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Family Medicine Residency Interview Questions and Answers

Medical Residency Application & Interview Preparation Specialists

Interviews for a Family Medicine Residency can require a breadth of knowledge and attributes. Here, we present 10 questions and answers suitable for candidates to a Family Medicine Residency in the US. Further questions can be found in our Medical Residency Question Bank

History Taking, Examination and Investigations

What would prompt you to screen for DM in an asymptomatic patient?

I would screen for T2DM in an asymptomatic patient if they had a BMI equal to or over 25, or equal to or greater than 23 in those with Asian heritage, and one or more of the following risk factors:
– physical inactivity
– first degree relative with diabetes 

– high-risk race/ethnic group
– women who delivered a baby weighing more than 9 pounds or were diagnosed with gestational diabetes
– If they have hypertension
– If they have conditions associated with insulin resistance, like acanthosis nigricans or polycystic ovarian syndrome
– If they have a history of cardiovascular disease

What is diagnostic of COPD?

I would consider an FEV1/FVC ratio of <0.7 as being diagnostic of COPD. We might also categorise the degree of impairment as mild, moderate, severe or very severe depending on the FEV1; an FEV1 of >80% would indicate mild impairment, whilst <80% is moderate, <50% is severe, and <30% is very severe. 

What are some red flags for neck lumps? What might you look for on palpation?

Red flags for neck lumps include a hard and fixed mass, the presence of a mucosal lesion in the head or neck, a history of persistent hoarseness or dysphagia, the presence of trismus, unilateral ear pain, irregular borders, and being over 35 years old. On palpation, a hard lump is more likely to be a malignancy than a soft lump, and a tethered lump is likely to indicate a malignant tumour. If the lump is not fluctuant it is unlikely to be a cyst, and thus more likely to be sinister. We might also note the temperature of overlying skin and if there are any changes – warmth or a punctum might indicate a cyst, for example. Pulsatility suggests vascular origin, and tenderness is indicative of inflammation or infection , likely due to a ruptured or infected cyst.

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Knowledge of Disease

What are the different categorisations of atrial fibrillation? What are two conditions that can lead to AF, and how?

What are the different categorisations of atrial fibrillation? What are two conditions that can lead to AF, and how?

The categorisation of AF is as follows:
– Paroxysmal: here, episodes last more than 30 seconds but less than 7 days and are self-terminating but recurrent.
– Persistent: here, episodes may last less than or more than seven days, but require electrical or chemical cardioversion to be terminated.
– Permanent: here, episodes will not terminate with cardioversion, or may terminate but relapse within 24 hours. Longstanding AF of more than one year, where cardioversion has not been attempted, would also fall into this category. Two conditions which can lead to AF are hypertension and mitral regurgitation; they cause the atria to stretch, which in turn changes their electrical properties, thus increasing the substrate for AF.

What are the five most common conditions in primary care in the US?

In order, they are URTI, hypertension, arthritis, diabetes, and depression or anxiety. Additional conditions which are frequently seen in primary care are pneumonia, acute otitis media, back or spinal pain, dermatitis, cough, unspecified abdominal pain, pharyngitis, and fevers and headaches. Routine health maintenance appointments also account for a significant proportion of primary care physicians’ workloads. 

What are the causes of pancreatitis? What are some risk factors?

The most common causes of pancreatitis in the US are gallstones and alcohol. Overall, the causes of pancreatitis are as follows:
– idiopathic
– gallstones
– ethanol
– trauma
– steroids
– mumps or malignancy
– autoimmune disease
– scorpion stings
– hypertriglyceridemia/Hypercalcaemia
– endoscopic retrograde cholangiopancreatography
– drugs (azathioprine, thiazides, septrin, tetracyclines)

This is remembered by generations of medical students as ‘I GET SMASHED’, of course.

Risk factors include smoking, obesity, being male, and increasing age.

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Scenarios

A patient has developed a dry cough after being prescribed a new medication for their blood pressure. What’s likely to blame, and what could be used instead?

This is likely to be due to an ACE inhibitor. I would therefore initiate either a beta-blocker or calcium channel blocker, depending on the patient’s age and race. If they were 55 or older, or of Black African descent, I would use a calcium channel blocker. Otherwise a beta blocker would be my first choice.

A 36-year-old woman has noticed that she has weakness and numbness in her legs and arms. She first noticed this a few days ago, and it has since increased. She is short of breath on exertion. She had diarrhoea six weeks ago, whilst on holiday abroad, and a stool culture confirmed infection with Campylobacter jejuni. She was treated with ciprofloxacin and recovered fully. What is the likely diagnosis? Describe the diagnosis in brief.

The most likely diagnosis is Guillain-Barré syndrome. This is an acute ascending polyneuropathy, which will eventually affect the respiratory muscles, which usually occurs following an infection.

A 52 year-old man has been tired and lethargic over the past six months. This has been increasing. He has also developed erectile dysfunction. His partner states that he looks tanned, even when he hasn’t been in the sun. His serum ferritin and transferrin levels are raised, but his haemoglobin is normal. What is the diagnosis, and why?

Haemochromatosis is the likely diagnosis. This is an inherited disorder which increases absorption of dietary iron, which then accumulates gradually in the liver, pancreas, skin, joints, heart or endocrine glands. It can cause serious damage. Pigmentation in the skin is a tell-tale sign. Ferritin and transferrin are raised.

A 72 year old woman has attended, needing a repeat prescription of 100 mcg levothyroxine daily. She has been taking this for the past 25 years. The last record of any blood test was five years ago. She describes an episode of severe back pain, with a dull ache around the L3 region. There are no neurological signs. What is the most likely diagnosis? Tell me more about the diagnosis.

The most likely diagnosis is osteoporosis. A patient who has replacement levothyroxine needs to be monitored regularly to make sure that the dose is correct. If the patient’s dose is too high, osteoporosis can result, making this the most likely diagnosis. Osteoporosis is a progressive, systemic skeletal disorder. It is characterised by disruption of bone microarchitecture and loss of bone tissue. This leads to bone fragility and thus an increased risk of fracture. It is especially associated with postmenopausal women.

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