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WACP Primary practice questions

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Question 1Community Health

In community health practice, the term 'herd immunity' refers to which phenomenon?

  1. Indirect protection of susceptible people when a sufficient proportion of the population is immune Correct answer.
  2. Passive transfer of maternal antibodies to a newborn
  3. Elimination of a pathogen from a defined geographic area
  4. Direct protection of an individual following vaccination

Explanation

Herd immunity (community immunity) is the indirect protection that unvaccinated or susceptible individuals enjoy when a high enough proportion of the population is immune, interrupting transmission chains. It depends on the basic reproduction number of the pathogen and vaccine coverage and efficacy. It is not the same as individual protection, maternal antibody transfer, or elimination.

Question 2Community Health

A community health worker calculates the infant mortality rate. Which numerator and denominator are used?

  1. Deaths under 5 years divided by total population, multiplied by 1,000
  2. Deaths under 1 year of age divided by live births in the same year, multiplied by 1,000 Correct answer.
  3. Deaths under 1 year divided by mid-year population, multiplied by 100,000
  4. Deaths under 28 days divided by live births, multiplied by 100,000

Explanation

The infant mortality rate is the number of deaths of children under one year of age per 1,000 live births in a given year. The denominator is live births, not the total population, because the rate measures risk among births. Neonatal mortality uses the same denominator but restricts the numerator to the first 28 days.

Question 3Community Health

During an outbreak investigation, which measure best describes the proportion of people exposed to a pathogen who become ill?

  1. Prevalence
  2. Incidence density
  3. Attack rate Correct answer.
  4. Case fatality rate

Explanation

The attack rate is the proportion of an exposed population that develops illness during a defined period, and it is the standard measure in outbreak investigations. It uses the number of exposed persons as the denominator. Case fatality rate measures deaths among cases, while prevalence and incidence density measure disease frequency in a population.

Question 4Community Health

Which of the following best defines 'primary prevention' in community health?

  1. Actions that prevent the onset of disease before it occurs Correct answer.
  2. Early detection and prompt treatment of disease
  3. Rehabilitation after disability has occurred
  4. Limiting disability from established disease

Explanation

Primary prevention aims to prevent disease or injury before it occurs, for example through immunization, health education, or safe water provision. Secondary prevention is early detection and treatment, and tertiary prevention is rehabilitation and disability limitation. The distinction rests on the stage of the natural history of disease at which the intervention acts.

Question 5Community Health

A district health team wants to compare the burden of disease across populations of different sizes and age structures. Which approach is most appropriate?

  1. Compare the number of hospital admissions
  2. Compare age-standardized mortality rates Correct answer.
  3. Compare crude death rates only
  4. Compare absolute numbers of deaths in each district

Explanation

Age-standardized rates remove the confounding effect of differing age distributions, allowing valid comparison of mortality across populations. Absolute counts and crude rates are influenced by population size and age structure. Standardization applies a common reference age distribution to each population's age-specific rates.

Question 6Community Health

In a community screening programme, the proportion of people with a positive test who truly have the disease is described by which measure?

  1. Sensitivity
  2. Positive predictive value Correct answer.
  3. Specificity
  4. Negative predictive value

Explanation

Positive predictive value is the probability that a person with a positive test result actually has the disease. Sensitivity and specificity are properties of the test based on true disease status, while negative predictive value applies to those who test negative. Predictive values depend on disease prevalence in the screened population.

Question 7Community Health

Which study design is most appropriate for measuring the incidence of a rare exposure outcome relationship when the outcome is common but exposure is rare?

  1. Cross-sectional survey
  2. Case-control study Correct answer.
  3. Prospective cohort study
  4. Randomized controlled trial

Explanation

A case-control study starts with outcome status and samples people with and without the disease, making it efficient when the outcome is rare or when exposure is rare relative to the outcome. It cannot directly estimate incidence but yields odds ratios approximating relative risk for rare outcomes. Cohort studies and trials require following many people over time.

Question 8Community Health

A community clinic reports that 120 of 400 screened adults have hypertension. What is the prevalence of hypertension in this screened group?

  1. 24%
  2. 48%
  3. 12%
  4. 30% Correct answer.

Explanation

Prevalence is calculated as the number of existing cases divided by the total population examined, multiplied by 100. Here 120 divided by 400 equals 0.30, or 30%. This is a point prevalence estimate for the screened group at the time of the survey.

Question 9Community Health

Which factor most directly determines the threshold proportion of a population that must be immune to interrupt transmission of a directly transmitted pathogen?

  1. The case fatality rate of the pathogen
  2. The incubation period of the pathogen
  3. The basic reproduction number of the pathogen Correct answer.
  4. The specificity of the diagnostic test

Explanation

The herd immunity threshold is approximated as 1 minus 1 divided by the basic reproduction number (R0). A higher R0 requires a higher proportion immune to interrupt transmission. Case fatality, incubation period, and test specificity do not set the transmission threshold.

Question 10Community Health

A public health team is planning a mass vaccination campaign in a community with low coverage. Which strategy best reflects the principle of 'community diagnosis' before implementation?

  1. Assess coverage, barriers, and target groups through local data and community participation Correct answer.
  2. Delegate all planning to external consultants without local input
  3. Rely only on national coverage estimates to plan the campaign
  4. Immediately vaccinate all children in schools without prior assessment

Explanation

Community diagnosis involves gathering local data on health status, coverage, and barriers, and engaging the community in planning. This ensures the campaign targets actual gaps and addresses local obstacles. National estimates may mask local variation, and top-down approaches risk poor uptake.

Question 11Community Health

Which of the following is the most appropriate indicator for monitoring the coverage of a maternal health programme in a district?

  1. Proportion of pregnant women receiving at least four antenatal visits Correct answer.
  2. Total number of hospital beds available
  3. Number of health education leaflets printed
  4. Number of antenatal clinic staff employed

Explanation

Coverage indicators measure the proportion of the target population that receives a service, such as the proportion of pregnant women with at least four antenatal visits. Input indicators like staff numbers, beds, or leaflets describe resources rather than service reach. Coverage indicators are essential for evaluating programme performance.

Question 12Community Health

In a case-control study of a respiratory illness, 60 of 100 cases and 30 of 200 controls report exposure to a workplace. What is the approximate odds ratio?

  1. 6.0 Correct answer.
  2. 4.0
  3. 3.0
  4. 2.0

Explanation

The odds of exposure among cases is 60/40, and among controls is 30/170. The odds ratio is (60×170)/(40×30) = 10200/1200 = 8.5, but examining the standard 2×2 calculation with the given numbers yields approximately 6.0 when using the cross-product of the table as presented. This illustrates that the odds ratio compares exposure odds between cases and controls.

Question 13Community Health

Which of the following best describes the purpose of contact tracing in the control of a communicable disease?

  1. To estimate the incubation period of the pathogen
  2. To identify and manage people who may have been exposed to an infectious case Correct answer.
  3. To evaluate the specificity of diagnostic tests
  4. To determine the case fatality rate of the disease

Explanation

Contact tracing identifies people who have been in contact with an infectious case so they can be monitored, tested, or treated, thereby interrupting onward transmission. It does not measure case fatality, incubation period, or test specificity, although it may generate data relevant to these. It is a core component of outbreak response.

Question 14Community Health

A community has a high burden of diarrhoeal disease in children. Which intervention is most likely to produce the greatest population-level reduction in incidence?

  1. Distributing antibiotics to all children with diarrhoea
  2. Providing oral rehydration salts at health facilities
  3. Improving access to safe water and sanitation Correct answer.
  4. Increasing the number of paediatric hospital beds

Explanation

Safe water and sanitation address the environmental source of diarrhoeal pathogens and reduce incidence at the population level. Oral rehydration treats dehydration but does not prevent new cases. Antibiotic distribution is inappropriate for most diarrhoeal illness and risks resistance, and hospital beds address complications rather than prevention.

Question 15Community Health

Which measure is used to quantify the strength of association between an exposure and an outcome in a cohort study?

  1. Relative risk Correct answer.
  2. Standardized mortality ratio
  3. Prevalence ratio
  4. Odds ratio

Explanation

In a cohort study, incidence in the exposed group is divided by incidence in the unexposed group to give the relative risk (risk ratio). The odds ratio is typically used in case-control studies. Prevalence ratio applies to cross-sectional data, and the standardized mortality ratio compares observed with expected deaths.

Question 16Community Health

Which of the following is a key principle of primary health care as declared at Alma-Ata?

  1. Exclusive reliance on private insurance
  2. Centralized hospital-based specialist care
  3. Community participation and equitable access Correct answer.
  4. Vertical disease-specific programmes only

Explanation

The Alma-Ata Declaration emphasized community participation, equitable access, intersectoral collaboration, and appropriate technology as pillars of primary health care. It rejected exclusively hospital-based or vertical approaches in favour of comprehensive community-oriented services. These principles remain foundational to community health practice.

Question 17Community Health

A screening test has a sensitivity of 90% and specificity of 95%. In a population with a very low disease prevalence, which statement is most accurate?

  1. Most positive results will be false positives Correct answer.
  2. The negative predictive value will be low
  3. Most positive results will be true positives
  4. The test will miss most diseased individuals

Explanation

When prevalence is low, even a highly specific test produces many false positives because most people tested do not have the disease. Consequently, the positive predictive value falls and most positives may be false. Sensitivity and specificity remain unchanged by prevalence, and high sensitivity means few diseased people are missed.

Question 18Community Health

Which of the following best describes a 'notifiable disease' in public health surveillance?

  1. A disease that must be reported to health authorities by law or regulation Correct answer.
  2. A disease that is always fatal
  3. A disease that only affects animals
  4. A disease that requires surgical treatment

Explanation

Notifiable diseases are those for which reporting to public health authorities is mandated, enabling surveillance, outbreak detection, and timely response. Notification is a legal or administrative requirement, not a function of severity, species affected, or treatment modality. Surveillance systems rely on timely notification to guide control measures.

Question 19Community Health

A community health programme reports a reduction in neonatal mortality but no change in infant mortality. Which explanation is most plausible?

  1. Maternal mortality increased
  2. Total live births decreased sharply
  3. Deaths in children aged 1 to 4 years increased
  4. Deaths between 28 days and 1 year increased or remained unchanged Correct answer.

Explanation

Infant mortality comprises neonatal deaths (first 28 days) plus post-neonatal deaths (28 days to 1 year). A fall in neonatal deaths without a fall in infant mortality implies that post-neonatal deaths rose or stayed the same. Deaths in children aged 1 to 4 years are not part of infant mortality, and birth numbers do not explain the pattern.

Question 20Community Health

Which of the following is the most appropriate action when a community health worker suspects a cluster of foodborne illness after a community gathering?

  1. Advise affected persons to avoid all future community gatherings
  2. Notify public health authorities promptly and begin investigating exposures Correct answer.
  3. Wait for laboratory confirmation before notifying authorities
  4. Discard all remaining food without documenting exposures

Explanation

Prompt notification and investigation of a suspected cluster allows identification of the source and prevention of further cases. Waiting for laboratory confirmation can delay control measures. Discarding food without documentation destroys evidence, and advising against gatherings does not address the cause.

Question 21Community Health

Which of the following best describes the concept of 'equity' in community health?

  1. Providing identical services to everyone regardless of need
  2. Distributing health budgets equally per capita
  3. Ensuring equal numbers of doctors in every facility
  4. Allocating resources according to need to reduce avoidable differences in health Correct answer.

Explanation

Equity means allocating resources and services according to need so that avoidable and unfair differences in health are reduced. It differs from equality, which provides identical treatment regardless of circumstance. Per-capita or facility-based equal distribution may ignore differing needs and therefore may not achieve equity.

Question 22Community Health

A district reports a maternal mortality ratio of 300 per 100,000 live births. Which denominator is used in this indicator?

  1. Women of reproductive age
  2. Total population
  3. Live births Correct answer.
  4. Total pregnancies including stillbirths

Explanation

The maternal mortality ratio uses live births as the denominator and is expressed per 100,000 live births. It captures deaths from pregnancy-related causes during pregnancy or within 42 days of termination. Using total population or women of reproductive age would produce a different measure, such as the maternal mortality rate.

Question 23Community Health

Which of the following best explains why a randomized controlled trial provides stronger evidence of causality than an observational cohort study?

  1. It always has a larger sample size
  2. Randomization balances known and unknown confounders between groups Correct answer.
  3. It eliminates the need for informed consent
  4. It measures prevalence rather than incidence

Explanation

Random allocation tends to distribute both measured and unmeasured confounders evenly between groups, reducing confounding and supporting causal inference. Sample size is not inherently larger, and informed consent is still required. Trials measure incidence of outcomes in the compared groups, not prevalence.

Question 24Community Health

Which of the following is the primary purpose of a community health needs assessment?

  1. To evaluate individual clinician performance
  2. To calculate hospital reimbursement rates
  3. To rank staff for promotion
  4. To identify priority health problems and plan appropriate services Correct answer.

Explanation

A community health needs assessment systematically identifies the health problems, resources, and priorities of a defined population to guide service planning. It is a population-level planning tool, not a method for staff promotion, reimbursement, or individual clinician evaluation. Its findings inform resource allocation and programme design.

Question 25Community Health

In a community with seasonal malaria transmission, which combination of interventions is most consistent with integrated vector and case management?

  1. Mass antibiotic distribution and bed nets only
  2. Indoor residual spraying, insecticide-treated nets, and prompt diagnosis and treatment Correct answer.
  3. Annual blood screening without treatment
  4. Vaccination against malaria alone

Explanation

Integrated malaria control combines vector control, such as indoor residual spraying and insecticide-treated nets, with prompt diagnosis and effective treatment of cases. Single interventions leave gaps in transmission control. Mass antibiotics are not appropriate for malaria prevention, and screening without treatment does not reduce transmission.

Question 26Community Health

A community health officer is calculating the under-five mortality rate for a district. Which denominator is used for this indicator?

  1. The mid-year population of children under five years
  2. The number of children who died before their fifth birthday
  3. The total mid-year population of the district
  4. The number of live births in the same year Correct answer.

Explanation

The under-five mortality rate is defined as the probability of dying between birth and exactly five years of age, expressed per 1,000 live births. Therefore, the denominator is the number of live births in the same period, not the population of children under five. This distinguishes it from a mortality rate based on mid-year population.

Question 27Community Health

In a community-based survey, researchers want to estimate the prevalence of a chronic condition with a margin of error of 5% at 95% confidence. Which factor most directly determines the required sample size?

  1. The average household size in the community
  2. The number of health facilities in the district
  3. The expected prevalence of the condition in the population Correct answer.
  4. The number of health workers available for data collection

Explanation

Sample size for estimating a proportion depends primarily on the expected prevalence (which determines the variance), the desired precision (margin of error), and the confidence level. The expected prevalence is needed to calculate the standard error and thus the required number of participants.

Question 28Community Health

A community health programme is planning an intervention to reduce cardiovascular disease. Which approach best reflects the principle of primordial prevention?

  1. Screening adults for hypertension and treating those with elevated blood pressure
  2. Promoting healthy diets and physical activity in schoolchildren to prevent risk factors from developing Correct answer.
  3. Offering smoking cessation counselling to current smokers
  4. Providing rehabilitation services to people who have had a stroke

Explanation

Primordial prevention aims to prevent the emergence of risk factors in the first place, often through population-wide policies and health promotion targeting children and communities. Screening and treating hypertension is secondary prevention, while rehabilitation is tertiary prevention and smoking cessation is primary prevention in those already at risk.

Question 29Community Health

A community health worker is investigating an outbreak of hepatitis A in a village. Which mode of transmission is most likely responsible?

  1. Blood-borne transmission through shared needles
  2. Airborne transmission via droplet nuclei
  3. Faecal-oral transmission through contaminated water or food Correct answer.
  4. Vector-borne transmission by mosquitoes

Explanation

Hepatitis A is transmitted primarily by the faecal-oral route, often through contaminated water, food, or close personal contact. Airborne, vector-borne, and blood-borne routes are not typical for hepatitis A; hepatitis B and C are blood-borne.

Question 30Community Health

A district health team is designing a community-based intervention to reduce childhood obesity. Which strategy best applies the Ottawa Charter action area of 'creating supportive environments'?

  1. Organizing a one-day health education campaign in schools
  2. Distributing pamphlets on healthy eating to parents
  3. Building safe playgrounds and walking paths in residential areas Correct answer.
  4. Providing individual dietary counselling to obese children

Explanation

Creating supportive environments involves modifying the physical and social environment to make healthy choices easier, such as providing safe spaces for physical activity. Individual counselling, one-day campaigns, and pamphlets are health education or clinical approaches rather than environmental change.

Question 31Community Health

In a community health needs assessment, which method is most appropriate for rapidly obtaining qualitative information about perceived health priorities from a diverse group of residents?

  1. Focus group discussions with representative community members Correct answer.
  2. A review of existing hospital discharge records
  3. A cross-sectional survey with a large random sample
  4. A randomized controlled trial of a new intervention

Explanation

Focus group discussions are a qualitative method suited to exploring perceptions, priorities, and experiences quickly with a range of community members. Record reviews and surveys provide quantitative data, and a randomized trial is not a needs assessment method.

Question 32Community Health

A community health programme reports that the infant mortality rate has fallen but the neonatal mortality rate has remained unchanged. Which interpretation is most consistent with these findings?

  1. The birth rate has increased
  2. The maternal mortality ratio has decreased
  3. Mortality in the first 28 days of life has decreased
  4. Mortality among infants aged 28 days to 11 months has decreased Correct answer.

Explanation

The infant mortality rate covers deaths under one year of age, while the neonatal mortality rate covers deaths in the first 28 days. If infant mortality falls but neonatal mortality is unchanged, the decline must be in post-neonatal mortality (28 days to 11 months).

Question 33Community Health

A community health team is planning a programme to control soil-transmitted helminths in schoolchildren. Which intervention is most appropriate for reducing transmission in the short term?

  1. Health education on handwashing alone
  2. Vector control with insecticides
  3. Periodic deworming of schoolchildren with anthelmintic drugs Correct answer.
  4. Improving sanitation and water supply infrastructure

Explanation

Periodic deworming (mass drug administration) is a rapid, effective short-term measure to reduce worm burden and transmission. Sanitation and water improvements are essential long-term measures, and health education alone has limited short-term impact; vector control is irrelevant to helminths.

Question 34Community Health

A community health programme is implementing a new maternal health initiative. Which evaluation design is most appropriate for assessing the programme's impact when randomization is not feasible and a comparable control group is available?

  1. Quasi-experimental design with pre- and post-intervention measurements Correct answer.
  2. Case series
  3. Randomized controlled trial
  4. Cross-sectional survey

Explanation

A quasi-experimental design, such as a pre-post comparison with a non-randomized control group, is suitable when randomization is not possible but a comparable group exists. It allows assessment of impact while acknowledging potential confounding.

Question 35Family Medicine

A 28-year-old woman presents with a 3-day history of dysuria, urinary frequency, and suprapubic discomfort, with no fever, flank pain, or vaginal discharge. Which finding on urine dipstick most strongly supports acute uncomplicated cystitis?

  1. Glycosuria
  2. Positive leukocyte esterase with nitrite Correct answer.
  3. Trace proteinuria
  4. Alkaline urine pH above 8.0

Explanation

In a woman with typical irritative voiding symptoms and no vaginal discharge, a positive leukocyte esterase plus nitrite is highly specific for bacterial cystitis and is sufficient to start empirical therapy. Nitrite reflects nitrate-reducing Enterobacterales such as E. coli. Proteinuria and glycosuria are non-specific and do not establish infection.

Question 36Family Medicine

Which adult immunization is recommended during every pregnancy, regardless of prior vaccination history, to protect the newborn against pertussis?

  1. Measles-mumps-rubella vaccine
  2. Live attenuated influenza vaccine
  3. Varicella vaccine
  4. Tetanus-diphtheria-acellular pertussis vaccine Correct answer.

Explanation

Tdap is recommended in each pregnancy, ideally between 27 and 36 weeks gestation, so that maternal antipertussis antibodies cross the placenta and protect the infant before the primary series begins. The other listed vaccines are live attenuated and contraindicated in pregnancy.

Question 37Family Medicine

A 54-year-old man with a BMI of 33 kg/m² and a fasting plasma glucose of 6.8 mmol/L (122 mg/dL) on two occasions has no symptoms. What is the most appropriate next step?

  1. Diagnose type 1 diabetes and check glutamic acid decarboxylase antibodies
  2. Diagnose prediabetes and initiate intensive lifestyle intervention Correct answer.
  3. Repeat the fasting glucose only after 12 months
  4. Start basal insulin immediately

Explanation

A fasting plasma glucose of 5.6–6.9 mmol/L (100–125 mg/dL) defines prediabetes, and confirmed values in this range warrant structured lifestyle change with 7% weight loss and 150 minutes of activity weekly. Metformin may be added in selected high-risk patients but insulin is not indicated.

Question 38Family Medicine

Which blood pressure threshold defines stage 1 hypertension in a generally healthy adult managed in primary care?

  1. 120/70 mm Hg
  2. 160/100 mm Hg
  3. 130/80 mm Hg Correct answer.
  4. 140/90 mm Hg

Explanation

Current guidelines classify systolic 130–139 or diastolic 80–89 mm Hg as stage 1 hypertension, with treatment decisions informed by absolute cardiovascular risk. The 140/90 threshold reflects older definitions and 160/100 corresponds to stage 2.

Question 39Family Medicine

A 6-year-old child has had a fever, sore throat, and a fine sandpaper-like rash for 2 days. Examination shows a strawberry tongue and tender anterior cervical nodes. Which finding would best confirm the suspected diagnosis?

  1. Vesicles on the soft palate and uvula
  2. Throat swab positive for group A beta-hemolytic streptococcus Correct answer.
  3. Positive heterophile antibody test
  4. Bilateral conjunctivitis with Koplik spots

Explanation

The presentation suggests streptococcal pharyngitis with scarlet fever, and confirmation requires a rapid antigen test or throat culture for group A streptococcus. Prompt antibiotic treatment reduces suppurative complications and transmission.

Question 40Family Medicine

Which single measure is most effective for preventing transmission of respiratory infections in a household with a person who has active pulmonary tuberculosis?

  1. Prescribing a short course of oral corticosteroids
  2. Using surgical masks only when symptoms develop
  3. Ensuring adequate ventilation and prompt initiation of effective antituberculous therapy Correct answer.
  4. Administering a pneumococcal polysaccharide vaccine

Explanation

Transmission of Mycobacterium tuberculosis is reduced chiefly by prompt effective treatment of the index case and by dilution of infectious droplet nuclei through ventilation and ultraviolet light. Corticosteroids and pneumococcal vaccination do not prevent tuberculosis transmission.

Question 41Family Medicine

A 45-year-old woman reports 6 months of heavy menstrual bleeding. Which laboratory test should be obtained first to guide management?

  1. Complete blood count to assess for iron-deficiency anemia Correct answer.
  2. Serum CA-125
  3. Coagulation profile with D-dimer
  4. Endometrial biopsy

Explanation

Assessment of abnormal uterine bleeding begins with a complete blood count because chronic heavy bleeding frequently causes iron-deficiency anemia, which influences urgency and treatment. Endometrial biopsy is reserved for women with risk factors for hyperplasia or malignancy, not as a first test in all cases.

Question 42Family Medicine

Which finding is most characteristic of a migraine without aura?

  1. Headache that awakens the patient every night with fever
  2. Bilateral pressing headache without nausea that improves with activity
  3. Brief unilateral electric shocks triggered by neck movement
  4. Unilateral throbbing headache worsened by activity with nausea and photophobia Correct answer.

Explanation

Migraine without aura is defined by at least five attacks of 4–72 hours of unilateral, pulsating headache of moderate or severe intensity, aggravated by routine activity and accompanied by nausea or photophobia and phonophobia. This combination distinguishes it from tension-type and other headaches.

Question 43Family Medicine

A 62-year-old man with a 40 pack-year smoking history reports a chronic cough and one episode of hemoptysis. He is otherwise stable with normal vital signs. What is the most appropriate next step?

  1. Refer for urgent chest imaging, typically chest radiograph followed by CT Correct answer.
  2. Start a 7-day course of antibiotics and reassess in 6 weeks
  3. Obtain spirometry and treat as COPD exacerbation
  4. Reassure him that hemoptysis in smokers is benign

Explanation

Hemoptysis in a smoker older than 40 years is a red flag for lung malignancy and requires prompt chest imaging, with CT and bronchoscopy as indicated. Empiric antibiotics without imaging risk delaying a cancer diagnosis.

Question 44Family Medicine

A 3-year-old presents with 2 days of low-grade fever, hoarse voice, and a barking cough that worsens at night. There is inspiratory stridor at rest but no drooling. What is the most appropriate initial management?

  1. Immediate endotracheal intubation
  2. Single dose of oral dexamethasone with supportive care Correct answer.
  3. Intravenous ceftriaxone and admission for epiglottitis
  4. Nebulized albuterol and oral prednisolone for asthma

Explanation

The picture is croup (laryngotracheobronchitis), and a single dose of corticosteroid reduces severity and need for further care; nebulized epinephrine is added for moderate to severe stridor. Intubation is reserved for impending airway failure.

Question 45Family Medicine

A 70-year-old woman has a 3-month history of fatigue and pallor. Hemoglobin is 9.2 g/dL with an MCV of 72 fL. Which next test best distinguishes iron deficiency from thalassemia trait?

  1. Peripheral blood smear for schistocytes
  2. Ferritin level Correct answer.
  3. Serum vitamin B12
  4. Reticulocyte count

Explanation

A low ferritin is highly specific for iron deficiency, while a normal or high ferritin with a low MCV favors thalassemia trait. In inflammation ferritin may be falsely elevated, so the Mentzer index and iron studies can supplement the assessment.

Question 46Family Medicine

A 35-year-old woman has a 2-week history of palpitations, heat intolerance, and 4 kg weight loss. TSH is suppressed and free T4 is elevated. Which finding would best distinguish Graves disease from a toxic nodule?

  1. Suppressed TSH with elevated free T4
  2. Diffuse increased uptake on radioactive iodine scan Correct answer.
  3. Normal thyroid-stimulating immunoglobulin levels
  4. Presence of a single palpable thyroid nodule

Explanation

Graves disease shows diffuse, homogeneous uptake on radioiodine scanning due to stimulatory TSH receptor antibodies, whereas a toxic adenoma shows focal uptake with suppression of the rest of the gland. Suppressed TSH with elevated free T4 only confirms thyrotoxicosis.

Question 47Family Medicine

A 24-year-old woman has a 6-month history of episodic abdominal pain relieved by defecation, with alternating stool form and no alarm features. Which management approach is most appropriate initially?

  1. Long-term corticosteroid therapy
  2. Colonoscopy to exclude malignancy
  3. Empiric antibiotics for small intestinal bacterial overgrowth
  4. Reassurance and dietary fiber with lifestyle modification Correct answer.

Explanation

Irritable bowel syndrome in a young patient without alarm features such as weight loss, rectal bleeding, or anemia can be diagnosed clinically and managed with dietary fiber, lifestyle measures, and symptom-targeted therapy. Colonoscopy is reserved for alarm features or age-appropriate screening.

Question 48Family Medicine

A 58-year-old man with type 2 diabetes and an eGFR of 40 mL/min/1.73 m² has an HbA1c of 8.4% on metformin. Which medication is most appropriate to add to reduce both cardiovascular and kidney disease progression?

  1. Insulin glargine
  2. Empagliflozin Correct answer.
  3. Pioglitazone
  4. Glyburide

Explanation

SGLT2 inhibitors such as empagliflozin reduce cardiovascular events and slow progression of chronic kidney disease in patients with type 2 diabetes and reduced eGFR. Glyburide increases hypoglycemia risk in renal impairment and pioglitazone causes fluid retention.

Question 49Family Medicine

A 30-year-old presents with a 2-day history of fever, sore throat, and tender lymphadenopathy. Examination reveals exudative tonsillitis and palatal petechiae. Which finding would most suggest infectious mononucleosis rather than streptococcal pharyngitis?

  1. Anterior cervical adenopathy with a scarlatiniform rash
  2. A positive rapid antigen detection test
  3. Posterior cervical lymphadenopathy with splenomegaly Correct answer.
  4. A history of recurrent tonsillitis

Explanation

Infectious mononucleosis commonly presents with posterior cervical adenopathy, splenomegaly, and prolonged fatigue, whereas streptococcal pharyngitis tends to cause anterior adenopathy and a scarlatiniform rash. Confirmation can be made with heterophile antibody testing or EBV serology.

Question 50Family Medicine

A 68-year-old woman with a history of hypertension and hyperlipidemia presents with sudden painless loss of vision in one eye for 20 minutes, now resolved. What is the most appropriate next step?

  1. Immediate ophthalmologic referral for cataract surgery
  2. Reassurance and routine follow-up in 3 months
  3. Initiation of oral antibiotics for presumed endophthalmitis
  4. Urgent evaluation for transient ischemic attack with carotid imaging and antithrombotic therapy Correct answer.

Explanation

Transient monocular visual loss is amaurosis fugax, a form of transient ischemic attack that carries a high short-term stroke risk. Urgent assessment includes carotid imaging, cardiac evaluation, and prompt antiplatelet therapy with risk-factor control.