Family Medicine Exam with Complete
Solutions
A 52-year-old female presents to your office with worsening inter-mentstrual and
heavier periods than usual over the last three months. She has a past medical history of
hypertension and takes atenolol. Her physical examination is unremarkable and vaginal
exam reveals dark blood at the cervical os and in the vagina. Her hemoglobin level is
10.5 g/dL. A pregnancy test is negative. Which one of the following is the most
important next step in management? - correct answer-An endometrial biopsy
A 17-year old male who is an avid golfer comes to your office because of a rash on his
neck that continues to get worse. He wears sun screen whenever he goes outside but it
does not appear to be helping. The rash is shown below. What is the most likely cause?
- correct answer-Tinea Versicolor
You are seeing a 51-year old white male non smoker with a past medical history of
hypertension in the office for follow up on some recent lab work. He currently takes
lisinopril 10 mg. He currently has no complaints. His vitals show his blood pressure to
be 135/81, HR 66, RR 16, Temp 98.7. His cholesterol panel showed a total cholesterol
was 230 mg/dl, LDL-C 180 mg/dl, HDL 50 mg/dl. His 10-Year ASCVD Risk is estimated
at 6.1%. Which of the following is the best treatment option for this patient? - correct
answer-Atorvastatin (Lipitor), 20 mg
You are seeing a previously healthy 42-year-old man who is brought to the ER 1 day
after the sudden onset of shortness of breath and chest pain. He notes the pain is
exacerbated by deep inspiration.
On exam his pulse is 120/min, respirations are 24/min, and blood pressure is 140/90
mm Hg. Breath sounds are normal. The remainder of the examination shows no
abnormalities. Arterial blood gas analysis on room air shows:
pH 7.49
PCO2 30 mm Hg
PO2 64 mm Hg
O2 saturation 91%
An x-ray of the chest shows no abnormalities.
Which of the following is the most likely mechanism of these findings? - correct answer-
Ventilation-perfusion mismatch
,What is the most common cause of right heart failure in adults? - correct answer-left
sided heart failure
According to JNC 8, what is the diastolic blood pressure goal in diabetes? - correct
answer-< 90 mm Hg
True or False: Per JNC 8 Guidelines, all patients diagnosed with hypertension should
be screened for secondary causes. - correct answer-False
In the medical management of malignant hypertension, which of the following actions
should be undertaken? - correct answer-Assessment of secondary causes of
hypertension
Of the options below, what is the recommended first step of the abdominal exam? -
correct answer-Inspection
Which of the following abnormalities defines a patient with "Unstable or Massive"
Pulmonary Embolism (PE)? - correct answer-Hypotension with systolic BP < 90 mmhg
Which of the following is a symptom of a peripheral cause of vertigo? - correct answer-
All of the above
You are seeing a 64-year old male in clinic for a follow up visit for his recurrent severe
GERD symptoms, hoarseness, and chronic cough. He has a past medical history of
GERD for the last 10 years and has had 2-3 EGDs in the past with no evidence or signs
of Barrett's esophagus. He takes (omeprazole 40 mg BID) but is always forgetful about
taking his medication. Which of the following statements is true regarding further
surgical treatment for this patient? - correct answer-The Nissen fundoplication has been
found superior to other procedures, with symptomatic improvement occurring in 85 to 90
percent of patients
Below are list of drugs that are associated with nephrotoxicity. Which of the following
causes acute interstitial nephritis as its mechanism? - correct answer-Vancomycin
You are seeing a 67-year old black male in your clinic for a routine health visit. He has a
past medical history of type II diabetes, hypertension and stage IV CKD (last GFR was
27 ml). He notes prior TIA and MI and has had 2 stents in the last 5 years. Which of the
following is the most likely outcome of this patient? - correct answer-Death from MI
A 24-year-old female with insomnia and mild depression comes to the office because of
recurrent severe generalized, throbbing headaches associated with nausea, occasional
vomiting, and light and noise sensitivity. The headaches occur 2 to 3 times weekly and
last 12 to 24 hours. She misses approximately 1 workday each month. She has been
taking zolmitriptan, 5 mg orally, for acute attacks, with good benefit approximately two
thirds of the time. Which of the following medications is most appropriate to prevent the
headaches in this patient? - correct answer-amitriptyline
,You are seeing a 26-year old white female in clinic for consultation for her recurrent
headaches over the last 4 years. She has no medical problems and only takes NSAIDs
(alleve or motrin) for her headaches. Which one of the following therapeutic agents is
most appropriate for daily use in the prevention of migraine headache? - correct
answer-Amitriptyline (Elavil)
A previously healthy 24-year old female presents to you complaining of recurrent
headaches over the last 2 months. Which of the following symptoms would be more
suggestive of a tension type headache? - correct answer-not aggravated by routine
physical activity such as walking or climbing stairs
Which of the following is considered criteria to diagnose STEMI on ECG? - correct
answer-All of the above
Which of the following symptoms has been found to be the strongest predictor for
Detecting Myocardial Infarction in Patients with Chest Pain in the Emergency
Department? - correct answer-Diaphoresis
Normal or near-normal ECG findings decrease the risk of MI, especially in patients with
no history of coronary artery disease, but NSTEMI may occur in what percentage of
these patients? - correct answer-1-6%
You are seeing a previously healthy 28-year-old female in your clinic with a complaint of
intermittent irregular heartbeats or palpitations. She states the symptoms occur a few
times per week. They last only a few seconds and resolve spontaneously. She denies
chest pains, or shortness of breath and has never passed out or had difficulty with
exertion. She takes no medications, denies drugs or tobacco, and denies family history
of heart disease. Her physical examination is normal including normal heart sounds in
which you ascultate no murmurs, rubs, or gallops. Which of the following statements
regarding "palpitations" is false? - correct answer-Standard 12-lead ECG has been
shown determine the cause of palpitations in only 10% of patients
Which of the following is NOT part of the Rome III Diagnostic Criteria for Functional
Dyspepsia? - correct answer-Vomiting
What is the most prevalent diagnosis in patient presenting with symptoms of dyspepsia,
i.e. postprandial fullness, early satiation, or epigastric pain or burning? - correct answer-
Functional (nonulcer) dyspepsia
Which of the following statements is True regarding Functional Dyspepsia? - correct
answer-All of the above
According to multiple sources, what is the most common diagnosis of abdominal pain in
the adult? - correct answer-Non Diagnostic Abdominal Pain
, What is the most common surgical cause of abdominal pain in adults? - correct answer-
Appendicitis
You are seeing a 35-year old male who presents with upper abdominal pain over the
last 4 hours along with bilious emesis and the pain comes on in waves. He notes the
pain came on shortly after he ate Arby's for dinner. He denies similar pain in the past.
What is the best initial imaging modality in the evaluation of this patients pain? - correct
answer-Ultrasound of the abdomen
Your are seeing a 45-year-old African-American female in your clinic who has a history
of hypertension that has been well controlled with hydrochlorothiazide. However, she
has developed an intolerance to the medication and wants to be switched to another
drug. Successful monotherapy for her hypertension would be most likely with which one
of the following? - correct answer-Diltiazem (Cardizem)
You are seeing a 72-year old female who has a past medical history of hypertension
and atrial fibrillation in the hospital after she was admitted for heart failure symptoms.
She presented with impaired exercise tolerance, dyspnea, and orthopnea.
Her physical exam showed tachycardia, elevated neck veins, an S3 gallop, inspiratory
crackles, displaced apical impulse, and mild hepatomegaly. Her admitting ECG showed
atrial fibrillation at a rate of 114 beats/min along with LVH. Her chest x-ray showed
bilateral pulmonary edema. Her previous medical records indicate she had a normal left
heart cath with normal coronaries last year.
Which of the following is better able to differentiate heart failure with preserved ejection
fraction (HFpEF) from heart failure with reduced ejection fraction (HFrEF)? - correct
answer-none of the above are able to differentiate between the two entities
What is the most common type of primary headache disorder? - correct answer-
Tension-Type Headaches
A 45-year old female presents with pleuritic chest pain and a dry cough for the last 24
hours. She is otherwise healthy and has no past medical or family history for coronary
artery disease, pulmonary embolism or DVT. She denies hormone use now or in the
past, denies recent surgery or long trips and denies any unilateral leg swelling.
Vital signs show a heart rate of 78 beats/min, blood pressure 135/90, respiratory rate
16/min, O2 saturation on room air is 95%.
True or False: This patient is PERC negative which means she does not need to
undergo any further testing for pulmonary embolism. - correct answer-True
A 74-year old male with a past medical history of Type II DM and HTN presents with 30
minutes of crushing chest pain, dyspnea and nausea.
Solutions
A 52-year-old female presents to your office with worsening inter-mentstrual and
heavier periods than usual over the last three months. She has a past medical history of
hypertension and takes atenolol. Her physical examination is unremarkable and vaginal
exam reveals dark blood at the cervical os and in the vagina. Her hemoglobin level is
10.5 g/dL. A pregnancy test is negative. Which one of the following is the most
important next step in management? - correct answer-An endometrial biopsy
A 17-year old male who is an avid golfer comes to your office because of a rash on his
neck that continues to get worse. He wears sun screen whenever he goes outside but it
does not appear to be helping. The rash is shown below. What is the most likely cause?
- correct answer-Tinea Versicolor
You are seeing a 51-year old white male non smoker with a past medical history of
hypertension in the office for follow up on some recent lab work. He currently takes
lisinopril 10 mg. He currently has no complaints. His vitals show his blood pressure to
be 135/81, HR 66, RR 16, Temp 98.7. His cholesterol panel showed a total cholesterol
was 230 mg/dl, LDL-C 180 mg/dl, HDL 50 mg/dl. His 10-Year ASCVD Risk is estimated
at 6.1%. Which of the following is the best treatment option for this patient? - correct
answer-Atorvastatin (Lipitor), 20 mg
You are seeing a previously healthy 42-year-old man who is brought to the ER 1 day
after the sudden onset of shortness of breath and chest pain. He notes the pain is
exacerbated by deep inspiration.
On exam his pulse is 120/min, respirations are 24/min, and blood pressure is 140/90
mm Hg. Breath sounds are normal. The remainder of the examination shows no
abnormalities. Arterial blood gas analysis on room air shows:
pH 7.49
PCO2 30 mm Hg
PO2 64 mm Hg
O2 saturation 91%
An x-ray of the chest shows no abnormalities.
Which of the following is the most likely mechanism of these findings? - correct answer-
Ventilation-perfusion mismatch
,What is the most common cause of right heart failure in adults? - correct answer-left
sided heart failure
According to JNC 8, what is the diastolic blood pressure goal in diabetes? - correct
answer-< 90 mm Hg
True or False: Per JNC 8 Guidelines, all patients diagnosed with hypertension should
be screened for secondary causes. - correct answer-False
In the medical management of malignant hypertension, which of the following actions
should be undertaken? - correct answer-Assessment of secondary causes of
hypertension
Of the options below, what is the recommended first step of the abdominal exam? -
correct answer-Inspection
Which of the following abnormalities defines a patient with "Unstable or Massive"
Pulmonary Embolism (PE)? - correct answer-Hypotension with systolic BP < 90 mmhg
Which of the following is a symptom of a peripheral cause of vertigo? - correct answer-
All of the above
You are seeing a 64-year old male in clinic for a follow up visit for his recurrent severe
GERD symptoms, hoarseness, and chronic cough. He has a past medical history of
GERD for the last 10 years and has had 2-3 EGDs in the past with no evidence or signs
of Barrett's esophagus. He takes (omeprazole 40 mg BID) but is always forgetful about
taking his medication. Which of the following statements is true regarding further
surgical treatment for this patient? - correct answer-The Nissen fundoplication has been
found superior to other procedures, with symptomatic improvement occurring in 85 to 90
percent of patients
Below are list of drugs that are associated with nephrotoxicity. Which of the following
causes acute interstitial nephritis as its mechanism? - correct answer-Vancomycin
You are seeing a 67-year old black male in your clinic for a routine health visit. He has a
past medical history of type II diabetes, hypertension and stage IV CKD (last GFR was
27 ml). He notes prior TIA and MI and has had 2 stents in the last 5 years. Which of the
following is the most likely outcome of this patient? - correct answer-Death from MI
A 24-year-old female with insomnia and mild depression comes to the office because of
recurrent severe generalized, throbbing headaches associated with nausea, occasional
vomiting, and light and noise sensitivity. The headaches occur 2 to 3 times weekly and
last 12 to 24 hours. She misses approximately 1 workday each month. She has been
taking zolmitriptan, 5 mg orally, for acute attacks, with good benefit approximately two
thirds of the time. Which of the following medications is most appropriate to prevent the
headaches in this patient? - correct answer-amitriptyline
,You are seeing a 26-year old white female in clinic for consultation for her recurrent
headaches over the last 4 years. She has no medical problems and only takes NSAIDs
(alleve or motrin) for her headaches. Which one of the following therapeutic agents is
most appropriate for daily use in the prevention of migraine headache? - correct
answer-Amitriptyline (Elavil)
A previously healthy 24-year old female presents to you complaining of recurrent
headaches over the last 2 months. Which of the following symptoms would be more
suggestive of a tension type headache? - correct answer-not aggravated by routine
physical activity such as walking or climbing stairs
Which of the following is considered criteria to diagnose STEMI on ECG? - correct
answer-All of the above
Which of the following symptoms has been found to be the strongest predictor for
Detecting Myocardial Infarction in Patients with Chest Pain in the Emergency
Department? - correct answer-Diaphoresis
Normal or near-normal ECG findings decrease the risk of MI, especially in patients with
no history of coronary artery disease, but NSTEMI may occur in what percentage of
these patients? - correct answer-1-6%
You are seeing a previously healthy 28-year-old female in your clinic with a complaint of
intermittent irregular heartbeats or palpitations. She states the symptoms occur a few
times per week. They last only a few seconds and resolve spontaneously. She denies
chest pains, or shortness of breath and has never passed out or had difficulty with
exertion. She takes no medications, denies drugs or tobacco, and denies family history
of heart disease. Her physical examination is normal including normal heart sounds in
which you ascultate no murmurs, rubs, or gallops. Which of the following statements
regarding "palpitations" is false? - correct answer-Standard 12-lead ECG has been
shown determine the cause of palpitations in only 10% of patients
Which of the following is NOT part of the Rome III Diagnostic Criteria for Functional
Dyspepsia? - correct answer-Vomiting
What is the most prevalent diagnosis in patient presenting with symptoms of dyspepsia,
i.e. postprandial fullness, early satiation, or epigastric pain or burning? - correct answer-
Functional (nonulcer) dyspepsia
Which of the following statements is True regarding Functional Dyspepsia? - correct
answer-All of the above
According to multiple sources, what is the most common diagnosis of abdominal pain in
the adult? - correct answer-Non Diagnostic Abdominal Pain
, What is the most common surgical cause of abdominal pain in adults? - correct answer-
Appendicitis
You are seeing a 35-year old male who presents with upper abdominal pain over the
last 4 hours along with bilious emesis and the pain comes on in waves. He notes the
pain came on shortly after he ate Arby's for dinner. He denies similar pain in the past.
What is the best initial imaging modality in the evaluation of this patients pain? - correct
answer-Ultrasound of the abdomen
Your are seeing a 45-year-old African-American female in your clinic who has a history
of hypertension that has been well controlled with hydrochlorothiazide. However, she
has developed an intolerance to the medication and wants to be switched to another
drug. Successful monotherapy for her hypertension would be most likely with which one
of the following? - correct answer-Diltiazem (Cardizem)
You are seeing a 72-year old female who has a past medical history of hypertension
and atrial fibrillation in the hospital after she was admitted for heart failure symptoms.
She presented with impaired exercise tolerance, dyspnea, and orthopnea.
Her physical exam showed tachycardia, elevated neck veins, an S3 gallop, inspiratory
crackles, displaced apical impulse, and mild hepatomegaly. Her admitting ECG showed
atrial fibrillation at a rate of 114 beats/min along with LVH. Her chest x-ray showed
bilateral pulmonary edema. Her previous medical records indicate she had a normal left
heart cath with normal coronaries last year.
Which of the following is better able to differentiate heart failure with preserved ejection
fraction (HFpEF) from heart failure with reduced ejection fraction (HFrEF)? - correct
answer-none of the above are able to differentiate between the two entities
What is the most common type of primary headache disorder? - correct answer-
Tension-Type Headaches
A 45-year old female presents with pleuritic chest pain and a dry cough for the last 24
hours. She is otherwise healthy and has no past medical or family history for coronary
artery disease, pulmonary embolism or DVT. She denies hormone use now or in the
past, denies recent surgery or long trips and denies any unilateral leg swelling.
Vital signs show a heart rate of 78 beats/min, blood pressure 135/90, respiratory rate
16/min, O2 saturation on room air is 95%.
True or False: This patient is PERC negative which means she does not need to
undergo any further testing for pulmonary embolism. - correct answer-True
A 74-year old male with a past medical history of Type II DM and HTN presents with 30
minutes of crushing chest pain, dyspnea and nausea.
