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HKCFP Conjoint MCQ study materials
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HKCFP Conjoint MCQ practice questions

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Question 1Family Medicine (content domains not enumerated in source)

A 28-year-old woman presents with 3 days of dysuria and urinary frequency. She is otherwise well, has no vaginal discharge, and is not pregnant. According to current guidance for uncomplicated cystitis in primary care, which management is most appropriate?

  1. Immediate referral for intravenous antibiotics
  2. Routine urine culture before any treatment in all cases
  3. A 7-day course of oral fluconazole
  4. A 3-day course of oral trimethoprim where local resistance is low Correct answer.

Explanation

Uncomplicated cystitis in a non-pregnant woman is usually managed empirically with a short course of an appropriate oral antibiotic such as trimethoprim, nitrofurantoin, or fosfomycin, guided by local resistance data. Routine culture is not required for typical uncomplicated presentations, and antifungal therapy is irrelevant to bacterial cystitis.

Question 2Family Medicine (content domains not enumerated in source)

Which single measurement is the most reliable confirmation of a diagnosis of hypertension when clinic readings are persistently elevated?

  1. Patient-reported home readings on one occasion
  2. A random office reading taken after exercise
  3. A single clinic reading above 140/90 mmHg
  4. Ambulatory blood pressure monitoring over 24 hours Correct answer.

Explanation

Ambulatory blood pressure monitoring is the reference standard for confirming hypertension because it averages multiple readings across the day and night and avoids white-coat effect. Single clinic readings and isolated home values are insufficient for diagnosis.

Question 3Family Medicine (content domains not enumerated in source)

A 45-year-old man with no other risk factors has a fasting plasma glucose of 6.4 mmol/L on two occasions. What is the most appropriate interpretation?

  1. Established type 2 diabetes mellitus
  2. Normal glucose tolerance
  3. Impaired fasting glucose (prediabetes) Correct answer.
  4. Need for immediate insulin therapy

Explanation

A fasting plasma glucose between 6.1 and 6.9 mmol/L defines impaired fasting glucose, a prediabetic state. Diabetes requires a fasting value of 7.0 mmol/L or above, or other confirmatory criteria.

Question 4Family Medicine (content domains not enumerated in source)

A 30-year-old woman has a confirmed uncomplicated first episode of genital herpes simplex. Which treatment approach is recommended?

  1. Topical aciclovir alone applied to lesions
  2. Long-term suppressive therapy from the outset
  3. Oral aciclovir started within the first few days of the episode Correct answer.
  4. No treatment unless symptoms persist beyond two weeks

Explanation

A first episode of genital herpes should be treated with a short course of oral antiviral therapy, ideally started within 5 days of lesion onset or while new lesions are forming. Topical agents are ineffective, and suppressive therapy is reserved for frequent recurrences.

Question 5Family Medicine (content domains not enumerated in source)

Which finding in an infant most strongly suggests developmental dysplasia of the hip on routine screening?

  1. Symmetrical skin creases
  2. A positive Ortolani or Barlow manoeuvre Correct answer.
  3. Mild bowing of the tibia
  4. Bilateral flat feet

Explanation

The Ortolani and Barlow manoeuvres test for hip instability and are the key clinical screening signs for developmental dysplasia of the hip in infancy. Asymmetrical creases may raise suspicion but are less specific, and foot or tibial findings are unrelated.

Question 6Family Medicine (content domains not enumerated in source)

A 60-year-old woman with type 2 diabetes attends for review. Which single intervention has the strongest evidence for reducing cardiovascular events in this population?

  1. Routine aspirin for primary prevention in all diabetics
  2. Blood pressure control to target Correct answer.
  3. Routine vitamin E supplementation
  4. Annual chest radiography

Explanation

Tight blood pressure control is one of the most effective interventions for reducing cardiovascular events in people with type 2 diabetes. Aspirin for primary prevention is no longer routinely recommended because bleeding risk offsets benefit, and vitamin E and chest radiography have no role.

Question 7Family Medicine (content domains not enumerated in source)

A 25-year-old woman requests emergency contraception after unprotected intercourse 48 hours ago. She has a regular 28-day cycle and her last period began 10 days ago. Which option is most appropriate?

  1. No intervention, as the timing is outside the fertile window
  2. Oral levonorgestrel only, since the copper device is ineffective after 24 hours
  3. Mifepristone as first-line emergency contraception
  4. Copper intrauterine device or oral levonorgestrel, both being suitable within this timeframe Correct answer.

Explanation

Both the copper intrauterine device (effective up to 5 days) and oral levonorgestrel (effective up to 72 hours, best within 24 hours) are suitable at 48 hours after unprotected intercourse. The copper device is actually the most effective option and remains valid well beyond 24 hours.

Question 8Family Medicine (content domains not enumerated in source)

Which of the following is the recommended first-line pharmacological treatment for a patient with newly diagnosed uncomplicated type 2 diabetes and no contraindications?

  1. Insulin glargine
  2. Metformin Correct answer.
  3. A sulfonylurea
  4. A thiazolidinedione

Explanation

Metformin is recommended as first-line pharmacotherapy for type 2 diabetes because it is effective, weight-neutral, and has a good safety profile. Insulin and other agents are added or substituted when metformin is contraindicated or targets are not met.

Question 9Family Medicine (content domains not enumerated in source)

A 35-year-old man presents with a 2-day history of severe unilateral testicular pain and swelling, with nausea and no urinary symptoms. What is the most important immediate step?

  1. Reassurance and outpatient review in one week
  2. Immediate treatment for epididymitis without assessment
  3. Ultrasound arranged for the following week
  4. Urgent surgical/emergency assessment to exclude testicular torsion Correct answer.

Explanation

Acute severe unilateral testicular pain in a young man is a urological emergency until torsion is excluded, and surgical assessment must be immediate. Delay for imaging or outpatient review risks testicular loss.

Question 10Family Medicine (content domains not enumerated in source)

A 70-year-old woman with atrial fibrillation has a CHA2DS2-VASc score of 4. She has no contraindication to anticoagulation. What is the appropriate management?

  1. Anticoagulation only after a stroke occurs
  2. Long-term oral anticoagulation Correct answer.
  3. No anticoagulation because of age
  4. Aspirin alone

Explanation

A CHA2DS2-VASc score of 2 or more in a woman indicates a clear indication for long-term oral anticoagulation to prevent stroke. Aspirin is less effective and not a substitute, and anticoagulation should not be deferred until a stroke occurs.

Question 11Family Medicine (content domains not enumerated in source)

A 50-year-old smoker presents with a persistent cough and one episode of haemoptysis. Which action is most appropriate in primary care?

  1. Urgent referral for suspected lung cancer assessment Correct answer.
  2. Reassurance and symptomatic treatment only
  3. Antibiotics and review only if symptoms persist for three months
  4. Chest radiograph in six months

Explanation

Haemoptysis in a smoker aged over 40 warrants urgent referral for suspected lung cancer under standard referral criteria. Symptomatic treatment alone or delayed imaging risks missing a curable malignancy.

Question 12Family Medicine (content domains not enumerated in source)

A 55-year-old woman reports 6 months of low mood, anhedonia, poor sleep, and reduced concentration affecting her work. She has no suicidal ideation. What is the most appropriate initial management?

  1. Long-term benzodiazepines
  2. Immediate psychiatric admission
  3. Structured psychological therapy or an antidepressant, with regular review Correct answer.
  4. Watchful waiting without any intervention

Explanation

Moderate to severe depression with functional impairment is managed with structured psychological therapy and/or an antidepressant, with regular follow-up to assess response. Watchful waiting is inadequate for this severity, and benzodiazepines are not a treatment for depression.

Question 13Family Medicine (content domains not enumerated in source)

A 40-year-old woman has a blood pressure of 158/98 mmHg on three separate visits. She has no other cardiovascular risk factors. What is the recommended initial approach?

  1. Lifestyle advice plus antihypertensive medication Correct answer.
  2. Immediate referral to a cardiologist
  3. Lifestyle advice alone with no medication
  4. No action until she develops symptoms

Explanation

Stage 2 hypertension (clinic readings of 160/100 mmHg or above, or sustained elevation with high cardiovascular risk) generally warrants antihypertensive medication alongside lifestyle advice. For readings in the 140–159/90–99 range, risk assessment guides whether to start medication, but with sustained stage 2 readings treatment is indicated.

Question 14Family Medicine (content domains not enumerated in source)

A 3-year-old child presents with a barking cough, hoarse voice, and inspiratory stridor at rest. What is the most appropriate first-line treatment?

  1. Nebulised salbutamol
  2. Antihistamines
  3. Oral antibiotics
  4. Oral corticosteroids Correct answer.

Explanation

The presentation is croup, and a single dose of oral corticosteroid is first-line for stridor at rest. Antibiotics are ineffective for viral croup, and salbutamol and antihistamines have no role in its management.

Question 15Family Medicine (content domains not enumerated in source)

A 65-year-old man with chronic kidney disease stage 3 presents with gout. Which consideration is most important when selecting treatment?

  1. Avoid NSAIDs and adjust urate-lowering therapy to renal function Correct answer.
  2. Use standard-dose NSAIDs freely
  3. Withhold all treatment until dialysis is required
  4. Double the allopurinol dose to compensate for reduced clearance

Explanation

NSAIDs can worsen renal function and should be avoided in chronic kidney disease. Urate-lowering therapy such as allopurinol requires dose adjustment to renal function, and treatment should not be withheld.

Question 16Family Medicine (content domains not enumerated in source)

A 22-year-old woman has a BMI of 17.5 and reports food restriction and fear of weight gain. Which feature most strongly indicates a diagnosis of anorexia nervosa rather than another eating disorder?

  1. Binge eating followed by purging
  2. Normal weight with recurrent binge eating
  3. Obesity with no concerns about body image
  4. Low body weight with body-image distortion and fear of weight gain Correct answer.

Explanation

Anorexia nervosa is characterised by significantly low body weight, an intense fear of gaining weight, and body-image disturbance. Binge-purge patterns at normal weight suggest bulimia nervosa, while binge eating without weight concern suggests binge eating disorder.

Question 17Family Medicine (content domains not enumerated in source)

A 30-year-old woman with a history of asthma presents with increased wheeze and night-time symptoms over the past two weeks. She uses a short-acting beta-agonist several times a day. What is the most appropriate step?

  1. Stop all inhaled therapy
  2. Step up to a regular inhaled corticosteroid-containing regimen Correct answer.
  3. Continue the same treatment and review in six months
  4. Start long-term oral corticosteroids

Explanation

Frequent short-acting beta-agonist use and night-time symptoms indicate inadequate control, and treatment should be stepped up to include regular inhaled corticosteroids. Long-term oral steroids are reserved for severe refractory disease.

Question 18Family Medicine (content domains not enumerated in source)

A 50-year-old man has a total cholesterol of 7.2 mmol/L and a 10-year cardiovascular risk of 15%. He smokes and has no other conditions. What is the recommended management?

  1. No treatment because risk is below 20%
  2. Immediate referral for coronary angiography
  3. Lifestyle advice only, with review in ten years
  4. Offer a statin alongside lifestyle advice Correct answer.

Explanation

A 10-year cardiovascular risk of 10% or more generally warrants offering a statin in addition to lifestyle advice. Waiting for risk to exceed 20% or delaying review for ten years would miss an opportunity for prevention.

Question 19Family Medicine (content domains not enumerated in source)

A 28-year-old woman at 10 weeks' gestation presents with confirmed uncomplicated urinary tract infection. Which antibiotic is most appropriate?

  1. Trimethoprim
  2. Doxycycline
  3. Nitrofurantoin, avoiding use near term Correct answer.
  4. Ciprofloxacin

Explanation

In pregnancy, nitrofurantoin is generally first-line for uncomplicated urinary tract infection, though it should be avoided near term because of neonatal haemolysis risk. Trimethoprim is a folate antagonist and avoided in the first trimester, while fluoroquinolones and tetracyclines are contraindicated.

Question 20Family Medicine (content domains not enumerated in source)

A 70-year-old man presents with sudden painless loss of vision in one eye. What is the most appropriate immediate action?

  1. Reassurance and review in one week
  2. Same-day urgent ophthalmology assessment Correct answer.
  3. Arrange routine optometry appointment in one month
  4. Prescribe antibiotic eye drops

Explanation

Sudden painless loss of vision may represent retinal artery occlusion, retinal detachment, or vitreous haemorrhage, all of which require same-day ophthalmological assessment. Delay risks irreversible visual loss.

Question 21Family Medicine (content domains not enumerated in source)

A 45-year-old woman has a 3 cm firm, painless breast lump. Which investigation is most appropriate for initial assessment?

  1. Mammography in one year
  2. Antibiotics and review in six weeks
  3. Urgent referral to a symptomatic breast clinic Correct answer.
  4. Reassurance without investigation

Explanation

A new discrete breast lump in a woman aged over 30 warrants urgent referral to a symptomatic breast service for triple assessment. Reassurance, delayed mammography, or antibiotics risks missing breast cancer.

Question 22Family Medicine (content domains not enumerated in source)

A 60-year-old man with known heart failure and reduced ejection fraction presents with worsening breathlessness and ankle swelling. Which medication improves survival in this condition?

  1. A short-acting beta-agonist
  2. A calcium channel blocker such as verapamil
  3. A non-steroidal anti-inflammatory drug
  4. An ACE inhibitor or ARIN Correct answer.

Explanation

ACE inhibitors (and ARINs such as sacubitril-valsartan) improve survival in heart failure with reduced ejection fraction. Verapamil may worsen heart failure, beta-agonists are not indicated, and NSAIDs can cause fluid retention and renal impairment.

Question 23Family Medicine (content domains not enumerated in source)

A 35-year-old woman presents with recurrent episodes of palpitations, sweating, and tremor that resolve spontaneously. Which investigation is most appropriate first-line to investigate a suspected phaeochromocytoma?

  1. Routine full blood count
  2. Plasma free metanephrines Correct answer.
  3. 24-hour Holter monitoring only
  4. Serum thyroxine only

Explanation

Plasma free metanephrines (or 24-hour urinary fractionated metanephrines) are the most sensitive initial biochemical tests for phaeochromocytoma. Thyroid function should also be checked, but it does not exclude phaeochromocytoma.

Question 24Family Medicine (content domains not enumerated in source)

A 65-year-old man with type 2 diabetes and an eGFR of 40 mL/min/1.73m² is on metformin. What is the most appropriate action?

  1. Double the metformin dose
  2. Stop all diabetes treatment immediately
  3. Review the dose and consider reducing it, with monitoring of renal function Correct answer.
  4. Continue metformin at the current dose without review

Explanation

Metformin should be reviewed and usually dose-reduced when eGFR falls below 45 mL/min/1.73m², with regular monitoring, and stopped if eGFR falls below 30. Doubling the dose is unsafe, and stopping all treatment is unnecessary.

Question 25Family Medicine (content domains not enumerated in source)

A 70-year-old woman on warfarin for atrial fibrillation is started on a course of an antibiotic. She presents with bruising and an INR of 6.0 but no bleeding. What is the most appropriate immediate action?

  1. Continue warfarin at the same dose and recheck in a month
  2. Give fresh frozen plasma immediately
  3. Double the warfarin dose to stabilise the INR
  4. Withhold warfarin, consider vitamin K, and identify the interacting antibiotic Correct answer.

Explanation

An INR of 6.0 without bleeding requires withholding warfarin and considering low-dose vitamin K, along with review of the precipitating cause such as an antibiotic interaction. Fresh frozen plasma is reserved for major bleeding, and continuing or increasing warfarin would worsen the coagulopathy.

Question 26Family Medicine (content domains not enumerated in source)

A 68-year-old man with hypertension and type 2 diabetes attends for review. His blood pressure is 148/86 mmHg on three occasions despite lifestyle advice and a single antihypertensive. Which step is most appropriate next in a family medicine setting?

  1. Reassure him that this reading is acceptable for his age group
  2. Intensify therapy by adding a second agent from a different class Correct answer.
  3. Refer urgently to the emergency department for intravenous therapy
  4. Stop his current agent and observe for three months

Explanation

In a patient with diabetes, the usual blood pressure target is below 130/80 mmHg, so 148/86 mmHg on repeated readings is above target. When lifestyle measures and one agent fail to control pressure, combination therapy with two agents of different classes is the standard next step. Urgent hospital referral is reserved for severe hypertension with acute target-organ features.

Question 27Family Medicine (content domains not enumerated in source)

A 24-year-old woman asks about cervical screening. She has never had sexual intercourse and has no symptoms. What is the most appropriate advice regarding cervical screening in her situation?

  1. She requires annual screening because she has never been screened
  2. Screening can be deferred until she has had sexual intercourse Correct answer.
  3. She should be screened on the same schedule as other women of her age
  4. She should have a diagnostic colposcopy instead of screening

Explanation

Cervical screening programmes generally start at a defined age and women who have never been sexually active have an extremely low risk of HPV-related disease, so screening can usually be deferred until they become sexually active. Screening is not a diagnostic test, and colposcopy is reserved for abnormal results. The decision should be discussed and documented rather than imposed.

Question 28Family Medicine (content domains not enumerated in source)

A 45-year-old woman presents with a three-day history of dysuria, frequency and suprapubic discomfort. She is otherwise well, has no fever or flank pain, and is not pregnant. What is the most appropriate initial management?

  1. Refer for urgent renal ultrasound
  2. Admit for intravenous antibiotics and urine culture
  3. Prescribe a short course of an appropriate oral antibiotic Correct answer.
  4. Reassure and advise increased fluid intake alone

Explanation

This is a typical uncomplicated lower urinary tract infection in a non-pregnant woman, for which a short course of an appropriate oral antibiotic is first-line. Urine culture is not routinely required in uncomplicated cases but is indicated if symptoms are atypical or recurrent. Imaging and admission are reserved for complications such as pyelonephritis or structural concerns.

Question 29Family Medicine (content domains not enumerated in source)

A 72-year-old woman who lives alone has had two falls in the past six months. She takes five regular medicines and reports dizziness on standing. Which single action is most useful in reducing her future fall risk?

  1. Restricting her walking to reduce the chance of falling
  2. Advising her to move into residential care immediately
  3. Prescribing a benzodiazepine to improve her sleep
  4. Reviewing her medication and assessing for postural hypotension Correct answer.

Explanation

Medication review and assessment of postural blood pressure are core components of multifactorial falls assessment, because sedatives, antihypertensives and polypharmacy are common reversible contributors. Addressing these modifiable factors reduces falls more reliably than restricting mobility. Residential care is a major decision that should not be the first response to two falls.

Question 30Family Medicine (content domains not enumerated in source)

A 30-year-old man is diagnosed with major depressive disorder. He has no psychotic features and is not suicidal. He prefers not to take medication initially. Which psychological approach has the strongest evidence as first-line treatment for moderate depression?

  1. Long-term supportive listening from a family member
  2. Psychodynamic psychotherapy as the sole recommended modality
  3. General lifestyle advice without any structured therapy
  4. Structured cognitive behavioural therapy of adequate duration Correct answer.

Explanation

Structured cognitive behavioural therapy, delivered over an adequate course, has robust evidence for moderate depression and is recommended as a first-line option alongside antidepressant medication. It targets unhelpful thoughts and behaviours with a defined therapeutic framework. Unstructured support, while valuable, is not equivalent to a formal evidence-based therapy.

Question 31Family Medicine (content domains not enumerated in source)

A 55-year-old man with a BMI of 32 kg/m² and no other risk factors asks about screening for type 2 diabetes. Which statement best reflects appropriate screening practice?

  1. Screening is unnecessary because he has no symptoms
  2. He should be offered a blood glucose or HbA1c test as part of risk assessment Correct answer.
  3. He should have an oral glucose tolerance test every year
  4. Screening should be delayed until he develops symptoms

Explanation

Obesity is a recognised risk factor for type 2 diabetes, and risk-assessment tools combined with a blood glucose or HbA1c measurement are the standard approach to screening. Asymptomatic people with risk factors are precisely the group targeted by screening. Annual oral glucose tolerance testing is not the routine screening method.

Question 32Family Medicine (content domains not enumerated in source)

A 40-year-old woman presents with a two-week history of a dry cough, low-grade fever and fatigue. She returned from a trip two weeks ago. Chest examination is normal. Which initial investigation is most appropriate?

  1. CT pulmonary angiogram
  2. Bronchoscopy
  3. Chest radiograph Correct answer.
  4. Sputum culture for acid-fast bacilli

Explanation

A persistent cough with fever and fatigue after travel warrants a chest radiograph as the initial investigation to look for pneumonia, tuberculosis or other pulmonary pathology. It is widely available, quick and guides further testing. More invasive or specialised tests follow only if the radiograph or clinical course suggests they are needed.

Question 33Family Medicine (content domains not enumerated in source)

A 65-year-old man with chronic obstructive pulmonary disease has a resting oxygen saturation of 88% on room air when clinically stable. What is the most appropriate next step regarding long-term oxygen therapy?

  1. Prescribe oxygen only during exercise
  2. Reassure him that oxygen is not indicated in COPD
  3. Assess arterial blood gases to confirm eligibility for long-term oxygen Correct answer.
  4. Start continuous oxygen immediately without further testing

Explanation

Long-term oxygen therapy in COPD is indicated when arterial blood gas measurements confirm significant hypoxaemia while clinically stable, typically on two occasions. A single oximetry reading is not sufficient to start long-term oxygen, and blood gas assessment also identifies hypercapnia. Confirming eligibility prevents unnecessary treatment and its risks.

Question 34Family Medicine (content domains not enumerated in source)

A 28-year-old woman has a regular 28-day cycle and requests advice on fertility awareness. She asks when ovulation most commonly occurs in a typical cycle. What is the most appropriate answer?

  1. On the first day of menstruation
  2. Around day 7 of the cycle
  3. Around 14 days before the next expected period Correct answer.
  4. Around day 21 of every cycle

Explanation

Ovulation occurs approximately 14 days before the next menstrual period, so in a 28-day cycle it falls around day 14. The luteal phase is relatively constant while the follicular phase varies, which is why timing is described relative to the next period. This underpins the fertile window used in fertility awareness methods.

Question 35Family Medicine (content domains not enumerated in source)

A 50-year-old woman has a fasting plasma glucose of 6.4 mmol/L on two separate occasions. She is asymptomatic. What is the most appropriate interpretation and plan?

  1. This is diagnostic of diabetes and requires immediate insulin therapy
  2. This is a normal result requiring no action
  3. This indicates impaired fasting glucose; advise lifestyle changes and reassess Correct answer.
  4. This requires an urgent referral for a pancreatic scan

Explanation

A fasting plasma glucose between 6.1 and 6.9 mmol/L is classified as impaired fasting glucose, indicating increased risk of progression to diabetes. Management is lifestyle modification with regular reassessment, and many guidelines also consider metformin in selected high-risk patients. It is not diagnostic of diabetes, which requires a fasting glucose of 7.0 mmol/L or above or other confirmatory criteria.

Question 36Family Medicine (content domains not enumerated in source)

A 62-year-old man with atrial fibrillation is being considered for anticoagulation. His estimated glomerular filtration rate is 25 mL/min/1.73m². Which consideration is most important when choosing an anticoagulant?

  1. Dose selection and drug choice must account for renal function and specific agent criteria Correct answer.
  2. All direct oral anticoagulants are contraindicated below 30 mL/min/1.73m²
  3. Warfarin is always preferred regardless of monitoring ability
  4. Anticoagulation should be stopped because of his renal function

Explanation

Renal function influences both the choice and the dose of anticoagulants, and each direct oral anticoagulant has its own licensed renal thresholds and dose adjustments. Warfarin remains an option and may be preferred if renal function is very poor or monitoring is feasible. Anticoagulation should not be abandoned automatically, because stroke risk persists.

Question 37Family Medicine (content domains not enumerated in source)

A 35-year-old woman has a body mass index of 27 kg/m² and reports irregular periods and unwanted hair growth. Which initial investigation is most appropriate when polycystic ovary syndrome is suspected?

  1. Bone marrow biopsy
  2. Overnight dexamethasone suppression test
  3. Serum calcium and parathyroid hormone
  4. Serum testosterone and pelvic ultrasound Correct answer.

Explanation

Assessment for polycystic ovary syndrome includes clinical or biochemical hyperandrogenism, ovulatory dysfunction and ovarian morphology on ultrasound. Serum testosterone and pelvic ultrasound therefore form the initial investigation, alongside exclusion of other causes such as thyroid disease and hyperprolactinaemia. Tests for Cushing syndrome, hyperparathyroidism or marrow disease are not first-line.

Question 38Family Medicine (content domains not enumerated in source)

A 4-year-old child has a temperature of 38.9°C, is drinking, has a normal respiratory rate and no rash. The parents ask about antipyretics. What is the most appropriate advice?

  1. Give paracetamol regularly to keep the temperature normal at all times
  2. Alternate paracetamol and ibuprofen routinely every two hours
  3. Give aspirin to reduce the risk of febrile complications
  4. Use antipyretics for discomfort rather than solely to lower the temperature Correct answer.

Explanation

Antipyretics are used to relieve discomfort from fever rather than to normalise temperature, since fever itself is not harmful. Regular dosing purely to keep the temperature down is unnecessary and may risk overdose. Aspirin is avoided in children because of its association with Reye syndrome.

Question 39Family Medicine (content domains not enumerated in source)

A 58-year-old woman with type 2 diabetes has an HbA1c of 7.4% and is on metformin. She has no cardiovascular disease or renal impairment. What is the most appropriate approach to her glycaemic target?

  1. Stop metformin and rely on diet alone
  2. Individualise the target, generally aiming for around 7% or below Correct answer.
  3. Accept any HbA1c because she is over 50
  4. Intensify treatment to reach an HbA1c below 6.0%

Explanation

Most adults with type 2 diabetes aim for an HbA1c around 7% or below, with the target individualised according to age, comorbidity, hypoglycaemia risk and life expectancy. A target below 6.0% is generally too tight for most patients and increases hypoglycaemia risk. Stopping effective treatment would worsen control.

Question 40Family Medicine (content domains not enumerated in source)

A 70-year-old man has been on long-term prednisolone for polymyalgia rheumatica. Which measure is most important to reduce the risk of glucocorticoid-induced osteoporosis?

  1. Routine calcium and vitamin D supplementation alone without further assessment
  2. Annual chest radiograph
  3. Increasing dietary protein to 200 g daily
  4. Assessment of fracture risk with bone density and consideration of bone protection Correct answer.

Explanation

Long-term glucocorticoid use substantially increases fracture risk, so assessment with bone density and fracture-risk tools, together with bone-protective treatment where indicated, is the key measure. Calcium and vitamin D are supportive but insufficient alone for higher-risk patients. Imaging and protein loading do not address bone loss.

Question 41Family Medicine (content domains not enumerated in source)

A 45-year-old man presents with a three-month history of heartburn and regurgitation. He has no dysphagia, weight loss or anaemia. What is the most appropriate initial management?

  1. Long-term antibiotics for Helicobacter pylori without testing
  2. Antacid therapy as the only long-term treatment
  3. Lifestyle advice and a trial of a proton pump inhibitor Correct answer.
  4. Immediate referral for oesophagectomy

Explanation

Typical reflux symptoms without alarm features are managed initially with lifestyle measures and a trial of a proton pump inhibitor. If symptoms persist or alarm features appear, further investigation such as endoscopy is considered. Surgery is reserved for selected refractory cases.

Question 42Family Medicine (content domains not enumerated in source)

A 32-year-old woman presents with a two-day history of severe unilateral headache with a drooping eyelid and a small pupil on the same side. What is the most likely diagnosis?

  1. Migraine with aura
  2. Giant cell arteritis
  3. Cluster headache Correct answer.
  4. Tension-type headache

Explanation

Severe unilateral periorbital headache with ipsilateral ptosis and miosis constitutes a Horner syndrome and is characteristic of cluster headache. The attacks are typically short and severe and may be associated with lacrimation and nasal congestion. Giant cell arteritis should be considered in older patients with scalp tenderness and visual symptoms.

Question 43Family Medicine (content domains not enumerated in source)

A 60-year-old woman has a painless, firm, irregular breast mass. She asks which investigation is most appropriate to establish the diagnosis.

  1. Observation with repeat examination in six months
  2. Fine-needle aspiration cytology alone
  3. Core needle biopsy with histology Correct answer.
  4. Mammography alone

Explanation

Core needle biopsy with histological assessment provides a definitive tissue diagnosis and allows receptor testing, which guides treatment planning. Imaging alone cannot confirm malignancy, and cytology alone cannot distinguish invasive from in-situ disease. Delayed repeat examination would risk progression.

Question 44Family Medicine (content domains not enumerated in source)

A 25-year-old man has a three-day history of urethral discharge and dysuria. He reports unprotected intercourse with a new partner. Which initial management is most appropriate?

  1. Reassurance that the symptoms will resolve without treatment
  2. Empirical treatment and testing for gonorrhoea and chlamydia with partner notification Correct answer.
  3. Immediate referral for urethral surgery
  4. Treatment of the patient only without partner notification

Explanation

Urethral discharge in a sexually active young man suggests a sexually transmitted infection, most commonly chlamydia or gonorrhoea. Empirical treatment guided by local protocols, appropriate testing and partner notification are all essential to prevent reinfection and onward transmission. Surgery has no role, and treating the patient alone leaves partners untreated.

Question 45Family Medicine (content domains not enumerated in source)

A 78-year-old woman with moderate dementia has become more confused over two days and is less responsive. Which initial step is most important in her assessment?

  1. Increasing her cholinesterase inhibitor dose
  2. Arranging long-term residential placement
  3. Reassuring the family that this is expected in dementia
  4. Looking for a precipitating cause such as infection, medication or dehydration Correct answer.

Explanation

An acute change in cognition and responsiveness in a patient with dementia suggests delirium superimposed on dementia. The priority is to identify and treat precipitating causes such as infection, medication effects, pain, constipation or dehydration. Increasing dementia medication does not treat delirium and may worsen confusion.

Question 46Family Medicine (content domains not enumerated in source)

A 50-year-old woman asks about colorectal cancer screening. She has no symptoms and no family history. Which statement best reflects appropriate screening advice?

  1. Screening is only for people with a family history
  2. Screening should be offered using a faecal test or colonoscopy according to local programme Correct answer.
  3. Screening should start only after symptoms develop
  4. Screening requires annual colonoscopy for everyone

Explanation

Population screening for colorectal cancer is offered to people in the eligible age range using a faecal occult blood or immunochemical test, with colonoscopy for positive results, or by colonoscopy where programmes use it. Family history affects risk and may prompt earlier or more intensive screening but is not a prerequisite. Screening is for asymptomatic people by definition.

Question 47Family Medicine (content domains not enumerated in source)

A 65-year-old man with heart failure and reduced ejection fraction has worsening breathlessness and ankle swelling. He is on an angiotensin-converting enzyme inhibitor, a beta-blocker and a diuretic. Which additional agent improves outcomes in this condition?

  1. A thiazolidinedione
  2. A mineralocorticoid receptor antagonist Correct answer.
  3. A calcium channel blocker
  4. An alpha blocker

Explanation

Mineralocorticoid receptor antagonists improve mortality and hospitalisation in heart failure with reduced ejection fraction when added to standard therapy, provided renal function and potassium are monitored. Calcium channel blockers, alpha blockers and thiazolidinediones do not improve outcomes in this setting, and thiazolidinediones can worsen fluid retention.

Question 48Family Medicine (content domains not enumerated in source)

A 30-year-old woman with a history of asthma reports worsening night-time symptoms and increased reliever use over two weeks. She is using her reliever most days. What is the most appropriate initial step in management?

  1. Stop her inhaled corticosteroid and use a reliever alone
  2. Step up treatment with regular inhaled corticosteroid-containing therapy Correct answer.
  3. Continue her current regimen and review in three months
  4. Start long-term oral corticosteroids

Explanation

Increasing reliever use and night-time symptoms indicate inadequate asthma control and a need to step up therapy, typically by ensuring adherence to regular inhaled corticosteroid-containing treatment. Reliever-only treatment is unsafe because it does not address airway inflammation. Oral corticosteroids are reserved for acute exacerbations.

Question 49Family Medicine (content domains not enumerated in source)

A 55-year-old man has a blood pressure of 150/95 mmHg. He smokes and has a family history of premature cardiovascular disease. Which additional assessment is most important for estimating his overall cardiovascular risk?

  1. A brain MRI
  2. A routine chest radiograph
  3. An exercise stress test for all patients
  4. A lipid profile and assessment of other risk factors Correct answer.

Explanation

Estimating cardiovascular risk requires assessment of lipids, smoking status, diabetes, renal function and other risk factors, usually combined in a validated risk tool. This guides decisions about antihypertensive and lipid-lowering treatment. Exercise testing, chest radiography and brain MRI are not routine for primary risk estimation.

Question 50Family Medicine (content domains not enumerated in source)

A 40-year-old woman has a newly diagnosed uncomplicated urinary tract infection. She is not pregnant and has no allergies. Which antibiotic choice is most appropriate when local resistance patterns are unknown?

  1. Trimethoprim or nitrofurantoin according to local guidance Correct answer.
  2. An aminoglycoside
  3. A fluoroquinolone as first-line therapy
  4. A tetracycline

Explanation

For uncomplicated urinary tract infection, first-line agents are typically trimethoprim or nitrofurantoin, chosen according to local resistance data and contraindications. Fluoroquinolones are reserved for complicated or resistant infections because of collateral damage and adverse effects. Aminoglycosides and tetracyclines are not oral first-line options.