SPEX Family Medicine 5

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?

Accepted Answer

Thiazide diuretic

Answer

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?

Accepted Answer

Oral or IM dexamethasone

Answer

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?

Accepted Answer

Daily suppressive valacyclovir

Answer

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?

Accepted Answer

Add a sulfonylurea

Answer

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?

Accepted Answer

Pelvic floor muscle exercises (Kegel)

Answer

Pelvic floor muscle training is first-line therapy for stress urinary incontinence, with evidence showing significant improvement in symptoms.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Family Medicine 5