I85PREP
⌘ K
ABPS Family Medicine (BCFM) study materials
ABPS Family Medicine (BCFM) study resources

ABPS Family Medicine (BCFM) practice questions

One question at a time. Build your ABPS Family Medicine (BCFM) understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Adult Medicine

A 58-year-old man with type 2 diabetes has an eGFR of 38 mL/min/1.73 m². Which medication should be avoided because of reduced clearance and risk of lactic acidosis?

  1. Glipizide
  2. Metformin Correct answer.
  3. Empagliflozin
  4. Sitagliptin

Explanation

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² and should be avoided or dose-reduced in the 30–45 range because impaired renal clearance raises the risk of lactic acidosis. The other agents listed are not associated with this specific risk at this eGFR.

Question 2Adult Medicine

Which finding on urinalysis most strongly suggests nephrotic-range proteinuria rather than a urinary tract infection?

  1. Positive nitrite
  2. Trace blood with pyuria
  3. 3+ protein without hematuria Correct answer.
  4. Positive leukocyte esterase

Explanation

Marked proteinuria (3+ or greater) without hematuria or pyuria points toward glomerular disease such as nephrotic syndrome. Infection markers like leukocyte esterase, nitrite, and pyuria are typical of UTI, not nephrotic syndrome.

Question 3Adult Medicine

What is the most appropriate initial pharmacologic therapy for a 45-year-old with newly diagnosed uncomplicated hypertension?

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

Explanation

ACE inhibitors, ARBs, thiazide diuretics, and calcium channel blockers are all first-line for uncomplicated hypertension. In patients under 60, ACE inhibitors or ARBs are often favored, particularly when diabetes or CKD coexists.

Question 4Adult Medicine

A 62-year-old with atrial fibrillation and a CHA₂DS₂-VASc score of 4 asks about stroke prevention. What is the most appropriate recommendation?

  1. No antithrombotic therapy
  2. Warfarin only if INR is monitored
  3. Direct oral anticoagulant therapy Correct answer.
  4. Aspirin 81 mg daily

Explanation

A CHA₂DS₂-VASc score of 2 or greater in men (3 or greater in women) warrants oral anticoagulation. Direct oral anticoagulants are preferred over warfarin for nonvalvular AF due to similar or better efficacy and lower intracranial bleeding risk.

Question 5Adult Medicine

Which laboratory finding is most consistent with primary hypothyroidism?

  1. High TSH, low free T4 Correct answer.
  2. High TSH, high free T4
  3. Low TSH, high free T4
  4. Low TSH, low free T4

Explanation

Primary hypothyroidism results from thyroid gland failure, producing low free T4 with a compensatory rise in TSH. The combination of high TSH and low free T4 is diagnostic.

Question 6Adult Medicine

A 30-year-old woman has a positive urine pregnancy test and right lower quadrant pain with adnexal tenderness. What is the most important next step?

  1. Serum beta-hCG and transvaginal ultrasound Correct answer.
  2. Outpatient ultrasound in one week
  3. Reassurance and NSAIDs
  4. Oral antibiotics for PID

Explanation

Ectopic pregnancy must be excluded urgently in any woman of reproductive age with abdominal pain and a positive pregnancy test. Quantitative beta-hCG combined with transvaginal ultrasound is the diagnostic standard.

Question 7Adult Medicine

Which medication class is first-line for chronic stable angina in a patient without contraindications?

  1. Calcium channel blockers
  2. Nitrates
  3. Beta-blockers Correct answer.
  4. Ranolazine

Explanation

Beta-blockers reduce myocardial oxygen demand and are first-line for chronic stable angina unless contraindicated by asthma, bradycardia, or heart block. Other agents are used as add-on or when beta-blockers are not tolerated.

Question 8Adult Medicine

A 70-year-old presents with sudden-onset unilateral weakness and facial droop 45 minutes ago. What is the most appropriate immediate action?

  1. Schedule outpatient MRI
  2. Activate emergency stroke protocol and obtain CT Correct answer.
  3. Wait for symptoms to resolve
  4. Give aspirin 325 mg and observe

Explanation

Acute stroke requires immediate activation of the stroke pathway with emergent noncontrast head CT to differentiate ischemic from hemorrhagic stroke before thrombolysis. Time is brain; delays worsen outcomes.

Question 9Adult Medicine

Which is the most appropriate screening recommendation for colorectal cancer in a 50-year-old average-risk adult?

  1. Annual CEA level
  2. Colonoscopy every 10 years or annual FIT Correct answer.
  3. No screening until age 60
  4. Annual CT colonography

Explanation

Average-risk adults should begin screening at age 45–50 with colonoscopy every 10 years or annual stool-based testing. CEA is a tumor marker for monitoring, not screening.

Question 10Adult Medicine

A 55-year-old with COPD has an FEV1 of 60% predicted and one exacerbation in the past year. What is the most appropriate maintenance therapy?

  1. Long-acting bronchodilator therapy Correct answer.
  2. Oral corticosteroids daily
  3. Short-acting beta-agonist alone
  4. Antibiotic prophylaxis

Explanation

Patients with symptomatic COPD and FEV1 under 60% benefit from long-acting bronchodilators (LAMA, LABA, or both) for symptom control and exacerbation reduction. Short-acting agents are for rescue only.

Question 11Adult Medicine

Which finding most suggests community-acquired pneumonia rather than acute bronchitis in a patient with cough?

  1. Clear lungs with wheezing
  2. Productive cough
  3. Focal crackles and lobar infiltrate Correct answer.
  4. Rhonchi on auscultation

Explanation

Focal crackles with a lobar infiltrate on imaging indicate alveolar consolidation typical of pneumonia. Bronchitis typically shows clear lungs without focal consolidation.

Question 12Adult Medicine

A 24-year-old with a positive rapid strep test has a penicillin allergy (anaphylaxis). What is the most appropriate antibiotic?

  1. Azithromycin Correct answer.
  2. Amoxicillin
  3. Cephalexin
  4. Trimethoprim-sulfamethoxazole

Explanation

For group A streptococcal pharyngitis with severe penicillin allergy, macrolides such as azithromycin or clindamycin are appropriate alternatives. Cross-reactivity with cephalosporins is low but generally avoided in anaphylactic penicillin allergy.

Question 13Adult Medicine

Which is the most appropriate treatment for a first unprovoked seizure in an otherwise healthy adult?

  1. Start valproic acid
  2. No anticonvulsant unless seizure recurs Correct answer.
  3. Start phenytoin
  4. Start daily levetiracetam

Explanation

After a single unprovoked seizure, anticonvulsant therapy is generally not initiated unless there is a high risk of recurrence (e.g., abnormal EEG, structural lesion, or a second seizure).

Question 14Adult Medicine

A 40-year-old woman has a TSH of 0.02 mIU/L, free T4 elevated, and a diffuse goiter with exophthalmos. What is the most likely diagnosis?

  1. Hashimoto thyroiditis
  2. Subacute thyroiditis
  3. Toxic multinodular goiter
  4. Graves disease Correct answer.

Explanation

Hyperthyroidism with diffuse goiter and ophthalmopathy is classic for Graves disease, caused by TSH-receptor antibodies. Exophthalmos is highly specific.

Question 15Adult Medicine

Which is the most appropriate initial management for a patient with symptomatic gallstones and biliary colic?

  1. Ursodeoxycholic acid
  2. ERCP
  3. Low-fat diet alone
  4. Elective cholecystectomy Correct answer.

Explanation

Symptomatic cholelithiasis is best treated with elective laparoscopic cholecystectomy to prevent complications such as cholecystitis or pancreatitis.

Question 16Adult Medicine

A 65-year-old with heart failure and reduced ejection fraction (HFrEF) has persistent symptoms. Which medication class improves survival in HFrEF?

  1. Sacubitril-valsartan Correct answer.
  2. Calcium channel blockers
  3. Alpha-blockers
  4. Thiazolidinediones

Explanation

Sacubitril-valsartan, an ARNI, reduces mortality in HFrEF and is recommended in place of an ACE inhibitor or ARB in appropriate patients.

Question 17Adult Medicine

A 35-year-old presents with a 3-day history of watery diarrhea after recent antibiotic use. Which is the most appropriate initial test?

  1. Colonoscopy
  2. Blood cultures
  3. Stool testing for C. difficile toxin or PCR Correct answer.
  4. Stool culture for C. difficile

Explanation

Antibiotic-associated watery diarrhea suggests Clostridioides difficile infection; stool testing with PCR or toxin assay is the initial diagnostic step.

Question 18Adult Medicine

Which is the most appropriate treatment for a 28-year-old with a first episode of uncomplicated urinary tract infection?

  1. Single dose of azithromycin
  2. Nitrofurantoin for 5 days Correct answer.
  3. Ciprofloxacin for 7 days
  4. Amoxicillin for 10 days

Explanation

Nitrofurantoin for 5 days is first-line for uncomplicated cystitis, offering good efficacy with low collateral damage. Fluoroquinolones are reserved for complicated cases due to resistance and adverse effects.

Question 19Adult Medicine

A 70-year-old with a BMI of 22 and chronic kidney disease has elevated PTH and low vitamin D. Which is the most appropriate initial management?

  1. Cinacalcet
  2. Vitamin D supplementation Correct answer.
  3. Phosphate binders
  4. Calcitriol

Explanation

Secondary hyperparathyroidism in CKD usually begins with vitamin D deficiency; repletion with vitamin D is the initial step before considering active vitamin D analogs or calcimimetics.

Question 20Adult Medicine

Which is the most appropriate screening test for a 55-year-old with a 30 pack-year smoking history?

  1. Annual chest X-ray
  2. Low-dose CT chest annually Correct answer.
  3. PET scan
  4. Sputum cytology

Explanation

Annual low-dose CT screening is recommended for adults aged 50–80 with a 20 pack-year history who currently smoke or quit within 15 years. Chest X-ray and sputum cytology are not effective screening tools.

Question 21Adult Medicine

A 45-year-old with type 2 diabetes has an HbA1c of 9.5% on metformin. What is the most appropriate next step?

  1. Add a GLP-1 receptor agonist or SGLT2 inhibitor Correct answer.
  2. Switch to insulin only
  3. Add a sulfonylurea
  4. Continue metformin alone

Explanation

When HbA1c is more than 1.5% above target on metformin, adding an agent with proven cardiovascular or renal benefit (GLP-1 RA or SGLT2 inhibitor) is recommended.

Question 22Adult Medicine

Which finding is most specific for acute bacterial rhinosinusitis rather than viral upper respiratory infection?

  1. Mild sore throat
  2. Immediate symptom onset
  3. Clear nasal discharge
  4. Symptoms lasting 10 days without improvement Correct answer.

Explanation

Bacterial rhinosinusitis is suggested by symptoms persisting beyond 10 days without improvement, severe symptoms, or worsening after initial improvement. Clear discharge and rapid onset favor viral illness.

Question 23Adult Medicine

A 32-year-old woman has a new diagnosis of generalized anxiety disorder. What is the most appropriate first-line pharmacotherapy?

  1. SSRIs Correct answer.
  2. Antipsychotics
  3. Beta-blockers
  4. Benzodiazepines as monotherapy

Explanation

SSRIs are first-line pharmacotherapy for generalized anxiety disorder due to efficacy and favorable long-term safety. Benzodiazepines are not recommended as monotherapy due to dependence risk.

Question 24Adult Medicine

A 50-year-old with alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. Which is the most likely diagnosis?

  1. Hepatic encephalopathy
  2. Delirium tremens
  3. Wernicke encephalopathy Correct answer.
  4. Subdural hematoma

Explanation

The triad of confusion, ataxia, and ophthalmoplegia in a patient with alcohol use disorder suggests Wernicke encephalopathy due to thiamine deficiency. Immediate parenteral thiamine is required.

Question 25Adult Medicine

Which is the most appropriate first-line treatment for a patient with an acute gout flare?

  1. Probenecid
  2. Allopurinol
  3. NSAIDs, colchicine, or corticosteroids Correct answer.
  4. Low-purine diet alone

Explanation

Acute gout flares are treated with NSAIDs, colchicine, or corticosteroids to reduce inflammation. Urate-lowering therapy is not initiated during an acute flare unless already established.

Question 26Adult Medicine

A 58-year-old man with a history of hypertension and diabetes presents with sudden-onset severe tearing chest pain radiating to the back. His blood pressure is 180/100 mm Hg in the right arm and 140/80 mm Hg in the left arm. Which is the most appropriate initial diagnostic study?

  1. Chest radiograph
  2. Electrocardiogram
  3. CT angiography of the chest Correct answer.
  4. Transthoracic echocardiography

Explanation

The clinical picture of sudden tearing chest pain with a blood pressure differential between arms is highly suggestive of aortic dissection. CT angiography of the chest is the preferred initial imaging modality because it rapidly visualizes the aorta and can confirm the diagnosis. Transthoracic echocardiography may show an intimal flap but is less sensitive and not the first-line test in stable patients.

Question 27Adult Medicine

A 45-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. On examination, she has dry skin and a diffuse goiter. Laboratory tests show TSH 10 mIU/L (reference 0.4-4.0) and free T4 0.6 ng/dL (reference 0.8-1.8). Which is the most appropriate initial treatment?

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

Explanation

The patient has primary hypothyroidism, evidenced by elevated TSH and low free T4. Levothyroxine is the standard replacement therapy. Methimazole and radioactive iodine are used for hyperthyroidism, and liothyronine (T3) is not first-line for chronic replacement.

Question 28Adult Medicine

A 62-year-old man with a history of myocardial infarction presents with progressive exertional dyspnea and orthopnea. Examination reveals bibasilar crackles, an S3 gallop, and jugular venous distension. Echocardiogram shows an ejection fraction of 30%. Which medication has been shown to reduce mortality in this condition?

  1. Furosemide
  2. Carvedilol Correct answer.
  3. Digoxin
  4. Amlodipine

Explanation

Carvedilol is a beta-blocker with mortality benefit in heart failure with reduced ejection fraction (HFrEF). Furosemide provides symptomatic relief but does not improve survival. Amlodipine and digoxin do not reduce mortality in HFrEF.

Question 29Adult Medicine

A 28-year-old woman presents with a 2-day history of dysuria, frequency, and suprapubic discomfort. She is afebrile with no flank pain. Urinalysis shows positive leukocyte esterase and nitrites. Which is the most appropriate management?

  1. Trimethoprim-sulfamethoxazole for 3 days Correct answer.
  2. Phenazopyridine alone
  3. Ciprofloxacin for 7 days
  4. Observation without antibiotics

Explanation

The presentation is consistent with uncomplicated cystitis. First-line treatment includes nitrofurantoin, trimethoprim-sulfamethoxazole (if local resistance is <20%), or fosfomycin. A 3-day course of trimethoprim-sulfamethoxazole is appropriate. Fluoroquinolones are reserved for more complicated infections, and phenazopyridine is only for symptom relief.

Question 30Adult Medicine

A 55-year-old man with a 40 pack-year smoking history presents with a 3-week history of a nonproductive cough and one episode of hemoptysis. He has no fever or weight loss. Which is the most appropriate next step in evaluation?

  1. Empiric antibiotics
  2. Observation and reassurance
  3. Sputum culture
  4. Chest radiograph Correct answer.

Explanation

Hemoptysis in a smoker with a significant smoking history warrants evaluation for lung cancer. A chest radiograph is the initial imaging test; if abnormal or if suspicion remains high, a CT scan is indicated. Sputum culture and empiric antibiotics are not appropriate without evidence of infection.

Question 31Adult Medicine

A 70-year-old woman with osteoporosis and a history of a fragility fracture is started on alendronate. Which instruction is most important to include when counseling her about this medication?

  1. Remain upright for at least 30 minutes after taking it. Correct answer.
  2. Take it with food to reduce gastrointestinal upset.
  3. Take it only on days when she has bone pain.
  4. Take it at bedtime with a glass of water.

Explanation

Alendronate can cause severe esophagitis; therefore, patients must take it with a full glass of water and remain upright for at least 30 minutes to prevent esophageal irritation. It should be taken on an empty stomach, not with food, and not at bedtime.

Question 32Adult Medicine

A 35-year-old man presents with a 4-day history of fever, sore throat, and tonsillar exudates. He has tender anterior cervical lymphadenopathy but no cough. Rapid antigen detection test for group A streptococcus is negative. Which is the most appropriate next step?

  1. Reassure and provide symptomatic care
  2. Prescribe amoxicillin
  3. Prescribe azithromycin
  4. Obtain a throat culture Correct answer.

Explanation

In adults with a negative rapid antigen test but clinical features suggestive of streptococcal pharyngitis, a throat culture is recommended to confirm the diagnosis before initiating antibiotics. Empiric antibiotics are not recommended unless the patient has severe symptoms or risk factors.

Question 33Adult Medicine

A 50-year-old woman presents with a 2-month history of episodic palpitations, sweating, and headache. She has a blood pressure of 160/95 mm Hg and heart rate of 100 bpm. Which is the most appropriate initial screening test for pheochromocytoma?

  1. Plasma free metanephrines Correct answer.
  2. Serum aldosterone and renin
  3. Thyroid-stimulating hormone
  4. 24-hour urinary cortisol

Explanation

Pheochromocytoma is suspected in patients with paroxysmal symptoms and hypertension. Plasma free metanephrines are the most sensitive initial test. Urinary cortisol, aldosterone/renin, and TSH are used to evaluate other causes of hypertension.

Question 34Adult Medicine

A 68-year-old man with chronic obstructive pulmonary disease (COPD) presents with increased dyspnea, increased sputum volume, and sputum purulence. He is febrile and has a chest radiograph showing a new infiltrate. Which is the most appropriate treatment?

  1. Increase his short-acting bronchodilator use only
  2. Admit for intravenous antibiotics
  3. Prescribe a course of systemic corticosteroids alone
  4. Start antibiotics and systemic corticosteroids Correct answer.

Explanation

The patient has an acute exacerbation of COPD with signs of pneumonia (fever, new infiltrate). Treatment includes antibiotics and systemic corticosteroids. Hospital admission may be considered based on severity, but outpatient management with oral antibiotics and steroids is appropriate for mild to moderate cases.

Question 35Adult Medicine

A 30-year-old woman presents with fatigue, arthralgias, and a malar rash. Laboratory tests show a positive antinuclear antibody (ANA) and elevated anti-double-stranded DNA (anti-dsDNA). Which finding is most specific for systemic lupus erythematosus (SLE)?

  1. Arthralgias
  2. Positive ANA
  3. Leukopenia
  4. Elevated anti-dsDNA Correct answer.

Explanation

Anti-dsDNA is highly specific for SLE and correlates with disease activity, particularly lupus nephritis. ANA is sensitive but not specific, and leukopenia and arthralgias are nonspecific findings.

Question 36Adult Medicine

A 55-year-old man with type 2 diabetes and a history of myocardial infarction is started on a new medication. Which medication has been shown to reduce cardiovascular mortality in patients with type 2 diabetes and established cardiovascular disease?

  1. Pioglitazone
  2. Glipizide
  3. Empagliflozin Correct answer.
  4. Sitagliptin

Explanation

Empagliflozin, an SGLT2 inhibitor, has been shown to reduce cardiovascular mortality in patients with type 2 diabetes and established cardiovascular disease. Glipizide, sitagliptin, and pioglitazone do not have this proven benefit.

Question 37Adult Medicine

A 40-year-old woman presents with a 6-month history of recurrent epigastric pain that occurs 2-3 hours after meals and at night. She has been using ibuprofen daily for chronic back pain. Which is the most likely diagnosis?

  1. Peptic ulcer disease Correct answer.
  2. Gastroesophageal reflux disease
  3. Acute pancreatitis
  4. Biliary colic

Explanation

The patient has typical symptoms of peptic ulcer disease: epigastric pain that occurs hours after meals and at night, often relieved by food or antacids. Chronic NSAID use is a major risk factor. GERD typically causes heartburn and regurgitation, while pancreatitis and biliary colic have different pain patterns.

Question 38Adult Medicine

A 65-year-old man with hypertension and diabetes presents with sudden-onset severe headache, nausea, and vomiting. His blood pressure is 220/120 mm Hg. Funduscopic examination reveals papilledema. Which is the most appropriate initial management?

  1. Sodium nitroprusside infusion
  2. Oral nifedipine
  3. Observation and reassurance
  4. Labetalol bolus Correct answer.

Explanation

The patient has a hypertensive emergency with signs of end-organ damage (papilledema). Intravenous labetalol is a first-line agent for hypertensive emergencies because it can be titrated and does not cause reflex tachycardia. Sodium nitroprusside is also used but requires invasive monitoring and can cause cyanide toxicity. Oral nifedipine is contraindicated due to unpredictable drops in blood pressure.

Question 39Adult Medicine

A 30-year-old woman presents with a 2-day history of severe unilateral headache with ptosis and miosis on the same side. She reports similar episodes occurring daily for the past week. Which is the most likely diagnosis?

  1. Cluster headache Correct answer.
  2. Tension-type headache
  3. Trigeminal neuralgia
  4. Migraine with aura

Explanation

Cluster headaches are characterized by severe unilateral periorbital pain with ipsilateral autonomic symptoms such as ptosis, miosis, lacrimation, and rhinorrhea. They often occur in clusters with frequent daily attacks. Migraine with aura typically has visual symptoms, and tension-type headache is bilateral and mild.

Question 40Adult Medicine

A 55-year-old man with a history of alcohol use disorder presents with confusion, ataxia, and ophthalmoplegia. Which is the most likely diagnosis?

  1. Wernicke encephalopathy Correct answer.
  2. Delirium tremens
  3. Hepatic encephalopathy
  4. Korsakoff syndrome

Explanation

Wernicke encephalopathy is characterized by the triad of confusion, ataxia, and ophthalmoplegia, often seen in alcohol use disorder due to thiamine deficiency. Korsakoff syndrome is a chronic memory disorder that may follow Wernicke. Delirium tremens is an acute withdrawal syndrome with agitation and autonomic hyperactivity.

Question 41Pediatrics and Adolescent Medicine

A healthy 4-year-old presents with a 2-day history of low-grade fever, runny nose, and a scattered vesicular rash on the palms, soles, and oral mucosa. Which of the following is the most likely causative agent?

  1. Parvovirus B19
  2. Group A beta-hemolytic Streptococcus
  3. Coxsackievirus A16 Correct answer.
  4. Varicella-zoster virus

Explanation

Hand-foot-and-mouth disease is typically caused by coxsackievirus A16 (and enterovirus 71) and produces vesicles on the palms, soles, and oral mucosa, often with mild fever. Parvovirus B19 causes slapped-cheek rash, varicella produces a generalized pruritic vesicular rash in different stages, and group A strep causes pharyngitis or scarlet fever.

Question 42Pediatrics and Adolescent Medicine

A 2-month-old infant is brought for a well-child visit. Which of the following is the most appropriate routine immunization at this age according to the standard US childhood schedule?

  1. MMR and varicella
  2. Hepatitis A and influenza
  3. DTaP, IPV, Hib, PCV, and rotavirus (second dose series) Correct answer.
  4. Meningococcal conjugate and HPV

Explanation

At 2 months, the routine schedule includes DTaP, IPV, Hib, PCV, and rotavirus (second dose in the series) along with hepatitis B. MMR/varicella are given at 12-15 months, hepatitis A at 12-23 months, and HPV/meningococcal in adolescence.

Question 43Pediatrics and Adolescent Medicine

A 3-year-old is brought in with a barking cough, hoarse voice, and inspiratory stridor that worsens at night. He has a low-grade fever and appears nontoxic. What is the most appropriate first-line pharmacologic treatment?

  1. Nebulized epinephrine as sole therapy
  2. Oral amoxicillin
  3. Nebulized albuterol
  4. Oral dexamethasone Correct answer.

Explanation

This presentation is consistent with viral croup (laryngotracheobronchitis), for which a single dose of oral dexamethasone is first-line and reduces airway edema. Nebulized epinephrine is reserved for moderate-to-severe stridor at rest, and antibiotics are not indicated for viral croup.

Question 44Pediatrics and Adolescent Medicine

A newborn is noted to have a bluish-gray macule over the lumbosacral area with ill-defined borders and no associated swelling. The parents are concerned. What is the most appropriate management?

  1. Urgent MRI of the spine
  2. Topical corticosteroid
  3. Punch biopsy
  4. Reassurance and observation Correct answer.

Explanation

Congenital dermal melanocytosis (formerly Mongolian spots) is a benign finding common in infants with darker skin and requires only reassurance. Imaging is reserved for lesions over the midline with associated hair tufts, dimples, or other markers of occult spinal dysraphism.

Question 45Pediatrics and Adolescent Medicine

A 6-year-old presents with a 3-week history of nocturnal perianal itching. A tape test confirms pinworm infection. Which of the following is the most appropriate treatment?

  1. Albendazole Correct answer.
  2. Acyclovir
  3. Metronidazole
  4. Amoxicillin

Explanation

Enterobiasis is treated with albendazole or mebendazole, and household contacts should be treated simultaneously to prevent reinfection. Metronidazole treats protozoa and anaerobes, not helminths.

Question 46Pediatrics and Adolescent Medicine

A 12-month-old is brought in with a 3-day history of fever, fussiness, and pulling at the right ear. Otoscopy reveals a bulging, erythematous tympanic membrane. Which of the following is the most appropriate initial antibiotic?

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

Explanation

High-dose amoxicillin is the first-line therapy for acute otitis media in children without penicillin allergy, covering the common pathogens Streptococcus pneumoniae and Haemophilus influenzae. Azithromycin and TMP-SMX are second-line options reserved for allergy or treatment failure.

Question 47Pediatrics and Adolescent Medicine

A 15-year-old girl presents with primary amenorrhea, normal breast development, and a short stature with a webbed neck. Which of the following is the most likely diagnosis?

  1. Klinefelter syndrome
  2. Turner syndrome Correct answer.
  3. Constitutional delay of puberty
  4. Androgen insensitivity syndrome

Explanation

Turner syndrome (45,X) presents with primary amenorrhea, short stature, webbed neck, and gonadal dysgenesis; breast development may occur from estrogen replacement or residual function. Klinefelter occurs in males, and androgen insensitivity presents with absent breast development.

Question 48Pediatrics and Adolescent Medicine

A 4-year-old is brought in after a febrile illness with new bruising and petechiae, and a platelet count of 18,000/microL with otherwise normal cell lines. Which of the following is the most likely diagnosis?

  1. Von Willebrand disease
  2. Acute lymphoblastic leukemia
  3. Hemolytic uremic syndrome
  4. Immune thrombocytopenic purpura Correct answer.

Explanation

Immune thrombocytopenic purpura presents with isolated thrombocytopenia and mucocutaneous bleeding after a viral illness, with normal white and red cell lines. Leukemia typically causes cytopenias across multiple lineages, and HUS features anemia and renal failure.

Question 49Pediatrics and Adolescent Medicine

A 7-year-old presents with a 2-week history of fever, rash, conjunctivitis, cracked lips, and a strawberry tongue. Echocardiography is planned. What is the most important reason for this evaluation?

  1. Assessment of valvular vegetations
  2. Detection of coronary artery aneurysms Correct answer.
  3. Evaluation of ventricular hypertrophy
  4. Screening for pericardial effusion

Explanation

Kawasaki disease is a medium-vessel vasculitis that can cause coronary artery aneurysms, making echocardiography essential for risk stratification. Treatment with IVIG and aspirin within 10 days reduces this risk.

Question 50Pediatrics and Adolescent Medicine

A 3-year-old presents with fever, drooling, and a muffled voice, sitting forward with the neck extended. Which of the following is the most appropriate immediate step?

  1. Administer oral amoxicillin and discharge
  2. Inspect the throat with a tongue depressor
  3. Obtain a lateral neck radiograph before any intervention
  4. Secure the airway with emergency personnel present Correct answer.

Explanation

This presentation suggests epiglottitis, a potential airway emergency; the priority is securing the airway with anesthesia or ENT support. Throat inspection and imaging should be avoided until the airway is controlled because they can precipitate obstruction.