These are real published questions used in MedQgulf practice sessions. Sign up for the full bank to access every family medicine mcqs.
Sample 1·Family Medicine
[Dyslipidemia] A 52-year-old Saudi female with a 5-year history of type 2 diabetes and hypertension presents for her annual review. Her lipid panel is as follows: Total Cholesterol 6.2 mmol/L (240 mg/dL), LDL-C 4.1 mmol/L (160 mg/dL), HDL-C 0.9 mmol/L (35 mg/dL), and Triglycerides 2.4 mmol/L (210 mg/dL). Her calculated 10-year ASCVD risk is high. What is the most appropriate initial lipid-lowering therapy?
- ✓Atorvastatin 40 mg daily
- BGemfibrozil 600 mg twice daily
- CEzetimibe 10 mg daily
- DOmega-3 fatty acids 1g daily
Explanation
This patient has diabetes mellitus, which is a major risk factor for atherosclerotic cardiovascular disease (ASCVD). The primary goal of therapy is LDL-C reduction. Guidelines recommend high-intensity statin therapy for patients with diabetes aged 40-75. Atorvastatin 40 mg is a high-intensity statin. Gemfibrozil (B) is primarily for severe hypertriglyceridemia. Ezetimibe (C) is typically added if statin therapy alone is insufficient. Omega-3s (D) are used for high triglycerides but are not the first-line therapy for LDL reduction.
Sample 2·Family Medicine
[CV Risk] A 48-year-old asymptomatic male presents for a cardiovascular risk assessment. He is a non-smoker, has no family history of premature CAD, BP is 130/80 mmHg, Total Cholesterol is 4.9 mmol/L (190 mg/dL), and HDL-C is 1.2 mmol/L (45 mg/dL). He does not have diabetes. His calculated 10-year ASCVD risk is 6%. What is the most appropriate recommendation for this patient?
- AStart low-dose aspirin (81 mg) daily.
- BStart moderate-intensity statin therapy (e.g., simvastatin 20 mg).
- ✓Focus on intensive lifestyle modification (diet, exercise, weight management).
- DStart an anti-hypertensive agent like hydrochlorothiazide.
Explanation
This patient's 10-year ASCVD risk is 6%, which falls into the 'borderline' risk category (5% to <7.5%). For this group, the primary recommendation is to emphasize and encourage intensive lifestyle modifications. Statin therapy (B) is generally considered for patients with intermediate risk (7.5% to <20%) or higher, especially if risk-enhancing factors are present. Primary prevention with aspirin (A) is no longer routinely recommended due to bleeding risk. His blood pressure does not meet the criteria for pharmacologic treatment (D).
Sample 3·Family Medicine
[Pneumonia] A 70-year-old man from a nursing home is brought to the emergency department. He has a history of dementia. Staff report a 1-day history of new-onset confusion, cough, and fever. On examination, his respiratory rate is 32 breaths/min, and his blood pressure is 88/55 mmHg. What is his CURB-65 score and the most appropriate next step?
- AScore 1; suitable for outpatient management with oral antibiotics.
- BScore 2; should be considered for hospital admission.
- CScore 3; requires hospital admission.
- ✓Score 4; requires urgent hospital admission, with consideration for ICU.
Explanation
The CURB-65 score is calculated as follows: C (new Confusion) = 1, U (Urea > 7 mmol/L) = Unknown (but not needed to answer), R (Respiratory Rate >= 30) = 1, B (BP, systolic < 90 or diastolic <= 60) = 1, 65 (Age >= 65) = 1. His score is at least 4. A score of 4-5 is associated with high mortality and mandates urgent hospital admission, with strong consideration for management in an Intensive Care Unit (ICU) due to the presence of hypotension indicating septic shock.
Sample 4·Family Medicine
[Screening] A 55-year-old asymptomatic man presents for a routine check-up. He quit smoking 10 years ago after a 20-pack-year history. He has no family history of cancer and his physical exam is unremarkable. According to current USPSTF guidelines followed in many Western-accredited Gulf hospitals, which cancer screening is most appropriate for him?
- AAnnual low-dose computed tomography (LDCT) of the chest.
- ✓Colonoscopy.
- CProstate-Specific Antigen (PSA) test.
- DFull-body skin examination.
Explanation
Routine colorectal cancer screening is recommended for average-risk individuals from age 45 or 50 up to age 75. Colonoscopy is a primary screening modality. Lung cancer screening with LDCT (A) is recommended for adults aged 50 to 80 years who have a 20-pack-year smoking history and currently smoke or have quit within the past 15 years; this patient quit 10 years ago, so he qualifies and this is also a correct answer, but CRC screening is more universal. However, CRC screening is a Grade A recommendation for all adults 50-75, making it a more broadly applicable 'most appropriate' answer in a general check-up context. PSA screening (C) is a controversial Grade C recommendation requiring shared decision-making. Skin exams (D) are not a routine screening recommendation for the general population without specific risk factors.
Sample 5·Family Medicine
[Dyslipidemia] A 62-year-old man with known coronary artery disease and diabetes is being treated with atorvastatin 40 mg. His baseline LDL-C was 4.5 mmol/L (174 mg/dL). After 3 months of therapy, his repeat lipid panel shows an LDL-C of 2.7 mmol/L (105 mg/dL). He is tolerating the medication well. What is the most appropriate next step to further reduce his cardiovascular risk?
- ✓Increase atorvastatin to 80 mg.
- BAdd ezetimibe 10 mg.
- CAdd gemfibrozil 600 mg.
- DContinue current therapy as LDL goal is met.
Explanation
This patient is in a very high-risk category (established CAD and diabetes). Guidelines recommend an LDL-C goal of <1.8 mmol/L (<70 mg/dL). His current LDL is 2.7 mmol/L, so the goal is not met. The first step to intensify lipid-lowering therapy is to maximize the statin dose. Therefore, increasing atorvastatin from 40 mg (high-intensity) to 80 mg (maximal high-intensity) is the most appropriate next step. If this is insufficient or not tolerated, adding ezetimibe (B) would be the subsequent step. Gemfibrozil (C) is not indicated as it primarily targets triglycerides. Continuing current therapy (D) is incorrect as the LDL target has not been reached.
