Free Sample Family Medicine Questions
See why TrueLearn is a trusted resource for thousands of medical students and residents. At TrueLearn, we understand that it’s all about the content. That’s why we have high-yield family medicine practice questions written and screened by high-performing physician authors that are updated on a regular basis to ensure our SmartBanks stay up-to-date with exam blueprint changes.
Below are 3 free family medicine questions as a sample of what you get with a SmartBank subscription. Check them out and see if you get them right. At the very least, we hope they help you in your exam prep.
Family Medicine Sample Question #1
During morning rounds with your medical students, you are examining a 31-year-old man admitted to your service at your local hospital. The patient was admitted the day prior with a new-onset seizure. The patient has no prior history of seizure activity. Lab testing initially revealed the patient had a serum calcium level of 6.2 mg/dL. Proper treatment was initiated and the patient is stabilizing. While checking the patient’s blood pressure, his hand begins to twitch. You use this as a teaching point and ask the students what this response is called.
What is this physical exam finding called?
A) Chvostek’s sign
B) Finkelstein test
C) Guthrie test
D) Sign of Hertoghe
E) Trousseau’s sign
The Answer and Explanation
Trousseau’s sign is a carpopedal spasm that occurs in response to ischemia when a blood pressure cuff is used for several minutes, typically three or more minutes. It is seen in patients suffering from hypocalcemia. This test should be avoided in individuals with severe vascular disease or coagulopathies. A variety of clinical manifestations may be seen with hypocalcemia. Neuromuscular irritability (tetany) is the hallmark manifestation of hypocalcemia.
These symptoms may be mild such as paresthesias of the hands and feet, muscle cramps, or perioral numbness or may be severe with seizures, generalized tonic muscle contractions, carpopedal spasm, or laryngospasm.
Did you get it right? The correct answer is E.
Answer A: Chvostek’s sign is a brief contraction of the perioral muscles that results in a twitching response of the corner of the mouth and ipsilateral eye and nose muscles. This occurs after light tapping over cranial nerve VII at the ear. This sign has a low sensitivity.
Answer B: The Finkelstein test is suggestive of tenosynovitis. It is positive when there is an exacerbation of pain with ulnar deviation of the wrist and the thumb clasped inside the palm.
Answer C: The Guthrie test is a screening test used in newborns to monitor for phenylketonuria (PKU). It consists of pricking an infant’s heel and soaking the blood into preprinted collection cards known as Guthrie cards. This test can detect Maple Syrup Urine Disease (MSUD or branched-chain ketonuria), phenylketonuria, thyroid stimulating hormone (TSH), immunoreactive trypsinogen (IRT), medium-chain acyl-coenzyme A dehydrogenase deficiency (MCADD), sickle-cell disease, and galactosemia.
Answer D: The sign of Hertoghe is seen in individuals with hypothyroidism. It describes the thinning of the outer third of the eyebrows.
Bottom Line: Trousseau’s sign is the carpopedal spasm seen in patients with hypocalcemia after prolonged blood pressure cuff inflation.
For more information, see:
Wilbur, Deborah and James Bonucchi. “Hypocalcemia.” University of Iowa: The Family Medicine Handbook. 5th ed. Philadelphia: Saunders Elsevier, 2006. 313. Print.
Family Medicine Sample Question #2
A 65 year old male with a past medical history of gout and a recent chemotherapy regimen presents with right flank pain. He tells you the pain was rapid in onset, and radiates to his groin. Physical exam shows an agitated male who can’t seem to find a position of ease. Lab analysis shows microscopic hematuria. A KUB is negative but a noncontrast CT scan is diagnostic. Which of the following should be used to prevent this condition from occurring again?
A) Citrate
B) Sodium Restriction
C) Penicillamine
D) Thiazide Diuretics
E) Surgery
The Answer and Explanation
Nephrolithiasis, or renal calculi are usually composed of calcium oxalate but may also be composed of calcium phosphate, struvite, uric acid or cysteine. Risk factors include a positive family history, low fluid intake, gout, medications such as allopurinol, chemotherapy and loop diuretics, enzyme deficiencies, type I TRA and hyperparathyroidism. Hydration and analgesia are the initial treatments in all patients with nephrolithiasis. Sodium bicarbonate or citrate can be used to prevent the formation of uric acid stones as they alkalinize the urine. Citrate is converted to bicarbonate in the liver.
Did you get it right? The correct answer is A.
Answer B: Sodium restriction is a mainstay in the treatment of nephrolithiasis in patients with calcium oxalate, calcium phosphate stones or cystine stones.
Answer C: Penicillamine is used to treat cystine stones in addition to hydration and dietary sodium restriction.
Answer D: Thiazide diuretics help the kidney retain calcium and are a mainstay in the treatment of nephrolithiasis in patients with calcium oxalate or calcium phosphate stones.
Answer E: Surgery is reserved for the removal of large staghorn calculi and stones that are too large to be treated with extracorporeal shock wave lithotripsy.
Bottom Line: Uric acid stone formation can be prevented by alkalinizing the urine with citrate.
For more information, see: Kidney Stones. AAFP
Family Medicine ITE Sample Question #3
Regarding the use of loop diuretics in the treatment of congestive heart failure, which of the following answer choices is correct?
A) A common side effect of their use is hypercalcemia
B) Loop diuretics decrease mortality
C) They are more effective than thiazide diuretics in treating of hypertension
D) They have a short half life and rapid onset of action
E) Loop diuretics are contraindicated in patients with renal insufficiency
The Answer and Explanation
Loop diuretics are effective in treating patients with heart failure due to their short half life and rapid onset of action.
Loop diuretics act on the Na+-K+-2Cl− symporter (cotransporter) in the thick ascending limb of the loop of Henle. They work to inhibit sodium and chloride resorption by competing for the Cl− binding site. Because magnesium and calcium resorption also occur in the same part of the nephron, loop diuretics also inhibit their resorption. This decreased resorption of osmotically active ions, results in increased urine production. A secondary effect of loop diuretics is to increase the production of prostaglandins, which results in afferent arteriolar vasodilation and an increase in renal blood flow. Not surprisingly, then, NSAIDs can reduce the efficacy of loop diuretics.
Most patients with cardiomyopathy retain fluid. Diuretics are the most effective pharmacologic means to provide symptomatic relief, but their effect on survival is unknown. Diuretics also provide rapid symptomatic relief of pulmonary and peripheral edema, due to their rapid onset of action. Loop diuretics are more effective for the treatment of symptomaitc fluid retention in cardiomyopathy than thiazide-type diuretics.
Loop diuretics should be used, instead of thiazide diuretics, to treat hypertension in patients with moderate to severe renal impairment. In patients with normal renal function, loop diuretics are less effective than thiazide diuretics for the treatment of hypertension. Ethacrynic acid can be used for patients allergic to sulfonamides (thiazide and loop diuretics, other than ethacrynic acid, contain sulfonamide moieties).
Diuretics should be initiated at a low dose, which can be titrated until urine output increases and weight decreases. Patients with renal dysfunction or prior refractoriness to loop diuretics can be treated with higher doses of diuretics. Intravenous administration, concurrent use of 2 different diuretics, or the addition of an aldosterone antagonist can sometimes overcome diuretic resistance.
The most common adverse effect of diuretic therapy is hypokalemia. Diuretics must therefore be used with caution, especially if a patient is taking digoxin. Diuretics can also cause worsening of renal function. The specific choice of a loop diuretic is less important than knowing the indications and contraindications of diuretic use. Torsemide is better absorbed than furosemide and has a longer duration of action, but there is no clinical evidence that torsemide or bumetanide is more effective than furosemide at improving symptoms.
Did you get it right? The correct answer is D.
Answer A: Hypercalcemia is a known side effect of thiazide diuretics. Loop diuretics inhibit the reabsorption of magnesium and calcium.
Answer B: Loop diuretics are the most effective pharmacologic means of providing symptomatic relief to patients with cardiomyopathy, but their effect on survival is unknown.
Answer C: Loop diuretics are used instead of thiazide diuretics to treat hypertension in patients with moderate to severe renal impairment. In patients with normal renal function, loop diuretics are less effective than thiazide diuretics for the treatment of hypertension. Ethacrynic acid can be used for patients allergic to sulfonamides (thiazide and loop diuretics, other than ethacrynic acid, contain sulfonamide moieties).
Answer E: Loop diuretics are used instead of thiazide diuretics to treat hypertension in patients with moderate to severe renal impairment. However, in severe renal disease, larger doses of diuretics are usually required.
Bottom Line: Understand the role loop diuretics play in the treatment of cardiomyopathy and hypertension.
For more information, see: McPhee, Stephen J., Papadakis, Maxine A., and Rabow, Micheal W., 2012 Current Medical Diagnosis and Treatment; Fifty-First Edition. McGraw-Hill Medical; 2012. Treatment Guidelines from The Medical Letter., Drugs for Hypertension., Vol. 12;141., May 2014.
Blog
