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PGIM MD Family Medicine study materials
PGIM MD Family Medicine study resources

PGIM MD Family Medicine practice questions

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Question 1Clinical Family Medicine and Primary Care

A 58-year-old man with type 2 diabetes has an eGFR of 38 mL/min/1.73 m² and an albumin-to-creatinine ratio of 45 mg/mmol. Which medication class should be prioritized for kidney and cardiovascular protection, with dose adjustment as needed?

  1. A thiazolidinedione such as pioglitazone
  2. A sulfonylurea such as glyburide
  3. An SGLT2 inhibitor such as empagliflozin Correct answer.
  4. A DPP-4 inhibitor such as sitagliptin

Explanation

SGLT2 inhibitors reduce progression of chronic kidney disease and major cardiovascular events in patients with type 2 diabetes and albuminuric CKD, and they can be used down to low eGFR thresholds with continued benefit. Glyburide is risky in renal impairment because active metabolites accumulate and cause hypoglycemia.

Question 2Clinical Family Medicine and Primary Care

Which blood pressure target is recommended for most adults with confirmed hypertension, according to current guidelines?

  1. Less than 150/90 mmHg
  2. Less than 120/70 mmHg
  3. Less than 140/90 mmHg
  4. Less than 130/80 mmHg Correct answer.

Explanation

Major guidelines (ACC/AHA and increasingly others) recommend a target of less than 130/80 mmHg for most adults with hypertension, based on trials showing reduced cardiovascular events. Targets below 120/70 are not routinely recommended and 140/90 or 150/90 represent higher thresholds.

Question 3Clinical Family Medicine and Primary Care

A 24-year-old woman has a 3-day history of dysuria and frequency without fever or flank pain. She is otherwise healthy and not pregnant. What is the most appropriate initial management for uncomplicated cystitis?

  1. Nitrofurantoin for 5 days Correct answer.
  2. Ciprofloxacin for 14 days
  3. Watchful waiting without antibiotics
  4. Intravenous ceftriaxone

Explanation

First-line therapy for uncomplicated cystitis includes nitrofurantoin for 5 days (or trimethoprim-sulfamethoxazole for 3 days where resistance is low). Short courses are effective and minimize collateral damage. Fluoroquinolones and parenteral therapy are reserved for complicated or upper tract infection.

Question 4Clinical Family Medicine and Primary Care

A 45-year-old man presents with sudden onset of severe unilateral scrotal pain and swelling that began 2 hours ago. The cremasteric reflex is absent on the affected side. What is the most appropriate immediate step?

  1. Reassurance and outpatient follow-up in one week
  2. Urgent urology referral for surgical exploration Correct answer.
  3. Oral antibiotics for epididymitis
  4. Scrotal ultrasound before any intervention

Explanation

Testicular torsion is a surgical emergency; the classic presentation is sudden severe unilateral pain with an absent cremasteric reflex. Immediate urologic consultation for detorsion is required, and imaging should not delay surgery when clinical suspicion is high.

Question 5Clinical Family Medicine and Primary Care

Which finding best supports a diagnosis of acute otitis media rather than otitis media with effusion in a child?

  1. Serous effusion present for 8 weeks without symptoms
  2. Bulging, erythematous tympanic membrane with acute onset of ear pain Correct answer.
  3. Mild erythema of the tympanic membrane alone
  4. A retracted tympanic membrane with an air-fluid level

Explanation

Acute otitis media requires acute symptom onset plus middle-ear effusion with moderate-to-severe bulging of the tympanic membrane or new-onset otorrhea. Otitis media with effusion is characterized by fluid without signs of acute inflammation.

Question 6Clinical Family Medicine and Primary Care

A 30-year-old woman with migraine with aura asks about contraception. Which method should be avoided because of increased stroke risk?

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

Explanation

Migraine with aura plus combined hormonal contraception increases ischemic stroke risk, so combined estrogen-containing methods are contraindicated. Progestin-only and intrauterine methods are preferred alternatives.

Question 7Clinical Family Medicine and Primary Care

A 68-year-old woman has a DXA T-score of -2.8 at the femoral neck and no prior fractures. What is the most appropriate first-line pharmacologic treatment?

  1. Raloxifene
  2. Teriparatide
  3. Calcium and vitamin D alone
  4. Alendronate with calcium and vitamin D Correct answer.

Explanation

A T-score of -2.5 or lower defines osteoporosis, and bisphosphonates such as alendronate are first-line therapy along with adequate calcium and vitamin D. Teriparatide is reserved for severe or high-risk cases, and calcium and vitamin D alone are insufficient to treat established osteoporosis.

Question 8Clinical Family Medicine and Primary Care

Which symptom pattern is most characteristic of major depressive disorder rather than a normal grief reaction?

  1. Self-esteem that remains intact
  2. Persistent anhedonia and worthlessness lasting more than 2 weeks Correct answer.
  3. Ability to enjoy activities when distracted from grief
  4. Sadness that comes in waves triggered by reminders of the deceased

Explanation

Major depressive disorder is characterized by persistent depressed mood or anhedonia for at least two weeks, often with worthlessness and functional impairment. Uncomplicated grief tends to come in waves, preserves self-esteem, and allows moments of positive emotion.

Question 9Clinical Family Medicine and Primary Care

A 6-year-old child with asthma uses a short-acting beta-agonist more than twice weekly during the day. What is the appropriate step-up controller therapy?

  1. Increase short-acting beta-agonist use
  2. Long-acting beta-agonist without inhaled corticosteroid
  3. Oral montelukast alone
  4. Low-dose inhaled corticosteroid Correct answer.

Explanation

Intermittent symptoms requiring SABA more than twice weekly indicate the need for daily controller therapy, and low-dose inhaled corticosteroids are the preferred first-line controller for children. LABAs should never be used as monotherapy in asthma.

Question 10Clinical Family Medicine and Primary Care

A 55-year-old man has a fasting glucose of 118 mg/dL on two occasions. Which next step is most appropriate?

  1. Start insulin therapy
  2. Repeat testing or measure HbA1c to confirm prediabetes Correct answer.
  3. No further evaluation needed
  4. Diagnose type 1 diabetes

Explanation

A fasting glucose of 100–125 mg/dL indicates prediabetes, which should be confirmed with repeat testing or HbA1c. Lifestyle intervention is the cornerstone of management. Insulin and type 1 diabetes are not appropriate for this presentation.

Question 11Clinical Family Medicine and Primary Care

Which finding is most consistent with community-acquired pneumonia requiring hospitalization rather than outpatient management?

  1. Temperature of 38.0°C with mild cough
  2. Respiratory rate of 32 breaths/min and oxygen saturation of 88% Correct answer.
  3. Isolated pleuritic chest pain
  4. White blood cell count of 11,000/µL

Explanation

Tachypnea and hypoxemia are components of severity scores such as CURB-65 and PSI that suggest the need for inpatient care. Mild fever, modest leukocytosis, or isolated pleuritic pain can often be managed as an outpatient.

Question 12Clinical Family Medicine and Primary Care

A 40-year-old woman has a new painless breast mass. What is the most appropriate next step in evaluation?

  1. Diagnostic mammography and breast ultrasound Correct answer.
  2. Observation for 6 months
  3. Reassurance without imaging
  4. Fine-needle aspiration as the sole test

Explanation

A new palpable breast mass in a woman of this age warrants imaging, typically diagnostic mammography plus ultrasound, with biopsy if suspicious. Observation alone risks missing malignancy, and FNA without imaging is inadequate.

Question 13Clinical Family Medicine and Primary Care

Which vaccine is recommended during every pregnancy, ideally in the third trimester, to protect the newborn?

  1. Tdap Correct answer.
  2. Human papillomavirus
  3. Measles-mumps-rubella
  4. Varicella

Explanation

Tdap is recommended during each pregnancy, ideally at 27–36 weeks, to provide passive antibody protection against pertussis in the newborn. Live vaccines such as MMR and varicella are contraindicated in pregnancy, and HPV vaccine is not given during pregnancy.

Question 14Clinical Family Medicine and Primary Care

A 70-year-old man has an eGFR of 30 mL/min/1.73 m² and takes metformin. What is the most appropriate action?

  1. Increase the metformin dose
  2. Continue metformin at the same dose
  3. Switch to a sulfonylurea without adjustment
  4. Discontinue metformin because of the risk of lactic acidosis Correct answer.

Explanation

Metformin is contraindicated when eGFR falls below 30 mL/min/1.73 m² because of the risk of lactic acidosis. Dose reduction is considered at lower eGFR thresholds, but discontinuation is required at this level.

Question 15Clinical Family Medicine and Primary Care

Which feature most strongly suggests a benign cause of dizziness rather than a central etiology?

  1. Vertigo accompanied by severe occipital headache
  2. Reproducible vertigo triggered by head position changes with a positive Dix-Hallpike test Correct answer.
  3. Vertigo with new focal limb weakness
  4. Sudden onset of vertigo with diplopia and dysarthria

Explanation

Positional vertigo with a positive Dix-Hallpike test is characteristic of benign paroxysmal positional vertigo. Central causes are suggested by neurologic signs such as diplopia, dysarthria, weakness, or severe headache.

Question 16Clinical Family Medicine and Primary Care

A 35-year-old man has a blood pressure of 158/96 mmHg on three separate visits with no identifiable secondary cause. What is the most appropriate initial pharmacologic therapy?

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

Explanation

For primary hypertension, first-line agents include thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers. Alpha-blockers, loop diuretics, and minoxidil are reserved for specific indications or resistant hypertension.

Question 17Clinical Family Medicine and Primary Care

A 28-year-old woman has a positive urine pregnancy test and sudden severe unilateral pelvic pain with vaginal bleeding. What is the most important diagnosis to exclude?

  1. Endometriosis
  2. Urinary tract infection
  3. Ectopic pregnancy Correct answer.
  4. Ovarian cyst

Explanation

A positive pregnancy test with severe unilateral pelvic pain and bleeding raises concern for ectopic pregnancy, which can be life-threatening if ruptured. Immediate evaluation with ultrasound and quantitative hCG is required.

Question 18Clinical Family Medicine and Primary Care

Which laboratory finding is most consistent with iron deficiency anemia?

  1. Low ferritin with low mean corpuscular volume Correct answer.
  2. High ferritin with high mean corpuscular volume
  3. Normal ferritin with elevated reticulocyte count
  4. Elevated ferritin with normal MCV

Explanation

Iron deficiency anemia is microcytic with low ferritin, reflecting depleted iron stores. Ferritin is an acute-phase reactant but remains the most specific single test, and a low value is diagnostic.

Question 19Clinical Family Medicine and Primary Care

A 62-year-old man has a 20 pack-year smoking history and reports a chronic cough that has changed in character. What is the most appropriate next step?

  1. Chest imaging to evaluate for lung cancer Correct answer.
  2. Reassurance and symptomatic cough suppressants
  3. Pulmonary function testing alone
  4. Empiric antibiotics for bronchitis

Explanation

A changed chronic cough in a person with significant smoking history warrants chest imaging to evaluate for malignancy. Symptomatic treatment or empiric antibiotics would delay diagnosis.

Question 20Clinical Family Medicine and Primary Care

A 50-year-old woman has a thyroid-stimulating hormone level that is low with an elevated free T4. What is the most likely diagnosis?

  1. Graves disease Correct answer.
  2. Iodine deficiency
  3. Hashimoto thyroiditis
  4. Subclinical hypothyroidism

Explanation

A suppressed TSH with elevated free T4 indicates primary hyperthyroidism, and Graves disease is the most common cause in this age group. Hashimoto and iodine deficiency cause hypothyroidism, and subclinical hypothyroidism has elevated TSH with normal free T4.

Question 21Clinical Family Medicine and Primary Care

Which is the recommended colorectal cancer screening strategy for an average-risk 50-year-old?

  1. No screening until age 60
  2. Colonoscopy every 10 years or annual fecal immunochemical test Correct answer.
  3. Colonoscopy every 5 years
  4. CT colonography every 15 years

Explanation

Average-risk adults should begin screening at age 45–50, with options including colonoscopy every 10 years or annual FIT. Shorter intervals or delayed screening are not recommended for average risk.

Question 22Clinical Family Medicine and Primary Care

A 19-year-old college student has fever, sore throat, and posterior cervical lymphadenopathy. A rapid strep test is negative. What is the most appropriate next step?

  1. Consider Epstein-Barr virus testing with heterophile antibody Correct answer.
  2. Start amoxicillin empirically
  3. Perform urgent tonsillectomy
  4. Reassure without further testing

Explanation

The presentation suggests infectious mononucleosis, and heterophile antibody testing supports the diagnosis. Amoxicillin should be avoided because it can cause a rash in EBV infection, and surgery is not indicated acutely.

Question 23Clinical Family Medicine and Primary Care

A 72-year-old woman has a urinary tract infection and is confused and hypotensive. Which factor most strongly predicts the need for hospital admission?

  1. Hemodynamic instability with altered mental status Correct answer.
  2. Dysuria
  3. Positive urine culture
  4. Low-grade fever

Explanation

Sepsis with hypotension and altered mental status in an older adult requires inpatient management with fluids and antibiotics. A positive culture or dysuria alone can be managed in the outpatient setting.

Question 24Clinical Family Medicine and Primary Care

A 45-year-old man has a blood pressure of 170/105 mmHg with headache and no evidence of end-organ damage. What is the most appropriate management?

  1. Gradual blood pressure reduction with oral agents and close follow-up Correct answer.
  2. Immediate intravenous nitroprusside to normalize blood pressure
  3. No treatment
  4. Rapid reduction to normal within 1 hour

Explanation

Hypertensive urgency without end-organ damage should be treated with oral agents and gradual reduction, avoiding overly rapid lowering that can cause ischemia. Intravenous therapy and rapid normalization are reserved for hypertensive emergencies.

Question 25Clinical Family Medicine and Primary Care

Which screening test is recommended for a 65-year-old man with no symptoms to detect abdominal aortic aneurysm?

  1. Abdominal ultrasound Correct answer.
  2. Physical examination alone
  3. CT angiography
  4. Abdominal radiograph

Explanation

One-time abdominal ultrasound screening is recommended for men aged 65–75 with a smoking history to detect abdominal aortic aneurysm. CT angiography is diagnostic but not a screening tool, and radiographs and examination are insensitive.

Question 26Clinical Family Medicine and Primary Care

A 24-year-old woman has recurrent episodes of wheezing and chest tightness that occur mainly at night and after exercise. Spirometry shows a forced expiratory volume in 1 second that improves by 14% and 250 mL after an inhaled bronchodilator. Which finding best confirms a diagnosis of asthma?

  1. Presence of a chronic productive cough for 3 months each year
  2. A reduced diffusing capacity for carbon monoxide
  3. A chest radiograph showing hyperinflation
  4. Reversibility of airflow obstruction after a short-acting beta-agonist Correct answer.

Explanation

Asthma is confirmed by demonstrating variable expiratory airflow limitation, and significant bronchodilator reversibility (an increase in FEV1 of at least 12% and 200 mL) supports the diagnosis in a patient with typical symptoms. The clinical pattern of nocturnal and exercise-related symptoms further supports asthma.

Question 27Clinical Family Medicine and Primary Care

A 58-year-old man with type 2 diabetes has an LDL cholesterol of 145 mg/dL and no clinical atherosclerotic disease. He is already on maximally tolerated statin therapy. Which additional lipid-lowering agent is most appropriate to further reduce cardiovascular risk?

  1. Gemfibrozil
  2. Cholestyramine
  3. Niacin
  4. Ezetimibe Correct answer.

Explanation

In patients with diabetes at high cardiovascular risk who remain above LDL targets on maximally tolerated statin, adding ezetimibe is a guideline-endorsed step because it lowers LDL further with proven outcome benefit. It is well tolerated and does not worsen glycemic control.

Question 28Clinical Family Medicine and Primary Care

A 34-year-old woman reports palpitations, heat intolerance, and weight loss. Examination shows a diffuse goiter, tremor, and lid lag. Which additional finding would most support Graves disease over a toxic nodule?

  1. Bilateral exophthalmos Correct answer.
  2. Suppressed uptake on a thyroid scan in one region
  3. A single palpable thyroid nodule
  4. A family history of multinodular goiter

Explanation

Graves disease is an autoimmune condition caused by TSH-receptor antibodies and classically produces diffuse goiter with extrathyroidal features such as ophthalmopathy. Bilateral exophthalmos is highly specific for Graves disease and helps distinguish it from autonomous nodular disease.

Question 29Clinical Family Medicine and Primary Care

A 47-year-old woman presents with a 3-day history of severe unilateral headache with a red, tearing eye and ptosis on the same side. Attacks last about 45 minutes and occur several times daily. Which medication is most appropriate for acute relief?

  1. Amitriptyline taken at bedtime
  2. High-flow inhaled oxygen Correct answer.
  3. Oral sumatriptan at the onset of pain
  4. Propranolol taken daily

Explanation

This presentation describes cluster headache, for which high-flow inhaled oxygen (typically 100% at 12 L/min via a non-rebreather mask) is a first-line acute therapy. It works rapidly and is safe, making it the preferred initial abortive option.

Question 30Clinical Family Medicine and Primary Care

A 22-year-old man has an acute monoarthritis of the knee with a joint aspirate showing needle-shaped, negatively birefringent crystals. Which diagnosis is most consistent with this finding?

  1. Gout Correct answer.
  2. Calcium pyrophosphate deposition disease
  3. Hemarthrosis
  4. Septic arthritis

Explanation

Needle-shaped crystals that are negatively birefringent under polarized light are characteristic of monosodium urate, confirming gout. Calcium pyrophosphate crystals are rhomboid and positively birefringent, which distinguishes the two conditions.

Question 31Clinical Family Medicine and Primary Care

A 62-year-old man with chronic obstructive pulmonary disease has a resting oxygen saturation of 88% confirmed on two occasions 3 weeks apart. Which intervention has been shown to improve survival in this setting?

  1. Oral theophylline
  2. Routine use of antitussives
  3. Long-term oxygen therapy for at least 15 hours per day Correct answer.
  4. Inhaled corticosteroids as monotherapy

Explanation

Long-term oxygen therapy improves survival in patients with COPD and chronic severe hypoxemia, defined as a resting PaO2 of 55 mmHg or less or oxygen saturation of 88% or less. The benefit depends on using it for a substantial portion of each day, typically at least 15 hours.

Question 32Clinical Family Medicine and Primary Care

A 30-year-old woman has a 2-day history of dysuria, frequency, and suprapubic discomfort without fever or flank pain. She is otherwise healthy and not pregnant. Which is the most appropriate initial management?

  1. A short course of oral nitrofurantoin Correct answer.
  2. A 10-day course of oral vancomycin
  3. Imaging with renal ultrasound
  4. Intravenous ceftriaxone

Explanation

Uncomplicated acute cystitis in a healthy nonpregnant woman is treated with a short course of an oral agent such as nitrofurantoin or trimethoprim-sulfamethoxazole. These agents achieve good urinary concentrations and are effective for lower tract infection.

Question 33Clinical Family Medicine and Primary Care

A 68-year-old man with atrial fibrillation has a CHA2DS2-VASc score of 4. He has no history of bleeding and normal renal function. Which strategy best reduces his risk of stroke?

  1. Clopidogrel monotherapy
  2. Aspirin 81 mg daily
  3. No antithrombotic therapy
  4. Oral anticoagulation with a direct oral anticoagulant Correct answer.

Explanation

A CHA2DS2-VASc score of 4 places this patient at high stroke risk, and oral anticoagulation is clearly indicated. Direct oral anticoagulants are preferred over warfarin in most patients because of comparable efficacy with lower intracranial bleeding risk.

Question 34Clinical Family Medicine and Primary Care

A 45-year-old woman reports fatigue, cold intolerance, and constipation. Her TSH is elevated and her free T4 is low. Which is the most appropriate treatment?

  1. Liothyronine alone
  2. Radioactive iodine ablation
  3. Levothyroxine titrated to a normal TSH Correct answer.
  4. Methimazole

Explanation

The combination of elevated TSH and low free T4 defines primary hypothyroidism, for which levothyroxine is the standard replacement therapy. The dose is adjusted based on TSH monitoring, typically rechecked 6 to 8 weeks after initiation or dose changes.

Question 35Clinical Family Medicine and Primary Care

A 55-year-old woman has a fasting glucose of 130 mg/dL and an HbA1c of 7.4% on two occasions. She has no cardiovascular disease. Which initial pharmacologic therapy is most appropriate in addition to lifestyle changes?

  1. Basal insulin
  2. A sulfonylurea
  3. A thiazolidinedione
  4. Metformin Correct answer.

Explanation

Metformin remains the preferred first-line pharmacologic agent for most patients with newly diagnosed type 2 diabetes because it is effective, weight-neutral, and inexpensive with a long safety record. It is initiated alongside lifestyle modification unless contraindicated by renal impairment.

Question 36Clinical Family Medicine and Primary Care

A 70-year-old woman has a DXA T-score of -2.6 at the hip and a prior low-trauma wrist fracture. Which treatment is most appropriate?

  1. A bisphosphonate such as alendronate Correct answer.
  2. Calcium supplementation alone
  3. Vitamin D alone
  4. Routine exercise without medication

Explanation

A T-score of -2.5 or lower or a prior fragility fracture establishes osteoporosis, and pharmacologic therapy is indicated to reduce future fracture risk. Bisphosphonates are first-line antiresorptive agents, with calcium and vitamin D as supportive measures.

Question 37Clinical Family Medicine and Primary Care

A 28-year-old woman has a blood pressure of 150/95 mmHg at 20 weeks of gestation. She has no proteinuria and no symptoms. Which diagnosis is most appropriate?

  1. Gestational hypertension Correct answer.
  2. Chronic hypertension
  3. Preeclampsia
  4. Eclampsia

Explanation

New hypertension arising after 20 weeks of gestation without proteinuria or other organ dysfunction is classified as gestational hypertension. It requires close monitoring because some women later develop preeclampsia.

Question 38Clinical Family Medicine and Primary Care

A 4-year-old child has a barking cough, hoarse voice, and inspiratory stridor that worsens at night. He is not drooling and has no high fever. Which is the most appropriate initial treatment?

  1. Intravenous antibiotics
  2. Immediate endotracheal intubation
  3. Nebulized albuterol
  4. A single dose of oral dexamethasone Correct answer.

Explanation

This presentation is typical of croup, a viral laryngotracheitis, and a single dose of dexamethasone reduces airway edema and symptoms. Nebulized epinephrine is added for moderate to severe stridor but steroids are the cornerstone of initial therapy.

Question 39Clinical Family Medicine and Primary Care

A 65-year-old man with heart failure with reduced ejection fraction is on an ACE inhibitor and a beta-blocker but remains symptomatic. Which additional agent has been shown to reduce mortality in this population?

  1. Amlodipine
  2. Furosemide as the sole addition
  3. Spironolactone Correct answer.
  4. Digoxin

Explanation

Mineralocorticoid receptor antagonists such as spironolactone reduce mortality in patients with heart failure with reduced ejection fraction who remain symptomatic despite standard therapy. Potassium and renal function must be monitored because of hyperkalemia risk.

Question 40Clinical Family Medicine and Primary Care

A 32-year-old man has a 2-week history of a painless penile ulcer with a clean base and nontender inguinal lymphadenopathy. Which test is most appropriate to confirm the diagnosis?

  1. Serologic testing for syphilis Correct answer.
  2. Herpes simplex virus polymerase chain reaction
  3. Gram stain of the ulcer exudate
  4. Urine nucleic acid amplification for chlamydia

Explanation

A painless ulcer with a clean base and nontender lymphadenopathy suggests primary syphilis, and diagnosis is confirmed with serologic tests such as nontreponemal and treponemal assays. Darkfield microscopy or PCR of the lesion can also be used in early disease.

Question 41Clinical Family Medicine and Primary Care

A 40-year-old woman has a 6-month history of fatigue, diffuse musculoskeletal pain, and poor sleep, with no joint swelling or elevated inflammatory markers. Which is the most appropriate initial management?

  1. Methotrexate
  2. Long-term opioid therapy
  3. Graded exercise and cognitive behavioral therapy Correct answer.
  4. High-dose corticosteroids

Explanation

The presentation suggests fibromyalgia, for which the cornerstones of management are education, graded exercise, and cognitive behavioral therapy. These approaches improve function and reduce pain without the risks of immunosuppression or dependence.

Question 42Clinical Family Medicine and Primary Care

A 75-year-old man has a serum sodium of 128 mmol/L and reports confusion. He takes hydrochlorothiazide. Which is the most appropriate initial step?

  1. Rapidly correct sodium with hypertonic saline
  2. Give intravenous furosemide
  3. Discontinue the thiazide and restrict free water intake Correct answer.
  4. Increase fluid intake

Explanation

Thiazide diuretics are a common cause of chronic hyponatremia, and management begins with stopping the offending agent and restricting free water. Rapid correction risks osmotic demyelination, so sodium should be corrected slowly unless the patient has severe symptomatic hyponatremia.

Question 43Clinical Family Medicine and Primary Care

A 50-year-old woman has sudden severe vertigo, nausea, and unsteady gait that began abruptly. She has no hearing loss. Which finding on examination would most suggest a central cause?

  1. Symptoms worse with head movement
  2. Nystagmus that is suppressed by visual fixation
  3. A positive Dix-Hallpike maneuver
  4. Direction-changing nystagmus on gaze testing Correct answer.

Explanation

Direction-changing nystagmus that changes with gaze indicates a central vestibular lesion, as does vertical nystagmus or nystagmus not suppressed by fixation. Peripheral causes such as vestibular neuritis typically produce unidirectional horizontal nystagmus that is suppressed by fixation.

Question 44Clinical Family Medicine and Primary Care

A 35-year-old woman has a new diagnosis of generalized anxiety disorder and no other medical conditions. Which is the most appropriate first-line pharmacologic treatment?

  1. Propranolol as monotherapy
  2. Sertraline Correct answer.
  3. Alprazolam as maintenance therapy
  4. Quetiapine

Explanation

Selective serotonin reuptake inhibitors such as sertraline are first-line pharmacotherapy for generalized anxiety disorder because of proven efficacy and favorable tolerability. They are started at low doses and titrated, with full effect often taking several weeks.

Question 45Clinical Family Medicine and Primary Care

A 60-year-old man has a creatinine of 1.4 mg/dL and an eGFR of 45 mL/min/1.73 m². He is scheduled for a CT scan with iodinated contrast. Which is the most appropriate action to reduce the risk of contrast-induced nephropathy?

  1. Give prophylactic furosemide
  2. Give oral sodium bicarbonate only
  3. Withhold all antihypertensive medications for 24 hours
  4. Ensure adequate intravenous hydration before and after the procedure Correct answer.

Explanation

Intravenous isotonic fluid administration is the most established preventive measure for contrast-induced nephropathy in at-risk patients. Adequate hydration preserves renal perfusion and is recommended before and after contrast exposure.

Question 46Clinical Family Medicine and Primary Care

A 55-year-old woman has a 3 cm firm, mobile thyroid nodule. She is euthyroid and has no compressive symptoms. Which is the most appropriate next step?

  1. Thyroid ultrasound with fine-needle aspiration Correct answer.
  2. Radioactive iodine ablation
  3. Immediate total thyroidectomy
  4. Observation with repeat examination in 5 years

Explanation

Thyroid nodules are evaluated with ultrasound to characterize features such as size, margins, and microcalcifications, followed by fine-needle aspiration when indicated. This guides the need for surgery without subjecting every patient to unnecessary thyroidectomy.

Question 47Clinical Family Medicine and Primary Care

A 70-year-old man has a 3 cm abdominal aortic aneurysm found on screening ultrasound. Which is the most appropriate management?

  1. Serial ultrasound surveillance Correct answer.
  2. No further follow-up
  3. Immediate open surgical repair
  4. Endovascular repair now

Explanation

Abdominal aortic aneurysms smaller than 5.5 cm in men are managed with periodic ultrasound surveillance because the risk of rupture is low and the risks of elective repair outweigh the benefits. Repair is considered when the aneurysm reaches 5.5 cm or grows rapidly.

Question 48Clinical Family Medicine and Primary Care

A 24-year-old woman has a 1-week history of a diffuse pruritic rash with vesicles on the lips and genitals, along with fever and malaise. She recently started a new medication. Which is the most appropriate initial step?

  1. Continue the medication and add an antihistamine
  2. Discontinue the suspected medication and provide supportive care Correct answer.
  3. Start oral terbinafine
  4. Apply topical corticosteroids only

Explanation

The combination of a new medication, mucosal involvement, fever, and a diffuse vesicular rash suggests a severe cutaneous adverse drug reaction such as erythema multiforme major or early Stevens-Johnson syndrome. Prompt discontinuation of the suspected drug is the most important initial step.

Question 49Clinical Family Medicine and Primary Care

A 45-year-old man has a fasting lipid panel showing triglycerides of 800 mg/dL. He drinks alcohol daily. Which is the most appropriate initial intervention to prevent pancreatitis?

  1. Fibrate therapy after fasting is confirmed
  2. Immediate initiation of a statin
  3. Dietary fat restriction and alcohol cessation Correct answer.
  4. Low-dose aspirin

Explanation

Severe hypertriglyceridemia above 500 mg/dL carries a risk of acute pancreatitis, and initial management includes dietary fat restriction and complete alcohol abstinence. Fasting should be confirmed before starting pharmacotherapy, and fibrates may be added if levels remain elevated.

Question 50Clinical Family Medicine and Primary Care

A 30-year-old man has a 4-week history of low back pain that is worse at night and improves with exercise, along with morning stiffness lasting more than an hour. Which finding would most support an inflammatory cause?

  1. Onset after heavy lifting
  2. Sacroiliitis on imaging Correct answer.
  3. Radicular pain radiating below the knee
  4. Pain that improves with rest

Explanation

Inflammatory back pain features include morning stiffness, improvement with exercise, and nocturnal pain, and imaging evidence of sacroiliitis supports an axial spondyloarthritis. Mechanical back pain typically worsens with activity and improves with rest.