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 Family Medicine Residency in the US. Further questions can be found in our Medical Residency Interview Question Bank.  

History and Examination

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 signs would you find on examination for a patient with COPD?

One might find a barrel chest, with the anteroposterior diameter increased due to air trapping secondary to incomplete expiration. On percussion the chest might be hyper-resonant, and on auscultation one might find distant breath sounds due to hyperinflation and air trapping. There may also be poor air movement, wheezing, and coarse crackles. 

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. 

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Knowledge: Specific Conditions

What type of crystals are found in gout and what is their appearance? What is the typical presentation of gout?

In gout we would find needle negative birefringent crystals (urate crystals). It’s important to differentiate these from the rhomboid positively birefringent crystals that we would find in pseudogout. The typical presentation of acute gout is a single swollen joint, which is erythematous and painful. Typically the joint involved is the metatarsophalangeal joint at the base of the big toe.

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.

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.

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A 50 year old man presents to you. He has severe central chest pain, which is radiating down his left arm, and has been doing so for the past two hours. He has no previous significant medical history, no comorbidities and no previous hospitalisations. His blood pressure is 155/85, his pulse is 92 BPM, regular. State two drugs that you would provide the patient with. What is the mechanism of action of one?

I would provide him with aspirin and diamorphine. This patient is likely suffering an acute MI, which requires both the provision of aspirin and adequate pain relief – in this case a slow intravenous injection of diamorphine. The mechanism of action of aspirin is largely due to a decreased production of prostaglandins and TXA2, which is a result of the irreversible inactivation of COX (cyclooxygenase). Aspirin acts as an acetylating agent, with an acetyl group covalently bonding a serine residue in the COX enzyme’s active site. 

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. 

A 17 year old female presents to you. She has asthma, which has become increasingly wheezy over the past two days. You provide a salbutamol nebuliser, which results in her peak flow rate increasing from 250 to 450L/minute. What would be the most appropriate next step in her management?

I would provide oral prednisolone as a next step. A short course of prednisolone is suitable for an acute exacerbation of asthma. The dose would be 40-50 mg once daily for 5 days.

A 21 year old female patient comes to you. She has noticed bright lines of light in both visual fields, which are followed afterwards by a partial loss of her vision. She states that her visual symptoms resolve after one hour. She also has slight nausea. What is the most likely diagnosis, and why?

The most likely diagnosis is a migraine. The visual aura and nausea are both typical of migraine. We need to consider that migraine can occur without a headache, as is likely the case here. The diagnosis is made all the more likely by the patient’s age, and the fact that the visual symptoms are short-lived.

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