SPEX Family Medicine 5 — Questions and Answers
Question 1: A 58-year-old man with hypertension presents with a blood pressure of 168/98 mmHg despite lifestyle modifications. He has no diabetes or CKD. What is the most appropriate first-line pharmacologic therapy?
- ACE inhibitor
- Thiazide diuretic (Correct answer)
- Beta-blocker
- Alpha-blocker
Correct answer: Thiazide diuretic
JNC guidelines and ACC/AHA recommend thiazide diuretics, ACE inhibitors, ARBs, or CCBs as first-line agents; thiazides are among the most cost-effective choices for the general population.
Question 2: A 3-year-old boy presents with sudden onset of inspiratory stridor, low-grade fever, and a barking cough that worsens at night. He is mildly distressed. What is the most appropriate initial treatment?
- Nebulized albuterol
- IV ampicillin
- Oral or IM dexamethasone (Correct answer)
- Endotracheal intubation
Correct answer: Oral or IM dexamethasone
Croup (viral laryngotracheobronchitis) is treated with a single dose of dexamethasone (oral or IM) to reduce airway inflammation.
Question 3: A 30-year-old woman presents with painful genital vesicles that ulcerate. She reports a similar episode 6 months ago. HSV-2 IgG is positive. What is the most appropriate management to prevent recurrences?
- Acyclovir only during outbreaks
- Daily suppressive valacyclovir (Correct answer)
- Topical penciclovir cream
- Topical corticosteroid cream
Correct answer: Daily suppressive valacyclovir
Daily suppressive antiviral therapy with valacyclovir reduces the frequency of recurrences and decreases risk of transmission to partners.
Question 4: A 52-year-old man with type 2 diabetes has an HbA1c of 9.2% on metformin monotherapy. He has no cardiovascular disease or CKD. What is the most appropriate next step?
- Add insulin glargine
- Add a sulfonylurea (Correct answer)
- Switch to SGLT2 inhibitor
- Intensify lifestyle modifications only
Correct answer: Add a sulfonylurea
Adding a sulfonylurea to metformin is a well-established, guideline-supported approach to intensify glycemic control when HbA1c remains above goal.
Question 5: A 66-year-old woman presents with urinary leakage when coughing, laughing, or sneezing. Pelvic exam shows no prolapse. Urinalysis is normal. What is the most appropriate initial treatment?
- Oxybutynin (anticholinergic)
- Pelvic floor muscle exercises (Kegel) (Correct answer)
- Midurethral sling surgery
- Pessary placement
Correct answer: Pelvic floor muscle exercises (Kegel)
Pelvic floor muscle training is first-line therapy for stress urinary incontinence, with evidence showing significant improvement in symptoms.
Question 6: A 44-year-old man presents with a 2-week history of sad mood, loss of interest, fatigue, insomnia, and poor concentration after losing his job. He denies suicidal ideation. These symptoms impair his daily functioning. What is the diagnosis?
- Adjustment disorder with depressed mood
- Major depressive disorder (Correct answer)
- Dysthymia (persistent depressive disorder)
- Grief reaction
Correct answer: Major depressive disorder
Five or more depressive symptoms lasting at least 2 weeks causing functional impairment meets DSM-5 criteria for major depressive disorder, regardless of a triggering event.
Question 7: A 72-year-old man presents with slowly progressive bradykinesia, resting tremor of the right hand, and cogwheel rigidity. Gait shows reduced arm swing. What is the most appropriate initial pharmacologic treatment?
- Donepezil
- Carbidopa-levodopa (Correct answer)
- Haloperidol
- Memantine
Correct answer: Carbidopa-levodopa
Carbidopa-levodopa is the most effective pharmacologic treatment for Parkinson's disease and is appropriate as initial therapy in older patients.
SPEX Family Medicine 5
A 58-year-old man with hypertension presents with a blood pressure of 168/98 mmHg despite lifestyle modifications.
He has no diabetes or CKD.
What is the most appropriate first-line pharmacologic therapy?