Low-dose CT scan of the chest annually (Correct answer)
- Sputum cytology every 2 years
- PET scan every 3 years
Correct answer: Low-dose CT scan of the chest annually
The USPSTF recommends annual low-dose CT for lung cancer screening in adults 50–80 with a 20 pack-year history who currently smoke or quit within the past 15 years.
SPEX Family Medicine 3
A 35-year-old woman presents with palpitations, heat intolerance, and a 10-lb weight loss over 2 months.
Exam reveals a diffusely enlarged thyroid and lid lag.
TSH is undetectable.
What is the most likely diagnosis?