SPEX Family Medicine 4 — Questions and Answers
Question 1: A 32-year-old woman at 10 weeks gestation presents with nausea and vomiting. She is unable to keep fluids down and has lost 5% of her body weight. Urinalysis shows ketonuria. What is the diagnosis?
- Morning sickness
- Hyperemesis gravidarum (Correct answer)
- Gastroenteritis
- Peptic ulcer disease
Correct answer: Hyperemesis gravidarum
Hyperemesis gravidarum is defined by intractable vomiting, dehydration, weight loss >5%, and ketonuria in pregnancy.
Question 2: A 60-year-old man presents with progressive difficulty initiating urination, weak stream, and nocturia. PSA is 3.2 ng/mL. Rectal exam shows a smooth, enlarged prostate. What is the most likely diagnosis?
- Prostate cancer
- Benign prostatic hyperplasia (Correct answer)
- Prostatitis
- Bladder neck obstruction
Correct answer: Benign prostatic hyperplasia
A smooth, enlarged prostate on exam with obstructive voiding symptoms and normal PSA is classic for benign prostatic hyperplasia.
Question 3: A 45-year-old woman presents with a butterfly rash across both cheeks, joint pain, and fatigue. ANA is positive at 1:320. Which additional test best supports the diagnosis of SLE?
- Anti-dsDNA antibody (Correct answer)
- Rheumatoid factor
- Anti-CCP antibody
- ANCA
Correct answer: Anti-dsDNA antibody
Anti-dsDNA antibodies are highly specific for SLE and their levels correlate with disease activity, including lupus nephritis.
Question 4: A 78-year-old man with a history of atrial fibrillation on warfarin presents with acute onset right-sided weakness and aphasia lasting 30 minutes that fully resolved. INR is 1.8. What is this presentation called?
- Completed ischemic stroke
- Transient ischemic attack (Correct answer)
- Todd paralysis
- Complex migraine
Correct answer: Transient ischemic attack
Sudden focal neurologic deficits that completely resolve within 24 hours (typically <1 hour) define a transient ischemic attack (TIA).
Question 5: A 19-year-old college student presents with productive cough, low-grade fever, and headache for 2 weeks. Chest X-ray shows patchy infiltrates. He remains ambulatory. What is the most likely causative organism?
- Streptococcus pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumoniae (Correct answer)
- Klebsiella pneumoniae
Correct answer: Mycoplasma pneumoniae
Mycoplasma pneumoniae is the classic cause of atypical (walking) pneumonia in young adults with gradual onset and patchy infiltrates.
Question 6: A 48-year-old woman presents with bilateral wrist pain, morning stiffness lasting over 1 hour, and symmetric joint swelling. RF and anti-CCP are positive. What is the recommended first-line disease-modifying therapy?
- Hydroxychloroquine
- Methotrexate (Correct answer)
- Sulfasalazine
- Leflunomide
Correct answer: Methotrexate
Methotrexate is the anchor DMARD for rheumatoid arthritis and the preferred first-line agent due to its efficacy and cost-effectiveness.
Question 7: A 65-year-old woman presents with sudden-onset severe vertigo, nausea, and vomiting without hearing loss or tinnitus. Dix-Hallpike test is negative. Neurologic exam shows gait ataxia and nystagmus that does not suppress with fixation. What is the most concerning diagnosis?
- Benign paroxysmal positional vertigo
- Meniere's disease
- Vestibular neuritis
- Posterior fossa stroke (Correct answer)
Correct answer: Posterior fossa stroke
Nystagmus that does not suppress with fixation and associated gait ataxia suggest a central cause such as cerebellar or brainstem stroke.
SPEX Family Medicine 4
A 32-year-old woman at 10 weeks gestation presents with nausea and vomiting.
She is unable to keep fluids down and has lost 5% of her body weight.
Urinalysis shows ketonuria.
What is the diagnosis?