SPEX Family Medicine 3

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?

Accepted Answer

Graves' disease

Answer

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?

Accepted Answer

Allopurinol

Answer

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?

Accepted Answer

Add long-acting muscarinic antagonist (LAMA)

Answer

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?

Accepted Answer

Splenic rupture with contact sports

Answer

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?

Accepted Answer

Alendronate plus calcium and vitamin D

Answer

Bisphosphonates like alendronate are the first-line pharmacologic treatment for osteoporosis to reduce fracture risk.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Family Medicine 3