Primary Care Clinical Decision Questions & Answers | 120
Board-Style Practice Questions with Verified Answers &
Detailed Rationales (2026 Edition)
1. A 52-year-old man has a blood pressure of 148/92 mmHg on two separate visits.
What is the next best step? A. Reassure and repeat in 2 years B. Diagnose
hypertension and begin lifestyle modification ± medication C. Order a CT scan D.
Start antibiotics
Answer: B Rationale: Persistent elevated blood pressure on separate visits is consistent
with hypertension and requires treatment based on overall cardiovascular risk.
2. Which test is most appropriate for screening diabetes in an asymptomatic adult at
increased risk? A. CBC B. HbA1c C. Chest X-ray D. Urinalysis
Answer: B Rationale: HbA1c is commonly used to screen for and diagnose diabetes.
3. A patient presents with sore throat, fever, and tonsillar exudates. What is the best
initial diagnostic test? A. ECG B. Rapid Group A Streptococcus antigen test C.
Colonoscopy D. MRI
Answer: B Rationale: A rapid strep test helps confirm streptococcal pharyngitis before
prescribing antibiotics.
4. Which medication is considered first-line for uncomplicated hypertension in many
adults? A. Amoxicillin B. Thiazide diuretic C. Prednisone D. Morphine
Answer: B Rationale: Thiazide diuretics are among the recommended first-line
antihypertensive medications.
5. A smoker aged 60 asks how to reduce cardiovascular risk. The most effective
intervention is: A. Vitamin supplements B. Smoking cessation C. Bed rest D. Routine
antibiotics
Answer: B Rationale: Quitting smoking significantly reduces cardiovascular morbidity and
mortality.
6. Which symptom requires urgent evaluation in a patient with chest pain? A. Pain
relieved by rest B. Chest pain with diaphoresis and shortness of breath C. Mild
muscle soreness D. Heartburn after eating
Answer: B Rationale: These symptoms may indicate acute coronary syndrome.
, 7. Which vaccine is recommended annually for most adults? A. Influenza vaccine B.
BCG C. Rabies vaccine D. Yellow fever vaccine
Answer: A Rationale: Annual influenza vaccination is recommended for most adults.
8. What is the preferred initial treatment for uncomplicated cystitis in a healthy
woman? A. Antibiotic therapy guided by local recommendations B. Corticosteroids
C. Antifungal medication D. Chemotherapy
Answer: A Rationale: Appropriate antibiotics are first-line treatment for uncomplicated
urinary tract infections.
9. Which laboratory value best reflects average blood glucose over the past 2–3
months? A. Random glucose B. HbA1c C. Serum sodium D. Creatinine
Answer: B Rationale: HbA1c reflects long-term glycemic control.
10. The first-line treatment for mild persistent asthma includes: A. Inhaled
corticosteroids B. Antibiotics C. Opioids D. Diuretics
Answer: A Rationale: Inhaled corticosteroids are the preferred controller medication.
11. Which patient should receive counseling on colorectal cancer screening? A.
Healthy 50-year-old adult B. Healthy 15-year-old C. Healthy 25-year-old D. Healthy
35-year-old
Answer: A Rationale: Average-risk adults are generally recommended to begin colorectal
cancer screening at age 45–50, depending on current guidelines.
12. Which organism most commonly causes uncomplicated urinary tract infections? A.
Escherichia coli B. Influenza virus C. Candida albicans D. Streptococcus
pneumoniae
Answer: A Rationale: E. Coli is the leading cause of uncomplicated UTIs.
13. Which lifestyle modification most effectively lowers LDL cholesterol? A. Increased
saturated fat intake B. Heart-healthy diet and regular exercise C. Smoking D. Excess
alcohol use
Answer: B Rationale: Diet and exercise improve lipid levels and cardiovascular health.
14. Which finding is most concerning in a patient with headache? A. Gradual onset after
stress B. Sudden severe “worst headache of my life” C. Mild tension headache D.
Headache relieved by rest
, Answer: B Rationale: Sudden severe headache may indicate subarachnoid hemorrhage
and requires emergency evaluation.
15. Which BMI defines obesity? A. 18.5–24.9 B. 25–29.9 C. ≥30 kg/m² D. <18.5
Answer: C Rationale: Obesity is defined as a BMI of 30 kg/m² or higher.
16. Which medication class is commonly prescribed for hyperlipidemia? A. Statins B.
Penicillins C. Benzodiazepines D. Antihistamines
Answer: A Rationale: Statins are first-line agents for lowering LDL cholesterol.
17. A patient has symptoms of hypothyroidism. Which laboratory test is the best initial
screening test? A. TSH B. ALT C. Troponin D. D-dimer
Answer: A Rationale: TSH is the preferred initial test for thyroid dysfunction.
18. Which condition is characterized by polyuria, polydipsia, and unexplained weight
loss? A. Type 2 diabetes mellitus B. Osteoarthritis C. COPD D. Migraine
Answer: A Rationale: These are classic symptoms of diabetes mellitus.
19. Which preventive counseling should be offered at every primary care visit when
appropriate? A. Smoking cessation counseling B. Bed rest advice C. Antibiotic
education for viral illnesses D. Restrict all exercise
Answer: A Rationale: Tobacco cessation counseling is an important preventive service.
20. A patient with fever, productive cough, tachypnea, and focal crackles should be
evaluated for: A. Community-acquired pneumonia B. Migraine C. Gastritis D.
Osteoporosis
Answer: A Rationale: These findings are classic for community-acquired pneumonia and
warrant further evaluation and treatment.
21.
A 67-year-old man with a 40-pack-year smoking history asks about lung cancer screening.
What is recommended? A. Chest X-ray annually B. Low-dose CT scan C. MRI of the chest D.
PET scan
Answer: B Rationale: Annual low-dose CT is recommended for eligible high-risk adults.
22.
Board-Style Practice Questions with Verified Answers &
Detailed Rationales (2026 Edition)
1. A 52-year-old man has a blood pressure of 148/92 mmHg on two separate visits.
What is the next best step? A. Reassure and repeat in 2 years B. Diagnose
hypertension and begin lifestyle modification ± medication C. Order a CT scan D.
Start antibiotics
Answer: B Rationale: Persistent elevated blood pressure on separate visits is consistent
with hypertension and requires treatment based on overall cardiovascular risk.
2. Which test is most appropriate for screening diabetes in an asymptomatic adult at
increased risk? A. CBC B. HbA1c C. Chest X-ray D. Urinalysis
Answer: B Rationale: HbA1c is commonly used to screen for and diagnose diabetes.
3. A patient presents with sore throat, fever, and tonsillar exudates. What is the best
initial diagnostic test? A. ECG B. Rapid Group A Streptococcus antigen test C.
Colonoscopy D. MRI
Answer: B Rationale: A rapid strep test helps confirm streptococcal pharyngitis before
prescribing antibiotics.
4. Which medication is considered first-line for uncomplicated hypertension in many
adults? A. Amoxicillin B. Thiazide diuretic C. Prednisone D. Morphine
Answer: B Rationale: Thiazide diuretics are among the recommended first-line
antihypertensive medications.
5. A smoker aged 60 asks how to reduce cardiovascular risk. The most effective
intervention is: A. Vitamin supplements B. Smoking cessation C. Bed rest D. Routine
antibiotics
Answer: B Rationale: Quitting smoking significantly reduces cardiovascular morbidity and
mortality.
6. Which symptom requires urgent evaluation in a patient with chest pain? A. Pain
relieved by rest B. Chest pain with diaphoresis and shortness of breath C. Mild
muscle soreness D. Heartburn after eating
Answer: B Rationale: These symptoms may indicate acute coronary syndrome.
, 7. Which vaccine is recommended annually for most adults? A. Influenza vaccine B.
BCG C. Rabies vaccine D. Yellow fever vaccine
Answer: A Rationale: Annual influenza vaccination is recommended for most adults.
8. What is the preferred initial treatment for uncomplicated cystitis in a healthy
woman? A. Antibiotic therapy guided by local recommendations B. Corticosteroids
C. Antifungal medication D. Chemotherapy
Answer: A Rationale: Appropriate antibiotics are first-line treatment for uncomplicated
urinary tract infections.
9. Which laboratory value best reflects average blood glucose over the past 2–3
months? A. Random glucose B. HbA1c C. Serum sodium D. Creatinine
Answer: B Rationale: HbA1c reflects long-term glycemic control.
10. The first-line treatment for mild persistent asthma includes: A. Inhaled
corticosteroids B. Antibiotics C. Opioids D. Diuretics
Answer: A Rationale: Inhaled corticosteroids are the preferred controller medication.
11. Which patient should receive counseling on colorectal cancer screening? A.
Healthy 50-year-old adult B. Healthy 15-year-old C. Healthy 25-year-old D. Healthy
35-year-old
Answer: A Rationale: Average-risk adults are generally recommended to begin colorectal
cancer screening at age 45–50, depending on current guidelines.
12. Which organism most commonly causes uncomplicated urinary tract infections? A.
Escherichia coli B. Influenza virus C. Candida albicans D. Streptococcus
pneumoniae
Answer: A Rationale: E. Coli is the leading cause of uncomplicated UTIs.
13. Which lifestyle modification most effectively lowers LDL cholesterol? A. Increased
saturated fat intake B. Heart-healthy diet and regular exercise C. Smoking D. Excess
alcohol use
Answer: B Rationale: Diet and exercise improve lipid levels and cardiovascular health.
14. Which finding is most concerning in a patient with headache? A. Gradual onset after
stress B. Sudden severe “worst headache of my life” C. Mild tension headache D.
Headache relieved by rest
, Answer: B Rationale: Sudden severe headache may indicate subarachnoid hemorrhage
and requires emergency evaluation.
15. Which BMI defines obesity? A. 18.5–24.9 B. 25–29.9 C. ≥30 kg/m² D. <18.5
Answer: C Rationale: Obesity is defined as a BMI of 30 kg/m² or higher.
16. Which medication class is commonly prescribed for hyperlipidemia? A. Statins B.
Penicillins C. Benzodiazepines D. Antihistamines
Answer: A Rationale: Statins are first-line agents for lowering LDL cholesterol.
17. A patient has symptoms of hypothyroidism. Which laboratory test is the best initial
screening test? A. TSH B. ALT C. Troponin D. D-dimer
Answer: A Rationale: TSH is the preferred initial test for thyroid dysfunction.
18. Which condition is characterized by polyuria, polydipsia, and unexplained weight
loss? A. Type 2 diabetes mellitus B. Osteoarthritis C. COPD D. Migraine
Answer: A Rationale: These are classic symptoms of diabetes mellitus.
19. Which preventive counseling should be offered at every primary care visit when
appropriate? A. Smoking cessation counseling B. Bed rest advice C. Antibiotic
education for viral illnesses D. Restrict all exercise
Answer: A Rationale: Tobacco cessation counseling is an important preventive service.
20. A patient with fever, productive cough, tachypnea, and focal crackles should be
evaluated for: A. Community-acquired pneumonia B. Migraine C. Gastritis D.
Osteoporosis
Answer: A Rationale: These findings are classic for community-acquired pneumonia and
warrant further evaluation and treatment.
21.
A 67-year-old man with a 40-pack-year smoking history asks about lung cancer screening.
What is recommended? A. Chest X-ray annually B. Low-dose CT scan C. MRI of the chest D.
PET scan
Answer: B Rationale: Annual low-dose CT is recommended for eligible high-risk adults.
22.
