FAMILY MEDICINE AQUIFER EXAM ACTUAL QUESTIONS
AND CORRECT ANSWERS ALREADY GRADED A+
GUARANTEED SUCCESS
A 68-year-old male with a past medical history significant for hypertension and diabetes presents
to your office with a three-month history of headaches. He describes a pain that has occasionally
awoken him from sleep and is often worse in the morning. He denies any weakness or changes in
vision. His exam shows 4+ reflexes in the right upper and lower extremities but is otherwise
normal. What is the best next step in management for this patient?
A. Reassurance
B. Neuroimaging
C. Initiate treatment with sumatriptan
D. Sleep Study
(B)
. A 55-year-old man presents with a 2-month history of fatigue and unintentional weight loss. He
has a 30-pack-year smoking history. Physical exam reveals supraclavicular lymphadenopathy.
What's the next best step?
A. Chest X-ray
B. CBC with differential
C. Colonoscopy
D. Abdominal ultrasound
E. PPD test
Correct answer: A. Chest X-ray
Rationale: In a smoker with weight loss and supraclavicular lymphadenopathy, lung cancer is a
concern. Chest X-ray is the most appropriate initial step.
A 35-year-old female with a history of headaches presents to your office with a headache that is
not responsive to 400 mg Ibuprofen TID or 500 mg Tylenol TID. Upon gathering further history
you find that in the past her headaches were controlled with these medications but recently have
1
,been worse with this same treatment. She complains of 4-5 headaches weekly that are often present
on awakening. Which of the following is the best treatment for her disorder?
A. Prescribe a different NSAID to take for acute headaches
B. Prescribe an opioid medication to take for acute headaches
C. Discontinue use of Ibuprofen and Tylenol
D. Prescribe a calcium-channel blocker for headache prevention
(C)
The patient in this case is likely experiencing rebound headaches, due to a dependence on the
ibuprofen and Tylenol. The appropriate treatment for this type of headache is discontinuation of
the agents. ** Counseling must be provided that headaches may worsen before resolving over
time. Adding an opioid would not resolve symptoms but might also lead to dependence.
A 28-year-old woman presents for contraception counseling. She has no chronic diseases and does
not smoke. She is interested in a long-term, reversible option. What is the most appropriate
recommendation?
A. Combined oral contraceptive pills
B. Contraceptive patch
C. Copper IUD
D. Vaginal ring
Correct answer: C. Copper IUD
Rationale: For healthy women desiring long-term contraception, IUDs (copper or hormonal) are
first-line due to efficacy and convenience.
A 60-year-old man with hypertension and hyperlipidemia presents for routine care. Which
preventive screening is recommended?
A. Colonoscopy every 5 years
B. PSA annually
C. Abdominal ultrasound for AAA
D. Chest CT
E. Hepatitis B serology
2
,Correct answer: C. Abdominal ultrasound for AAA
Rationale: One-time AAA screening is recommended in men aged 65–75 who have ever smoked.
A 4-year-old child presents for a well-child visit. He received his MMR vaccine at 12 months.
When should the second dose be administered?
A. At 4 years old
B. At 6 years old
C. At 10 years old
D. At 2 years old
E. Not needed
Correct answer: A. At 4 years old
Rationale: The second MMR dose is typically given at 4–6 years of age.
A 45-year-old woman presents with fatigue, cold intolerance, and weight gain. TSH is 10 mIU/L
(high), and free T4 is low. What is the most appropriate treatment?
A. Methimazole
B. Levothyroxine
C. Beta-blocker
D. No treatment needed
E. T3 supplementation
Correct answer: B. Levothyroxine
Rationale: This is overt hypothyroidism and requires thyroid hormone replacement.
6. A 17-year-old male presents with sore throat, fever, and fatigue. Examination shows posterior
cervical lymphadenopathy and splenomegaly. Rapid strep test is negative. What is the next best
test?
A. Monospot test
B. Throat culture
3
, C. CBC with differential
D. Chest X-ray
E. ASO titer
Correct answer: A. Monospot test
Rationale: Mononucleosis is suspected; the Monospot test detects heterophile antibodies.
7. A 66-year-old woman with a 10-year history of type 2 diabetes has an HbA1c of 8.2%. She has
stage 3 chronic kidney disease. Which antihyperglycemic agent should be avoided?
A. Glipizide
B. Sitagliptin
C. Metformin
D. Liraglutide
E. Insulin
Correct answer: C. Metformin
Rationale: Metformin is contraindicated in advanced CKD due to the risk of lactic acidosis.
8. A 6-month-old infant presents with fever, irritability, and a bulging fontanelle. What is the most
appropriate next step?
A. Give acetaminophen and reassess
B. Order a head CT
C. Lumbar puncture
D. Administer oral antibiotics
E. EEG
Correct answer: C. Lumbar puncture
Rationale: Suspected meningitis in infants requires immediate lumbar puncture.
9. A 30-year-old woman presents with dysuria and frequency. She has no fever, flank pain, or
vaginal discharge. What is the most appropriate management?
4
AND CORRECT ANSWERS ALREADY GRADED A+
GUARANTEED SUCCESS
A 68-year-old male with a past medical history significant for hypertension and diabetes presents
to your office with a three-month history of headaches. He describes a pain that has occasionally
awoken him from sleep and is often worse in the morning. He denies any weakness or changes in
vision. His exam shows 4+ reflexes in the right upper and lower extremities but is otherwise
normal. What is the best next step in management for this patient?
A. Reassurance
B. Neuroimaging
C. Initiate treatment with sumatriptan
D. Sleep Study
(B)
. A 55-year-old man presents with a 2-month history of fatigue and unintentional weight loss. He
has a 30-pack-year smoking history. Physical exam reveals supraclavicular lymphadenopathy.
What's the next best step?
A. Chest X-ray
B. CBC with differential
C. Colonoscopy
D. Abdominal ultrasound
E. PPD test
Correct answer: A. Chest X-ray
Rationale: In a smoker with weight loss and supraclavicular lymphadenopathy, lung cancer is a
concern. Chest X-ray is the most appropriate initial step.
A 35-year-old female with a history of headaches presents to your office with a headache that is
not responsive to 400 mg Ibuprofen TID or 500 mg Tylenol TID. Upon gathering further history
you find that in the past her headaches were controlled with these medications but recently have
1
,been worse with this same treatment. She complains of 4-5 headaches weekly that are often present
on awakening. Which of the following is the best treatment for her disorder?
A. Prescribe a different NSAID to take for acute headaches
B. Prescribe an opioid medication to take for acute headaches
C. Discontinue use of Ibuprofen and Tylenol
D. Prescribe a calcium-channel blocker for headache prevention
(C)
The patient in this case is likely experiencing rebound headaches, due to a dependence on the
ibuprofen and Tylenol. The appropriate treatment for this type of headache is discontinuation of
the agents. ** Counseling must be provided that headaches may worsen before resolving over
time. Adding an opioid would not resolve symptoms but might also lead to dependence.
A 28-year-old woman presents for contraception counseling. She has no chronic diseases and does
not smoke. She is interested in a long-term, reversible option. What is the most appropriate
recommendation?
A. Combined oral contraceptive pills
B. Contraceptive patch
C. Copper IUD
D. Vaginal ring
Correct answer: C. Copper IUD
Rationale: For healthy women desiring long-term contraception, IUDs (copper or hormonal) are
first-line due to efficacy and convenience.
A 60-year-old man with hypertension and hyperlipidemia presents for routine care. Which
preventive screening is recommended?
A. Colonoscopy every 5 years
B. PSA annually
C. Abdominal ultrasound for AAA
D. Chest CT
E. Hepatitis B serology
2
,Correct answer: C. Abdominal ultrasound for AAA
Rationale: One-time AAA screening is recommended in men aged 65–75 who have ever smoked.
A 4-year-old child presents for a well-child visit. He received his MMR vaccine at 12 months.
When should the second dose be administered?
A. At 4 years old
B. At 6 years old
C. At 10 years old
D. At 2 years old
E. Not needed
Correct answer: A. At 4 years old
Rationale: The second MMR dose is typically given at 4–6 years of age.
A 45-year-old woman presents with fatigue, cold intolerance, and weight gain. TSH is 10 mIU/L
(high), and free T4 is low. What is the most appropriate treatment?
A. Methimazole
B. Levothyroxine
C. Beta-blocker
D. No treatment needed
E. T3 supplementation
Correct answer: B. Levothyroxine
Rationale: This is overt hypothyroidism and requires thyroid hormone replacement.
6. A 17-year-old male presents with sore throat, fever, and fatigue. Examination shows posterior
cervical lymphadenopathy and splenomegaly. Rapid strep test is negative. What is the next best
test?
A. Monospot test
B. Throat culture
3
, C. CBC with differential
D. Chest X-ray
E. ASO titer
Correct answer: A. Monospot test
Rationale: Mononucleosis is suspected; the Monospot test detects heterophile antibodies.
7. A 66-year-old woman with a 10-year history of type 2 diabetes has an HbA1c of 8.2%. She has
stage 3 chronic kidney disease. Which antihyperglycemic agent should be avoided?
A. Glipizide
B. Sitagliptin
C. Metformin
D. Liraglutide
E. Insulin
Correct answer: C. Metformin
Rationale: Metformin is contraindicated in advanced CKD due to the risk of lactic acidosis.
8. A 6-month-old infant presents with fever, irritability, and a bulging fontanelle. What is the most
appropriate next step?
A. Give acetaminophen and reassess
B. Order a head CT
C. Lumbar puncture
D. Administer oral antibiotics
E. EEG
Correct answer: C. Lumbar puncture
Rationale: Suspected meningitis in infants requires immediate lumbar puncture.
9. A 30-year-old woman presents with dysuria and frequency. She has no fever, flank pain, or
vaginal discharge. What is the most appropriate management?
4
