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CFPC practice questions

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Question 1Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 54-year-old man with no symptoms has a blood pressure of 148/94 mmHg on two separate office visits. He has no diabetes, kidney disease, or other cardiovascular risk factors. According to Canadian hypertension guidance, which management is most appropriate initially?

  1. Recommend lifestyle modification and reassess in 3 to 6 months Correct answer.
  2. Start an ACE inhibitor immediately
  3. Refer urgently for renal denervation
  4. Start a thiazide diuretic plus a beta-blocker

Explanation

For grade 1 hypertension in a person without high cardiovascular risk or comorbidity, lifestyle modification with reassessment over several months is reasonable before adding pharmacotherapy. Drug therapy is added if blood pressure remains elevated or risk is high.

Question 2Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 3-year-old child presents with a barking cough, hoarse voice, and inspiratory stridor that worsens at night. He is alert, drinking, and has no drooling. What is the most likely diagnosis?

  1. Foreign body aspiration
  2. Bacterial tracheitis
  3. Epiglottitis
  4. Croup Correct answer.

Explanation

The combination of a barking cough, hoarseness, and inspiratory stridor in a well-appearing child with a viral prodrome is characteristic of croup (laryngotracheitis). Drooling and toxicity would raise concern for epiglottitis.

Question 3Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 28-year-old woman at 10 weeks' gestation reports mild nausea and vomiting but is tolerating fluids and has normal electrolytes. Which initial treatment is most appropriate?

  1. Admission for intravenous fluids
  2. Oral ondansetron as first line
  3. Intravenous metoclopramide
  4. Oral doxylamine-pyridoxine Correct answer.

Explanation

For mild nausea and vomiting of pregnancy with preserved hydration, delayed-release doxylamine combined with pyridoxine is the recommended first-line pharmacologic option in Canadian practice. It has a strong safety record in pregnancy.

Question 4Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 60-year-old woman has a fasting plasma glucose of 6.4 mmol/L and an HbA1c of 6.2%. She is asymptomatic. What is the most appropriate next step?

  1. Order an oral glucose tolerance test only if symptoms develop
  2. Diagnose type 2 diabetes and start metformin
  3. Repeat the fasting glucose or HbA1c to confirm prediabetes Correct answer.
  4. Reassure her that no follow-up is needed

Explanation

A fasting glucose of 6.1 to 6.9 mmol/L or an HbA1c of 6.0% to 6.4% indicates prediabetes, and confirmation with a repeat test is appropriate. Prediabetes warrants lifestyle intervention and periodic monitoring.

Question 5Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 6-month-old infant has a temperature of 39.2°C, is irritable but consolable, and has no focal findings on examination. He has received two sets of immunizations. What is the most appropriate management?

  1. Prescribe oral antibiotics and reassess in 48 hours
  2. Obtain a urinalysis and urine culture and reassess
  3. Reassure and send home without investigation
  4. Arrange urgent full septic workup including lumbar puncture and admit Correct answer.

Explanation

A febrile infant younger than 3 months requires a full sepsis evaluation, and an infant 3 to 6 months with fever and no clear source generally warrants investigation and admission. A 6-month-old with fever and no source needs a thorough workup, including urine testing and, depending on appearance, blood and cerebrospinal fluid studies.

Question 6Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 45-year-old woman describes a 6-month history of low mood, anhedonia, poor sleep, and reduced concentration affecting her work. She denies suicidal ideation. Which is the most appropriate first-line treatment?

  1. Cognitive behavioural therapy or a selective serotonin reuptake inhibitor Correct answer.
  2. Electroconvulsive therapy
  3. Long-term benzodiazepine therapy
  4. Antipsychotic monotherapy

Explanation

For moderate major depressive disorder, evidence-based psychotherapy such as cognitive behavioural therapy or a selective serotonin reuptake inhibitor is first-line. The choice depends on patient preference and availability.

Question 7Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 70-year-old man has an eGFR of 28 mL/min/1.73 m². Which medication class should be avoided because of reduced clearance and risk of adverse effects?

  1. Atorvastatin
  2. Salbutamol
  3. Amlodipine
  4. Nitrofurantoin Correct answer.

Explanation

Nitrofurantoin requires adequate renal function for efficacy and is associated with toxicity when clearance is reduced, so it is avoided when eGFR is below about 30 mL/min/1.73 m². The other agents do not carry this specific restriction.

Question 8Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 25-year-old woman presents with a 3-day history of dysuria, urinary frequency, and urgency without fever or flank pain. She is otherwise healthy and not pregnant. What is the most appropriate management?

  1. Empiric antibiotics for uncomplicated cystitis Correct answer.
  2. Intravenous antibiotics
  3. Urine culture and await results before treating
  4. Imaging with renal ultrasound

Explanation

Uncomplicated cystitis in a healthy non-pregnant woman is treated empirically with antibiotics based on local resistance patterns. Culture is generally reserved for treatment failure, recurrence, or complicating factors.

Question 9Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 2-year-old child is brought in with fever, pulling at the right ear, and irritability. Otoscopy shows a bulging, erythematous tympanic membrane with decreased mobility. What is the most appropriate first-line antibiotic?

  1. Clindamycin
  2. Trimethoprim-sulfamethoxazole
  3. Ciprofloxacin
  4. High-dose amoxicillin Correct answer.

Explanation

High-dose amoxicillin is the recommended first-line antibiotic for acute otitis media in most children, covering the common pathogens including Streptococcus pneumoniae. Alternatives are chosen for allergy or treatment failure.

Question 10Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 35-year-old man has a 2-week history of a painless penile ulcer with a clean base and bilateral inguinal lymphadenopathy. What is the most appropriate initial diagnostic test?

  1. Urine culture
  2. HIV antibody test alone
  3. Herpes simplex PCR from the ulcer
  4. Syphilis serology Correct answer.

Explanation

A painless genital ulcer with regional lymphadenopathy suggests primary syphilis, and serology is the appropriate initial test. Darkfield examination may also be used when available.

Question 11Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 68-year-old woman has a T-score of -2.7 at the lumbar spine and no prior fracture. She is postmenopausal and has adequate calcium and vitamin D intake. What is the most appropriate management?

  1. Repeat bone density in 5 years
  2. Pharmacologic therapy with an antiresorptive agent Correct answer.
  3. Calcium supplementation alone
  4. No intervention because she has not fractured

Explanation

A T-score of -2.5 or lower defines osteoporosis and warrants pharmacologic treatment to reduce fracture risk. Calcium and vitamin D are supportive but not sufficient as monotherapy in established osteoporosis.

Question 12Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 50-year-old woman presents with a 4-week history of fatigue, weight gain, cold intolerance, and constipation. TSH is elevated and free T4 is low. What is the most appropriate treatment?

  1. Methimazole
  2. Propranolol
  3. Levothyroxine Correct answer.
  4. Radioactive iodine

Explanation

The findings indicate primary hypothyroidism, which is treated with levothyroxine replacement titrated to TSH. Antithyroid treatments are used for hyperthyroidism.

Question 13Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 40-year-old man has a 3-month history of intermittent epigastric pain relieved by food, with no alarm features and no NSAID use. He is otherwise well. What is the most appropriate initial investigation?

  1. Abdominal CT scan
  2. Immediate upper endoscopy
  3. Serum gastrin level
  4. Test for Helicobacter pylori with a urea breath test or stool antigen Correct answer.

Explanation

For dyspepsia without alarm features in a younger patient, non-invasive testing for Helicobacter pylori and treatment if positive is recommended. Endoscopy is reserved for alarm features, older age, or treatment failure.

Question 14Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 7-year-old child is brought in with a 2-day history of sore throat, fever of 38.7°C, and tender anterior cervical nodes. He has no cough or rhinorrhea. A rapid streptococcal antigen test is positive. What is the most appropriate treatment?

  1. No antibiotics needed
  2. Azithromycin
  3. Penicillin V Correct answer.
  4. Amoxicillin-clavulanate

Explanation

Confirmed group A streptococcal pharyngitis is treated with penicillin as first-line therapy because it is effective, narrow-spectrum, and inexpensive. Alternatives are used for penicillin allergy.

Question 15Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 30-year-old woman with migraine without aura experiences 6 attacks per month that are disabling. She has no cardiovascular contraindications. What is the most appropriate medication for migraine prophylaxis?

  1. Acetaminophen
  2. Propranolol Correct answer.
  3. Ibuprofen
  4. Sumatriptan

Explanation

Propranolol is an evidence-based first-line option for migraine prophylaxis when attacks are frequent or disabling. Triptans and simple analgesics are acute treatments, not prophylactic.

Question 16Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 65-year-old man has an eGFR of 45 mL/min/1.73 m² and type 2 diabetes. Which medication reduces progression of chronic kidney disease and cardiovascular events?

  1. A beta-blocker
  2. A loop diuretic
  3. A calcium channel blocker
  4. An SGLT2 inhibitor Correct answer.

Explanation

SGLT2 inhibitors slow progression of chronic kidney disease and reduce cardiovascular events in patients with type 2 diabetes and reduced renal function. They are recommended in addition to standard care including renin-angiotensin blockade.

Question 17Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 22-year-old woman has a 3-day history of unilateral throbbing headache, nausea, and light sensitivity, and she reports seeing zigzag lines before the headache. What is the most likely diagnosis?

  1. Tension-type headache
  2. Subarachnoid hemorrhage
  3. Migraine with aura Correct answer.
  4. Cluster headache

Explanation

A unilateral throbbing headache with nausea and photophobia, preceded by transient visual symptoms that resolve, is characteristic of migraine with aura. The aura typically develops over minutes and lasts under an hour.

Question 18Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 55-year-old man has a 3-month history of progressive dyspnea on exertion and bilateral ankle swelling. Examination reveals elevated jugular venous pressure and bibasilar crackles. Which initial test is most useful to assess cardiac structure and function?

  1. Electrocardiogram
  2. Chest radiograph
  3. Brain natriuretic peptide level
  4. Echocardiography Correct answer.

Explanation

Echocardiography is the key test to evaluate ventricular function, valves, and structure in suspected heart failure. It distinguishes reduced from preserved ejection fraction and guides therapy.

Question 19Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 30-year-old woman has a 1-week history of a pruritic, annular, scaly plaque on her forearm. KOH microscopy shows septate hyphae. What is the most appropriate treatment?

  1. Oral prednisone
  2. Topical mupirocin
  3. Topical hydrocortisone
  4. Topical terbinafine Correct answer.

Explanation

KOH-confirmed dermatophyte infection responds to topical antifungal therapy such as terbinafine for localized disease. Corticosteroids alone can worsen fungal infections.

Question 20Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 62-year-old woman has a 2 cm firm, nontender breast mass and no skin changes. What is the most appropriate next step?

  1. Fine-needle aspiration alone without imaging
  2. Bilateral mastectomy referral
  3. Diagnostic mammography and ultrasound with tissue sampling Correct answer.
  4. Reassurance and repeat examination in 6 months

Explanation

A new, firm breast mass in a postmenopausal woman requires triple assessment with imaging and tissue sampling to exclude malignancy. Clinical examination alone is insufficient.

Question 21Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 75-year-old man has an eGFR of 20 mL/min/1.73 m² and is started on a new medication. Which principle best guides prescribing in this patient?

  1. Use standard adult dosing regardless of kidney function
  2. Avoid all medications with any renal metabolism
  3. Double the dose to ensure efficacy
  4. Start at a reduced dose and adjust based on renal function Correct answer.

Explanation

In advanced chronic kidney disease, drugs cleared renally require dose reduction and monitoring to avoid accumulation and toxicity. Standard dosing risks adverse effects.

Question 22Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 40-year-old woman has a 2-day history of fever, unilateral flank pain, and dysuria. She is hemodynamically stable and able to take oral medications. What is the most appropriate management?

  1. Analgesia alone
  2. Oral antibiotics with follow-up Correct answer.
  3. Observation without antibiotics
  4. Intravenous antibiotics and admission for all cases

Explanation

Acute pyelonephritis in a stable patient who can tolerate oral intake may be managed with oral antibiotics and close follow-up. Admission and intravenous therapy are reserved for severe illness, vomiting, or pregnancy.

Question 23Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 12-year-old boy has a 6-month history of frequent headaches, abdominal pain, and school avoidance, with normal examination and investigations. Which management approach is most appropriate?

  1. Reassurance, validation, and gradual return to school Correct answer.
  2. Extensive repeat imaging to rule out rare disease
  3. Immediate psychiatric admission
  4. Long-term opioid analgesia

Explanation

Functional somatic symptoms in a child with normal investigations are best managed with reassurance, validation, and a gradual return to normal activities. Overinvestigation can reinforce symptoms.

Question 24Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 50-year-old woman has a 3-month history of fatigue, and laboratory testing shows a hemoglobin of 105 g/L with a mean corpuscular volume of 72 fL. What is the most likely cause?

  1. Chronic liver disease
  2. Vitamin B12 deficiency
  3. Alcohol excess
  4. Iron deficiency Correct answer.

Explanation

A microcytic anemia with low MCV most commonly reflects iron deficiency in a non-pregnant adult. B12 deficiency and alcohol excess typically produce macrocytosis.

Question 25Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 65-year-old man with atrial fibrillation has a CHADS-65 score indicating anticoagulation. He has no contraindications. Which anticoagulant is most appropriate?

  1. Aspirin
  2. Low-molecular-weight heparin long term
  3. Clopidogrel
  4. A direct oral anticoagulant such as apixaban Correct answer.

Explanation

Direct oral anticoagulants are recommended over aspirin for stroke prevention in non-valvular atrial fibrillation when anticoagulation is indicated. Aspirin is not adequate stroke prophylaxis in this setting.

Question 26Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 58-year-old man with a BMI of 31 kg/m² and no other risk factors asks about screening for type 2 diabetes. He has no symptoms. Which test is most appropriate to screen for type 2 diabetes in this patient?

  1. Oral glucose tolerance test
  2. Fasting plasma glucose
  3. Glycated hemoglobin (A1C) Correct answer.
  4. Random plasma glucose

Explanation

A1C is a convenient single-sample screening test for type 2 diabetes and is recommended for adults at risk, including those with obesity. It reflects average glycemia over roughly three months and does not require fasting.

Question 27Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 3-month-old infant is brought for a routine visit. The parents ask which immunizations are due at this age under the routine Canadian schedule. Which vaccine is routinely given at 2 and 4 months of age?

  1. Varicella
  2. Measles-mumps-rubella
  3. Diphtheria-tetanus-acellular pertussis Correct answer.
  4. Meningococcal conjugate

Explanation

Diphtheria-tetanus-acellular pertussis is part of the routine infant series starting at 2 months. It is given at 2, 4, and 6 months as part of the primary series.

Question 28Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 28-year-old woman is seen for a preconception visit. She has no chronic illness and takes no medications. Which supplement is routinely recommended before conception and in early pregnancy to reduce the risk of neural tube defects?

  1. Folic acid 0.4 mg daily Correct answer.
  2. Calcium carbonate 1000 mg daily
  3. Ferrous sulfate 300 mg daily
  4. Vitamin D 4000 IU daily

Explanation

Folic acid 0.4 mg daily is recommended for at least three months before conception and through the first trimester to reduce neural tube defects. Women at higher risk may require a higher dose.

Question 29Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 45-year-old man presents with sudden onset of severe, sharp chest pain and dyspnea after a long flight. He is tachycardic and hypoxic. Which is the most appropriate initial diagnostic test in a stable patient?

  1. CT pulmonary angiography Correct answer.
  2. Chest radiograph
  3. D-dimer
  4. Troponin

Explanation

In a hemodynamically stable patient with high pretest probability of pulmonary embolism, CT pulmonary angiography is the confirmatory imaging test. D-dimer is used to rule out PE in low-probability patients.

Question 30Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 62-year-old woman with well-controlled hypertension reports a persistent dry cough since starting a new antihypertensive six weeks ago. Which medication is the most likely cause?

  1. Ramipril Correct answer.
  2. Atenolol
  3. Amlodipine
  4. Hydrochlorothiazide

Explanation

ACE inhibitors such as ramipril commonly cause a dry cough due to bradykinin accumulation. Switching to an ARB usually resolves the cough.

Question 31Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 6-year-old boy is brought in with a 3-day history of fever, sore throat, and a sandpaper-like rash. Examination reveals a strawberry tongue and a fine erythematous rash with Pastia lines. What is the most appropriate treatment?

  1. Supportive care only
  2. Amoxicillin for 10 days Correct answer.
  3. Penicillin V for 10 days
  4. Azithromycin for 5 days

Explanation

This presentation suggests streptococcal scarlet fever, for which penicillin or amoxicillin is first-line. Amoxicillin is commonly used and well tolerated.

Question 32Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 34-year-old woman has a 2-day history of unilateral facial pain, nasal congestion, and purulent nasal discharge. She has no fever and symptoms are mild. What is the most appropriate initial management?

  1. Oral corticosteroids
  2. Urgent CT of the sinuses
  3. Amoxicillin-clavulanate
  4. Saline irrigation and analgesics Correct answer.

Explanation

Acute rhinosinusitis is usually viral and mild cases are managed symptomatically with saline irrigation and analgesics. Antibiotics are reserved for severe or persistent cases.

Question 33Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 40-year-old woman presents with a 3-week history of palpitations, heat intolerance, and weight loss. TSH is suppressed and free T4 is elevated. Which is the most appropriate initial test to determine the cause?

  1. Fine-needle aspiration
  2. Radioactive iodine uptake scan Correct answer.
  3. TSH receptor antibodies
  4. Thyroid ultrasound

Explanation

A radioactive iodine uptake scan distinguishes Graves disease (diffuse uptake) from toxic nodular disease (focal uptake) and thyroiditis (low uptake). It is a key step in evaluating the cause of thyrotoxicosis.

Question 34Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 55-year-old man has a blood pressure of 158/96 mmHg on two separate visits. He has no diabetes or kidney disease. What is the most appropriate initial pharmacologic therapy?

  1. A thiazide diuretic, ACE inhibitor, or calcium channel blocker Correct answer.
  2. A loop diuretic
  3. An alpha-blocker
  4. Clonidine

Explanation

First-line antihypertensives for uncomplicated hypertension include thiazide diuretics, ACE inhibitors/ARBs, and calcium channel blockers. These have proven cardiovascular benefit.

Question 35Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 24-year-old woman presents with a 4-day history of vulvar itching and a thick, white, curd-like discharge. She has no fever. What is the most appropriate management?

  1. Intravaginal clindamycin
  2. Empiric azithromycin
  3. Oral metronidazole
  4. Oral fluconazole Correct answer.

Explanation

Vulvovaginal candidiasis typically presents with pruritus and thick white discharge and is treated with topical or oral azoles such as fluconazole.

Question 36Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 68-year-old man reports nocturia, hesitancy, and a weak urinary stream. Digital rectal examination shows a mildly enlarged, smooth prostate. Which is the most appropriate initial management?

  1. Finasteride immediately
  2. Transurethral resection of the prostate
  3. Prostate biopsy
  4. Watchful waiting with lifestyle advice Correct answer.

Explanation

Mild-to-moderate lower urinary tract symptoms from benign prostatic hyperplasia can initially be managed with watchful waiting and lifestyle measures. Medications are added if symptoms are bothersome or worsen.

Question 37Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 30-year-old man has a 2-day history of severe unilateral eye pain, redness, and blurred vision with halos around lights. The pupil is mid-dilated and the cornea is hazy. What is the most appropriate next step?

  1. Oral antihistamine
  2. Warm compresses
  3. Urgent ophthalmology referral Correct answer.
  4. Topical antibiotic drops

Explanation

Acute angle-closure glaucoma is an ophthalmologic emergency presenting with severe eye pain, halos, and a mid-dilated pupil. Immediate referral for definitive management is required.

Question 38Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 9-year-old girl is brought in with a 2-day history of fever and painful vesicles on the lips. She has had similar episodes before. What is the most appropriate management?

  1. Oral antibiotic
  2. Oral acyclovir started within 72 hours Correct answer.
  3. Topical corticosteroid
  4. No treatment needed

Explanation

Primary or recurrent herpes labialis can be treated with oral antivirals such as acyclovir if started early. Supportive care is also appropriate, but antiviral therapy can shorten the course.

Question 39Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 50-year-old woman has a 3-month history of fatigue. Hemoglobin is 105 g/L and mean corpuscular volume is 72 fL. Ferritin is low. Which is the most appropriate next step?

  1. Start oral iron and investigate the source of blood loss Correct answer.
  2. Start vitamin B12 injections
  3. Transfuse packed red blood cells
  4. Reassure and repeat CBC in one year

Explanation

Microcytic anemia with low ferritin indicates iron deficiency. In a middle-aged woman, evaluation for gastrointestinal blood loss is important while starting iron replacement.

Question 40Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 72-year-old woman with osteoporosis and a prior vertebral fracture is on adequate calcium and vitamin D. Which medication is most appropriate to reduce fracture risk?

  1. Alendronate Correct answer.
  2. Calcitriol
  3. Raloxifene
  4. Estrogen therapy

Explanation

Bisphosphonates such as alendronate are first-line for osteoporosis with prior fragility fracture. They reduce vertebral and hip fractures.

Question 41Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 35-year-old man has a 2-week history of palpitations and a resting heart rate of 130 bpm, irregularly irregular. He is hemodynamically stable. Which is the most appropriate initial management?

  1. Observation only
  2. Immediate electrical cardioversion
  3. Rate control with a beta-blocker or calcium channel blocker Correct answer.
  4. Amiodarone infusion

Explanation

For stable atrial fibrillation, rate control is the initial strategy. Electrical cardioversion is reserved for instability or after anticoagulation assessment.

Question 42Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 5-year-old boy is brought in with a 2-day history of vomiting and diarrhea. He is alert, has moist mucous membranes, and is passing urine. What is the most appropriate management?

  1. Intravenous fluids
  2. Oral rehydration solution Correct answer.
  3. Antimotility agents
  4. Antibiotic therapy

Explanation

Mild dehydration from gastroenteritis is managed with oral rehydration solution. Intravenous fluids are reserved for severe dehydration or inability to tolerate oral intake.

Question 43Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 60-year-old man with a 30 pack-year smoking history has a persistent cough and weight loss. Chest radiograph shows a hilar mass. What is the most appropriate next step?

  1. Reassurance
  2. Start antibiotics and reassess
  3. Urgent referral for further evaluation and biopsy Correct answer.
  4. Repeat chest radiograph in 3 months

Explanation

A hilar mass with weight loss and smoking history raises concern for lung cancer and requires urgent referral for staging and biopsy. Delay can worsen prognosis.

Question 44Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 42-year-old woman has a 6-month history of fatigue and diffuse musculoskeletal pain. Examination reveals multiple tender points and no synovitis. Which is the most appropriate management approach?

  1. High-dose corticosteroids
  2. Graded exercise and cognitive behavioural therapy Correct answer.
  3. Long-term opioids
  4. Immediate rheumatology referral for biologics

Explanation

Fibromyalgia is managed with a combination of education, graded exercise, and cognitive behavioural therapy. Opioids and steroids are not recommended.

Question 45Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 30-year-old woman with no prior pregnancies asks about contraception. She has migraine with aura and smokes. Which contraceptive is contraindicated?

  1. Progestin-only pill
  2. Condoms
  3. Copper intrauterine device
  4. Combined oral contraceptive Correct answer.

Explanation

Combined hormonal contraceptives are contraindicated in women with migraine with aura due to increased stroke risk, especially with smoking. Progestin-only or non-hormonal methods are preferred.

Question 46Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 78-year-old man with mild cognitive impairment lives alone. His daughter reports he has been missing medications. What is the most appropriate initial intervention?

  1. Assign a power of attorney
  2. Admission to long-term care
  3. Blister packs and medication review Correct answer.
  4. Discontinue all medications

Explanation

Medication nonadherence in older adults is often addressed with simplification, blister packaging, and review of the regimen. Long-term care is not the first step.

Question 47Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 16-year-old girl presents with a 2-day history of fever, dysuria, and flank pain. Urinalysis shows nitrites and leukocyte esterase. What is the most appropriate management?

  1. Observation without antibiotics
  2. Oral antibiotics and outpatient follow-up Correct answer.
  3. Topical antifungal therapy
  4. Intravenous antibiotics and admission

Explanation

Acute pyelonephritis in a stable adolescent can often be managed with oral antibiotics as an outpatient. Admission is reserved for severe illness or inability to tolerate oral intake.

Question 48Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 55-year-old woman has a 2 cm firm, nontender breast mass. She has no skin changes. What is the most appropriate next step?

  1. Antibiotics
  2. Repeat examination in 6 months
  3. Reassurance
  4. Mammography and referral for biopsy Correct answer.

Explanation

A firm, nontender breast mass in a woman over 50 requires imaging and tissue diagnosis to exclude malignancy. Delay is not appropriate.

Question 49Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 70-year-old man with atrial fibrillation and a CHADS-65 score indicating anticoagulation has no contraindications. Which anticoagulant is most appropriate?

  1. Low-molecular-weight heparin long-term
  2. Apixaban Correct answer.
  3. Aspirin
  4. Clopidogrel

Explanation

Direct oral anticoagulants such as apixaban are first-line for stroke prevention in nonvalvular atrial fibrillation when anticoagulation is indicated.

Question 50Family Medicine (general certification content, per Assessment Objectives for Certification in Family Medicine)

A 10-year-old boy has a 3-day history of sore throat, fever, and a fine rash. Rapid strep test is positive. He has a penicillin allergy with anaphylaxis. What is the most appropriate antibiotic?

  1. Cephalexin
  2. Azithromycin Correct answer.
  3. Amoxicillin
  4. Penicillin V

Explanation

For streptococcal pharyngitis with anaphylactic penicillin allergy, a macrolide such as azithromycin is appropriate. Cephalosporins carry cross-reactivity risk in severe allergy.