Family Medicine Fundamentals
Comprehensive Test Bank
TABLE OF CONTENTS - PART 1 of 5
Chapter 1: Acute Care - Upper Respiratory and ENT (Questions 1-25)
Chapter 2: Acute Care - Cardiovascular and Pulmonary (Questions 26-50)
Chapter 3: Chronic Disease - Diabetes and Hypertension (Questions 51-75)
Chapter 4: Preventive Care and Screening (Questions 76-100)
CHAPTER 1: ACUTE CARE - UPPER RESPIRATORY AND ENT
Q1. A 28-year-old man presents with sore throat, fever of 38.5 C, tender anterior cervical lymph
nodes, tonsillar exudates, and no cough. Which of the following is the most appropriate next step in
management?
A. Start amoxicillin empirically without testing
B. Perform rapid antigen detection testing for group A streptococcus
C. Obtain a monospot test first
D. Prescribe azithromycin empirically
Correct Answer: Perform rapid antigen detection testing for group A streptococcus
Rationale: The clinical findings are consistent with a high Centor score suggesting group A
streptococcal pharyngitis. However, clinical features alone are not sufficient to diagnose
streptococcal pharyngitis, and antibiotic treatment should be based on microbiologic confirmation.
Rapid antigen detection testing is the appropriate next step. If positive, treatment can be initiated. If
negative in an adult, no further testing is typically required. Empiric antibiotic therapy without
testing contributes to antibiotic overuse and resistance. Monospot testing is used for infectious
mononucleosis, which presents differently.
Q2. A 45-year-old woman presents with a 3-day history of nasal congestion, facial pain over the
maxillary sinuses, and purulent nasal discharge. She has been using saline irrigation without relief.
Which of the following is the most appropriate management?
A. Amoxicillin-clavulanate for 10 days
B. Observation with symptomatic care for 7-10 days
,C. Immediate CT scan of the sinuses
D. Referral to ENT for functional endoscopic sinus surgery
Correct Answer: Observation with symptomatic care for 7-10 days
Rationale: Current guidelines recommend observation with symptomatic care including
analgesics, saline irrigation, and intranasal corticosteroids for 7-10 days before initiating antibiotics,
as most cases of acute bacterial sinusitis resolve without antibiotic therapy. Antibiotics are indicated
if symptoms worsen after 3-5 days or fail to improve after 10 days. Amoxicillin-clavulanate would be
appropriate if antibiotics are indicated but is not the first step. CT scan is reserved for complications
or chronic sinusitis. ENT referral is not indicated for uncomplicated acute sinusitis.
Q3. A 6-year-old child presents with a 2-day history of barking cough, inspiratory stridor, and low-
grade fever. The child is playful and has no drooling or difficulty swallowing. Which of the following is
the most likely diagnosis?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bacterial tracheitis
D. Foreign body aspiration
Correct Answer: Croup (laryngotracheobronchitis)
Rationale: The classic presentation of croup includes a barking cough, inspiratory stridor, and
low-grade fever, often following a viral upper respiratory infection. The child appears well between
episodes of coughing and has no drooling or dysphagia, which distinguishes croup from epiglottitis.
Epiglottitis presents with rapid onset of high fever, drooling, difficulty swallowing, and a thumb sign
on lateral neck radiograph. Bacterial tracheitis presents with toxic appearance and thick purulent
secretions. Foreign body aspiration typically presents with sudden onset of choking and unilateral
wheezing.
Q4. A 70-year-old man presents with a 2-week history of unilateral nasal obstruction, epistaxis, and
facial numbness. Which of the following is the most appropriate next step?
A. Prescribe intranasal corticosteroids
B. Reassure and follow up in 6 weeks
C. Refer urgently for biopsy and imaging
D. Prescribe oral antibiotics
Correct Answer: Refer urgently for biopsy and imaging
Rationale: Unilateral nasal obstruction, epistaxis, and facial numbness in an older adult are red
flags for nasopharyngeal carcinoma or other malignancy. Urgent referral for biopsy and imaging is
,indicated. Intranasal corticosteroids and antibiotics would be appropriate for inflammatory
conditions, but the presence of facial numbness and persistent unilateral symptoms in an older adult
warrants urgent evaluation. Reassurance with follow-up would delay diagnosis.
Q5. A 30-year-old woman presents with a 1-week history of hoarseness following an upper
respiratory infection. She has no dysphagia, stridor, or weight loss. Which of the following is the most
appropriate management?
A. Referral to ENT
B. Voice rest, hydration, and follow-up in 2-3 weeks
C. Immediate laryngoscopy
D. Oral corticosteroids
Correct Answer: Voice rest, hydration, and follow-up in 2-3 weeks
Rationale: Acute hoarseness following an upper respiratory infection is typically due to viral
laryngitis and resolves spontaneously within 2-3 weeks. Voice rest, hydration, and humidification are
recommended. ENT referral and laryngoscopy are indicated if hoarseness persists beyond 3-4 weeks,
especially in smokers or those with other risk factors. Corticosteroids are not routinely indicated for
viral laryngitis.
Q6. A 4-year-old child presents with unilateral foul-smelling nasal discharge for 2 weeks. Which of
the following is the most likely diagnosis?
A. Allergic rhinitis
B. Acute bacterial sinusitis
C. Nasal foreign body
D. Choanal atresia
Correct Answer: Nasal foreign body
Rationale: Unilateral foul-smelling nasal discharge in a young child is highly suggestive of a
retained nasal foreign body. The diagnosis is confirmed by visualizing the object with a nasal
speculum or endoscope. Allergic rhinitis typically presents with bilateral clear discharge, sneezing,
and itching. Acute bacterial sinusitis is usually bilateral and associated with facial pain. Choanal
atresia presents in neonates with respiratory distress and inability to pass a nasal catheter.
Q7. A 55-year-old smoker presents with a 6-week history of persistent hoarseness. He has no recent
upper respiratory infection. Which of the following is the most appropriate next step?
A. Voice rest and follow-up in 4 weeks
B. Referral to ENT for laryngoscopy
, C. Prescribe proton pump inhibitors
D. Prescribe oral corticosteroids
Correct Answer: Referral to ENT for laryngoscopy
Rationale: Persistent hoarseness lasting more than 3-4 weeks, especially in a smoker, is a red
flag for laryngeal cancer. ENT referral for laryngoscopy is indicated. Voice rest and follow-up, proton
pump inhibitors, and corticosteroids would be appropriate for benign conditions but would delay
diagnosis of malignancy.
Q8. A 10-year-old child presents with a 2-day history of severe sore throat, drooling, and difficulty
swallowing. He appears toxic and is sitting forward. Which of the following is the most appropriate
next step?
A. Inspect the throat with a tongue depressor
B. Obtain a lateral neck radiograph
C. Prepare for emergent airway management
D. Prescribe oral amoxicillin
Correct Answer: Prepare for emergent airway management
Rationale: The presentation is classic for epiglottitis, a medical emergency that can rapidly
progress to complete airway obstruction. The child is sitting forward and drooling, and appears toxic.
Airway management should be the priority, with anesthesia and ENT available. Inspecting the throat
with a tongue depressor can precipitate airway obstruction. Lateral neck radiograph may be useful
but should not delay airway management. Oral antibiotics are inappropriate in an acute emergency.
Q9. A 35-year-old man presents with a 1-week history of unilateral facial pain and pressure over the
frontal sinus, worsened by bending forward. He has a history of allergic rhinitis. Which of the
following is the most appropriate initial management?
A. Amoxicillin
B. Intranasal corticosteroid and saline irrigation
C. Oral decongestant
D. CT scan of the sinuses
Correct Answer: Intranasal corticosteroid and saline irrigation
Rationale: The patient has symptoms consistent with acute rhinosinusitis, likely viral given the
1-week duration and history of allergic rhinitis. Initial management includes intranasal corticosteroids
and saline irrigation, with analgesics as needed. Antibiotics are indicated if symptoms persist beyond
10 days or worsen after 3-5 days. Oral decongestants may provide temporary relief but are not first-
line. CT scan is reserved for complications or chronic sinusitis.
Comprehensive Test Bank
TABLE OF CONTENTS - PART 1 of 5
Chapter 1: Acute Care - Upper Respiratory and ENT (Questions 1-25)
Chapter 2: Acute Care - Cardiovascular and Pulmonary (Questions 26-50)
Chapter 3: Chronic Disease - Diabetes and Hypertension (Questions 51-75)
Chapter 4: Preventive Care and Screening (Questions 76-100)
CHAPTER 1: ACUTE CARE - UPPER RESPIRATORY AND ENT
Q1. A 28-year-old man presents with sore throat, fever of 38.5 C, tender anterior cervical lymph
nodes, tonsillar exudates, and no cough. Which of the following is the most appropriate next step in
management?
A. Start amoxicillin empirically without testing
B. Perform rapid antigen detection testing for group A streptococcus
C. Obtain a monospot test first
D. Prescribe azithromycin empirically
Correct Answer: Perform rapid antigen detection testing for group A streptococcus
Rationale: The clinical findings are consistent with a high Centor score suggesting group A
streptococcal pharyngitis. However, clinical features alone are not sufficient to diagnose
streptococcal pharyngitis, and antibiotic treatment should be based on microbiologic confirmation.
Rapid antigen detection testing is the appropriate next step. If positive, treatment can be initiated. If
negative in an adult, no further testing is typically required. Empiric antibiotic therapy without
testing contributes to antibiotic overuse and resistance. Monospot testing is used for infectious
mononucleosis, which presents differently.
Q2. A 45-year-old woman presents with a 3-day history of nasal congestion, facial pain over the
maxillary sinuses, and purulent nasal discharge. She has been using saline irrigation without relief.
Which of the following is the most appropriate management?
A. Amoxicillin-clavulanate for 10 days
B. Observation with symptomatic care for 7-10 days
,C. Immediate CT scan of the sinuses
D. Referral to ENT for functional endoscopic sinus surgery
Correct Answer: Observation with symptomatic care for 7-10 days
Rationale: Current guidelines recommend observation with symptomatic care including
analgesics, saline irrigation, and intranasal corticosteroids for 7-10 days before initiating antibiotics,
as most cases of acute bacterial sinusitis resolve without antibiotic therapy. Antibiotics are indicated
if symptoms worsen after 3-5 days or fail to improve after 10 days. Amoxicillin-clavulanate would be
appropriate if antibiotics are indicated but is not the first step. CT scan is reserved for complications
or chronic sinusitis. ENT referral is not indicated for uncomplicated acute sinusitis.
Q3. A 6-year-old child presents with a 2-day history of barking cough, inspiratory stridor, and low-
grade fever. The child is playful and has no drooling or difficulty swallowing. Which of the following is
the most likely diagnosis?
A. Epiglottitis
B. Croup (laryngotracheobronchitis)
C. Bacterial tracheitis
D. Foreign body aspiration
Correct Answer: Croup (laryngotracheobronchitis)
Rationale: The classic presentation of croup includes a barking cough, inspiratory stridor, and
low-grade fever, often following a viral upper respiratory infection. The child appears well between
episodes of coughing and has no drooling or dysphagia, which distinguishes croup from epiglottitis.
Epiglottitis presents with rapid onset of high fever, drooling, difficulty swallowing, and a thumb sign
on lateral neck radiograph. Bacterial tracheitis presents with toxic appearance and thick purulent
secretions. Foreign body aspiration typically presents with sudden onset of choking and unilateral
wheezing.
Q4. A 70-year-old man presents with a 2-week history of unilateral nasal obstruction, epistaxis, and
facial numbness. Which of the following is the most appropriate next step?
A. Prescribe intranasal corticosteroids
B. Reassure and follow up in 6 weeks
C. Refer urgently for biopsy and imaging
D. Prescribe oral antibiotics
Correct Answer: Refer urgently for biopsy and imaging
Rationale: Unilateral nasal obstruction, epistaxis, and facial numbness in an older adult are red
flags for nasopharyngeal carcinoma or other malignancy. Urgent referral for biopsy and imaging is
,indicated. Intranasal corticosteroids and antibiotics would be appropriate for inflammatory
conditions, but the presence of facial numbness and persistent unilateral symptoms in an older adult
warrants urgent evaluation. Reassurance with follow-up would delay diagnosis.
Q5. A 30-year-old woman presents with a 1-week history of hoarseness following an upper
respiratory infection. She has no dysphagia, stridor, or weight loss. Which of the following is the most
appropriate management?
A. Referral to ENT
B. Voice rest, hydration, and follow-up in 2-3 weeks
C. Immediate laryngoscopy
D. Oral corticosteroids
Correct Answer: Voice rest, hydration, and follow-up in 2-3 weeks
Rationale: Acute hoarseness following an upper respiratory infection is typically due to viral
laryngitis and resolves spontaneously within 2-3 weeks. Voice rest, hydration, and humidification are
recommended. ENT referral and laryngoscopy are indicated if hoarseness persists beyond 3-4 weeks,
especially in smokers or those with other risk factors. Corticosteroids are not routinely indicated for
viral laryngitis.
Q6. A 4-year-old child presents with unilateral foul-smelling nasal discharge for 2 weeks. Which of
the following is the most likely diagnosis?
A. Allergic rhinitis
B. Acute bacterial sinusitis
C. Nasal foreign body
D. Choanal atresia
Correct Answer: Nasal foreign body
Rationale: Unilateral foul-smelling nasal discharge in a young child is highly suggestive of a
retained nasal foreign body. The diagnosis is confirmed by visualizing the object with a nasal
speculum or endoscope. Allergic rhinitis typically presents with bilateral clear discharge, sneezing,
and itching. Acute bacterial sinusitis is usually bilateral and associated with facial pain. Choanal
atresia presents in neonates with respiratory distress and inability to pass a nasal catheter.
Q7. A 55-year-old smoker presents with a 6-week history of persistent hoarseness. He has no recent
upper respiratory infection. Which of the following is the most appropriate next step?
A. Voice rest and follow-up in 4 weeks
B. Referral to ENT for laryngoscopy
, C. Prescribe proton pump inhibitors
D. Prescribe oral corticosteroids
Correct Answer: Referral to ENT for laryngoscopy
Rationale: Persistent hoarseness lasting more than 3-4 weeks, especially in a smoker, is a red
flag for laryngeal cancer. ENT referral for laryngoscopy is indicated. Voice rest and follow-up, proton
pump inhibitors, and corticosteroids would be appropriate for benign conditions but would delay
diagnosis of malignancy.
Q8. A 10-year-old child presents with a 2-day history of severe sore throat, drooling, and difficulty
swallowing. He appears toxic and is sitting forward. Which of the following is the most appropriate
next step?
A. Inspect the throat with a tongue depressor
B. Obtain a lateral neck radiograph
C. Prepare for emergent airway management
D. Prescribe oral amoxicillin
Correct Answer: Prepare for emergent airway management
Rationale: The presentation is classic for epiglottitis, a medical emergency that can rapidly
progress to complete airway obstruction. The child is sitting forward and drooling, and appears toxic.
Airway management should be the priority, with anesthesia and ENT available. Inspecting the throat
with a tongue depressor can precipitate airway obstruction. Lateral neck radiograph may be useful
but should not delay airway management. Oral antibiotics are inappropriate in an acute emergency.
Q9. A 35-year-old man presents with a 1-week history of unilateral facial pain and pressure over the
frontal sinus, worsened by bending forward. He has a history of allergic rhinitis. Which of the
following is the most appropriate initial management?
A. Amoxicillin
B. Intranasal corticosteroid and saline irrigation
C. Oral decongestant
D. CT scan of the sinuses
Correct Answer: Intranasal corticosteroid and saline irrigation
Rationale: The patient has symptoms consistent with acute rhinosinusitis, likely viral given the
1-week duration and history of allergic rhinitis. Initial management includes intranasal corticosteroids
and saline irrigation, with analgesics as needed. Antibiotics are indicated if symptoms persist beyond
10 days or worsen after 3-5 days. Oral decongestants may provide temporary relief but are not first-
line. CT scan is reserved for complications or chronic sinusitis.
