Conjoint HKCFP/RACGP Fellowship Examination - MCQ (Hong Kong)

According to the Hong Kong Reference Framework for Life Course Preventive Care in Primary Care, which of the following is recommended as the first-line maintenance therapy for a 65-year-old patient with stable COPD who has infrequent exacerbations (Group A)?

• AShort-acting beta2-agonist (SABA) as needed only
• BA long-acting bronchodilator (LAMA or LABA)
• CInhaled corticosteroid (ICS) monotherapy
• DCombination of LABA and ICS

A 54-year-old patient with Type 2 Diabetes Mellitus and no history of cardiovascular disease presents for routine follow-up. Her blood pressure is consistently 136/84 mmHg across three clinic visits. According to the Hong Kong Reference Framework, what is the recommended blood pressure target for this patient?

• ALess than 140/90 mmHg
• BLess than 130/80 mmHg
• CLess than 120/80 mmHg
• DLess than 135/85 mmHg

A 62-year-old man with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². He has been taking Metformin 1000 mg twice daily. Which of the following is the most appropriate management of his Metformin therapy?

• AContinue Metformin at the current dose of 1000 mg twice daily
• BReduce Metformin dose to 500 mg twice daily
• CDiscontinue Metformin
• DSwitch Metformin to once-daily dosing with food

A 68-year-old woman with a history of hypertension and Type 2 Diabetes is found to have a urine albumin-to-creatinine ratio (ACR) of 12 mg/mmol on two occasions. Her eGFR is 52 mL/min/1.73m². Which class of antihypertensive medication is the first choice to manage her hypertension and chronic kidney disease?

• ACalcium channel blocker (CCB)
• BThiazide-like diuretic
• CAngiotensin-converting enzyme inhibitor (ACEi) or Angiotensin receptor blocker (ARB)
• DBeta-blocker

A 24-year-old female presents to your clinic with symptoms of mild intermittent asthma. According to the Global Initiative for Asthma (GINA) guidelines, which of the following is the recommended preferred controller and reliever strategy for adults?

• AAs-needed short-acting beta2-agonist (SABA) alone
• BRegular daily low-dose inhaled corticosteroid (ICS) plus as-needed SABA
• CAs-needed low-dose combination ICS-formoterol
• DDaily low-dose ICS-formoterol as maintenance and reliever therapy

A 70-year-old male with chronic heart failure with reduced ejection fraction (HFrEF, EF 32%) is clinically stable on optimal doses of Lisinopril, Bisoprolol, and Spironolactone. He remains in NYHA Class II. Which of the following medications has been shown to reduce mortality and should be added next as part of Guideline-Directed Medical Therapy (GDMT)?

• ADigoxin
• BFurosemide
• CSGLT2 inhibitor (e.g., Dapagliflozin)
• DAmlodipine

A 45-year-old Han Chinese man presents with a painful, swollen first metatarsophalangeal joint consistent with acute gout. He is managed successfully with naproxen. He has normal renal function. Prior to initiating long-term uric acid-lowering therapy with Allopurinol, which genetic screening test should be considered in Hong Kong?

• AHLA-B*1502
• BHLA-B*5801
• CHLA-B*5701
• DG6PD status

A 72-year-old man presents with persistent knee pain due to osteoarthritis. He has a history of ischemic heart disease and peptic ulcer disease. Which of the following is the most appropriate first-line pharmacological treatment according to current international and local guidelines?

• AOral Naproxen with proton pump inhibitor (PPI)
• BTopical NSAIDs (e.g., Diclofenac gel)
• COral Paracetamol (Acetaminophen) scheduled daily
• DOral Tramadol

A 35-year-old woman is diagnosed with Graves' disease and is initiated on Carbimazole therapy. During counselling, what is the most critical adverse effect she must be warned about, requiring immediate medical evaluation and a full blood count?

• AMild pruritus and maculopapular rash
• BAgranulocytosis
• CCholestatic jaundice
• DDrug-induced lupus erythematosus

A 38-year-old asymptomatic male is found to be HBsAg positive during a routine pre-employment screen. His ALT is normal (22 U/L), and HBV DNA is 1,200 IU/mL. There is no evidence of cirrhosis on transient elastography. What is the recommended management plan for this patient?

• AInitiate Tenofovir immediately to prevent transmission
• BInitiate Entecavir immediately to prevent hepatocellular carcinoma (HCC)
• CMonitor ALT and HBV DNA every 3-6 months without antiviral therapy
• DPerform a liver biopsy to guide decision making

A 58-year-old man with stable angina reports chest pain on moderate exertion. He is already taking Amlodipine 5 mg daily for hypertension, but his heart rate is 78 bpm. What is the most appropriate first-line anti-anginal medication to add to improve his exertional symptoms?

• AIsosorbide mononitrate
• BMetoprolol (Beta-blocker)
• CNicorandil
• DIvabradine

A 74-year-old woman with a history of hypertension, ischemic stroke 2 years ago, and chronic non-valvular atrial fibrillation presents to your clinic. What is the most appropriate long-term antithrombotic strategy to prevent recurrent stroke in this patient?

• AAspirin 80 mg daily
• BClopidogrel 75 mg daily
• CAspirin 80 mg and Clopidogrel 75 mg daily
• DA Direct Oral Anticoagulant (DOAC, e.g., Apixaban)

A 50-year-old male with a history of acute coronary syndrome 3 months ago is on Atorvastatin 40 mg daily. His latest lipid profile shows an LDL-C of 2.2 mmol/L. According to current guidelines for very high-risk cardiovascular patients, what is the target LDL-C and the most appropriate next step in management?

• ATarget is <2.6 mmol/L; continue current dose of Atorvastatin
• BTarget is <1.8 mmol/L; increase Atorvastatin to 80 mg daily
• CTarget is <1.4 mmol/L; increase Atorvastatin to 80 mg daily and consider adding Ezetimibe
• DTarget is <1.8 mmol/L; switch to Rosuvastatin 10 mg daily

An 82-year-old woman with a history of hypertension and osteoarthritis presents with asymptomatic atrial fibrillation. Her pulse is 95 bpm and irregular. There is no valvular heart disease. Her CHA2DS2-VASc score is calculated as 5. Which of the following is the most appropriate first-line strategy to manage her stroke risk and symptoms?

• AImmediate electrical cardioversion
• BDirect Oral Anticoagulant (DOAC) and rate control (e.g., low-dose beta-blocker)
• CWarfarin with INR target 2.0-3.0 and Amiodarone
• DAspirin 80 mg daily and Digoxin

A 48-year-old obese man is diagnosed with metabolic dysfunction-associated steatotic liver disease (MASLD, formerly NAFLD) after an ultrasound shows fatty liver. His liver enzymes are slightly elevated (ALT 55 U/L, AST 42 U/L). What is the primary management recommendation to reverse steatosis and prevent progression?

• APrescribe Ursodeoxycholic acid (UDCA)
• BStrict weight loss targeting 7-10% of body weight through lifestyle modifications
• CInitiate low-dose Metformin
• DPerform a CT scan of the abdomen to monitor progression annually

A 78-year-old female patient with mild cognitive impairment presents with difficulty sleeping. Her family asks if she can be prescribed Amitriptyline or a long-acting Benzodiazepine for insomnia. Which of the following is the most appropriate guidance regarding prescribing these classes of medications in the elderly?

• AAmitriptyline is a safe choice as it has sedating properties and will also treat any co-e…
• BLong-acting benzodiazepines are preferred over short-acting ones because they maintain sl…
• CBoth medication classes should be avoided in older adults due to high risk of adverse eff…
• DBenzodiazepines are indicated for long-term use in elderly insomnia as long as the dose i…

A 65-year-old patient has been taking Omeprazole 20 mg daily for over five years for gastroesophageal reflux disease (GERD). Which of the following long-term adverse effects is most strongly associated with chronic Proton Pump Inhibitor (PPI) use?

• AHyperkalemia
• BVitamin B12 deficiency and osteoporosis
• CHyperthyroidism
• DLiver cirrhosis

A 28-year-old woman with a history of epilepsy is planning to conceive. She is currently taking Sodium Valproate to control her generalized tonic-clonic seizures. What is the most appropriate management strategy regarding her anticonvulsant therapy?

• ADiscontinue Sodium Valproate immediately and advise she can conceive once seizure-free
• BTransition her to Levetiracetam or Lamotrigine before conception and prescribe high-dose…
• CMaintain Sodium Valproate but reduce the dose to less than 200 mg daily
• DAdvise her that Sodium Valproate is safe during pregnancy as long as ultrasound monitorin…

A 60-year-old diabetic patient presents with burning and tingling pain in both feet in a stocking-like distribution, consistent with diabetic peripheral neuropathy. According to clinical guidelines, which of the following is the most appropriate first-line pharmacological treatment?

• AOxycodone
• BPregabalin or Amitriptyline
• CIbuprofen
• DParacetamol

A 42-year-old woman is diagnosed with early active rheumatoid arthritis. What is the recommended management strategy regarding Disease-Modifying Antirheumatic Drugs (DMARDs)?

• ADelay DMARDs until joint erosions are visible on X-ray to confirm disease severity
• BInitiate Methotrexate as soon as possible after diagnosis
• CTreat with oral Prednisolone monotherapy for the first year
• DUse NSAIDs as the sole therapy until systemic symptoms develop

According to the Colorectal Cancer Screening Programme of the Hong Kong Department of Health, what is the recommended screening protocol for asymptomatic average-risk individuals aged 50 to 75 years?

• AAnnual colonoscopy
• BFaecal Immunochemical Test (FIT) every 2 years
• CCT Colonography every 5 years
• DDigital rectal examination and faecal occult blood test annually

A 32-year-old asymptomatic woman who has been sexually active asks about cervical cancer screening in Hong Kong. According to the Hong Kong Cancer Coordinating Committee guidelines, what is the recommended screening strategy for her?

• ACervical cytology (Pap smear) every year starting at age 30
• BHPV DNA testing alone every 5 years, or cervical cytology every 3 years
• CScreening is not required unless she has symptoms such as post-coital bleeding
• DCo-testing (cytology and HPV) annually

A 45-year-old asymptomatic woman attends your clinic requesting a screening mammogram. She has no family history of breast cancer. According to the Hong Kong Cancer Coordinating Committee's risk-based screening recommendations, which of the following is the most appropriate management?

• ARoutine mammography screening every 2 years is recommended for all women aged 40-69.
• BEvaluate her breast cancer risk; average-risk women may consider mammography every 2 year…
• CAdvise her that mammography is contraindicated before age 50 in Hong Kong.
• DPerform a breast ultrasound instead of mammography as it is the preferred screening modal…

A 55-year-old man asks you about screening for prostate cancer using the Prostate-Specific Antigen (PSA) test. He has no urinary symptoms and no family history of prostate cancer. According to current consensus guidelines (including HKCFP and RACGP), what is the most appropriate advice?

• ARoutine annual PSA screening is recommended for all men aged 50-69.
• BPSA screening should not be performed as it has no clinical value.
• CDiscuss the potential benefits (early detection of aggressive cancer) and harms (overdiag…
• DPerform a digital rectal examination (DRE) first, and only order PSA if the DRE is abnorm…

A 48-year-old asymptomatic male smoker with hypertension presents for a check-up. You want to assess his 10-year risk of cardiovascular disease (CVD) to guide primary prevention. Which of the following parameters is NOT required to calculate a standard cardiovascular risk score (such as Framingham or QRISK)?

• ATotal Cholesterol and HDL Cholesterol levels
• BSystolic Blood Pressure
• CDietary sodium intake
• DSmoking status

A 66-year-old male retired construction worker who smoked one pack of cigarettes daily for 40 years presents for a general check-up. He has no abdominal symptoms. According to major preventive guidelines, what is the recommendation for screening him for an Abdominal Aortic Aneurysm (AAA)?

• AA one-time screening for AAA using abdominal ultrasound
• BAnnual screening for AAA using abdominal palpation
• CNo screening is recommended as he is asymptomatic
• DA screening CT scan of the abdomen and pelvis every 5 years

A 67-year-old postmenopausal woman with no history of fractures or secondary causes of bone loss presents to your clinic. What is the recommended screening strategy for osteoporosis in this patient?

• ANo screening is needed unless she experiences a low-trauma fracture.
• BA baseline Dual-energy X-ray Absorptiometry (DXA) scan of the hip and spine
• CA screening plain X-ray of the lumbar spine and pelvis
• DInitiate bisphosphonates empirically without bone density testing

A 70-year-old healthy female patient visits your clinic for preventive care. She has not received any pneumococcal vaccines in the past. According to current immunization guidelines in Hong Kong, which of the following is the recommended pneumococcal vaccination schedule for her?

• AA single dose of 23-valent pneumococcal polysaccharide vaccine (PPSV23) only
• BA single dose of 13-valent pneumococcal conjugate vaccine (PCV13) only
• CA dose of 15-valent pneumococcal conjugate vaccine (PCV15) or 20-valent pneumococcal conj…
• DAnnual pneumococcal vaccination with PPSV23

A 40-year-old nurse working in a public hospital in Hong Kong requires screening for Latent Tuberculosis Infection (LTBI) after a close contact exposure. Which of the following statements is true regarding the choice between the Tuberculin Skin Test (TST) and the Interferon-Gamma Release Assay (IGRA) in this patient?

• ATST is preferred because it is more specific in patients who have received the BCG vaccin…
• BIGRA is preferred because it is not affected by prior BCG vaccination, reducing false-pos…
• CTST is preferred because it can differentiate between active and latent TB.
• DIGRA is contraindicated in healthcare workers due to high rates of false-negative results.

A 35-year-old woman presents with vague somatic complaints. You decide to screen her for depression. Which of the following is the recommended initial two-question screening tool (PHQ-2) used in primary care?

• AQuestions about suicidal ideation and sleep disturbance
• BQuestions about depressed mood and anhedonia (loss of interest or pleasure) over the past…
• CQuestions about generalized anxiety and panic attacks
• DQuestions about alcohol use and family history of psychiatric illness

A 45-year-old asymptomatic woman with no medical history attends your clinic. Her body mass index (BMI) is 22 kg/m². According to standard screening guidelines, how should she be screened for Type 2 Diabetes Mellitus?

• AScreening is not indicated as her BMI is normal and she has no risk factors.
• BScreening should be initiated at age 45 using Fasting Plasma Glucose (FPG) or HbA1c, repe…
• CShe should be screened using an Oral Glucose Tolerance Test (OGTT) annually.
• DScreening is only indicated if she presents with polyuria or polydipsia.

A 68-year-old woman who smoked a half-pack of cigarettes daily for 20 years asks if she should be screened for an Abdominal Aortic Aneurysm (AAA). According to USPSTF and other major guidelines, what is the recommendation for AAA screening in females?

• AA one-time screening with abdominal ultrasound is recommended for all female smokers aged…
• BScreening is not recommended for women who have never smoked, and there is insufficient e…
• CAnnual physical examination for abdominal bruits is recommended.
• DScreening with abdominal CT is recommended for all women aged 65 and older.

A 45-year-old woman had a total hysterectomy (cervix and uterus removed) 3 years ago for symptomatic uterine fibroids. She has a history of normal cervical smear results. What is the recommendation for her future cervical cancer screening?

• AContinue routine cervical screening every 3 years using vaginal vault smears.
• BCervical screening can be discontinued.
• CScreening should be performed using HPV DNA testing every 5 years.
• DScreening is required annually until age 65.

A 55-year-old postmenopausal woman presents for a health check. She has no risk factors for osteoporosis, and a DXA scan is not immediately available. According to WHO guidelines, what is the best alternative to estimate her fracture risk and determine the need for a DXA scan?

• ACalculate her FRAX (Fracture Risk Assessment Tool) score without a BMD input.
• BOrder a serum calcium and alkaline phosphatase level.
• CMeasure her height weekly to check for height loss.
• DPerform a quantitative ultrasound of the calcaneus (heel) and initiate therapy if abnorma…

Which of the following practices is recommended as part of an evidence-based annual health check-up for an asymptomatic 40-year-old average-risk adult?

• ARoutine screening electrocardiogram (ECG)
• BRoutine screening chest X-ray
• CBlood pressure measurement, lipid profile risk assessment, and lifestyle review
• DRoutine screening complete blood count (CBC) and renal panel

A 22-year-old asymptomatic male student presents to your clinic for a general health check. He has no family history of premature cardiovascular disease, dyslipidemia, or diabetes. According to major preventive guidelines, what is the recommendation for lipid screening in this patient?

• AScreen now with a fasting lipid profile and repeat annually.
• BRoutine screening for lipid disorders is not recommended for low-risk males under the age…
• CPerform a point-of-care total cholesterol test today.
• DAdvise him to start taking a low-dose statin empirically.

A 52-year-old man visits your clinic. He has no history of injection drug use, blood transfusions, or high-risk sexual behavior. According to current guidelines for Hepatitis C Virus (HCV) screening, what is the recommended approach for this patient?

• AHCV screening is only recommended for individuals with specific risk factors.
• BA one-time screening for HCV with an antibody test is recommended for all adults aged 18…
• CAnnual HCV screening is recommended for all adults.
• DA screening liver biopsy is indicated to rule out silent HCV infection.

A 62-year-old healthy patient asks you about the shingles vaccine. He had a mild episode of herpes zoster 3 years ago. According to current guidelines in Hong Kong, what is the recommended advice regarding the recombinant zoster vaccine (Shingrix)?

• AHe does not need the vaccine because a prior episode of shingles provides lifelong immuni…
• BThe vaccine is recommended and consists of two doses, even in individuals with a history…
• CThe vaccine is contraindicated in patients with a history of shingles.
• DHe should receive a single dose of the live zoster vaccine (Zostavax) instead, as it is p…

Which of the following groups is NOT recommended by the Department of Health in Hong Kong to receive prioritized seasonal influenza vaccination under the Government Vaccination Programme?

• AElderly persons aged 65 years or above
• BHealthcare workers in public and private clinics
• CPregnant women
• DHealthy adults aged 18 to 49 years with no comorbidities

A 30-year-old woman presents to your clinic with chronic, non-specific abdominal pain and headaches that have not responded to treatment. During the consultation, you notice she is anxious and has poor eye contact. What is the most appropriate next step in screening and managing this patient?

• ARefer her to a gastroenterologist for an endoscopy.
• BScreen for intimate partner violence (IPV) using a validated tool or direct, sensitive qu…
• CPrescribe an antidepressant for somatization disorder.
• DAdvise her to return only if her physical symptoms worsen.

At a routine child health visit, a mother asks if her 18-month-old child is developing normally. Which of the following developmental milestones is typical for a healthy child at 18 months of age?

• ARuns well, climbs stairs one foot at a time, and speaks in 3-word sentences.
• BWalks independently, says at least 6-10 single words, points to show what they want, and…
• CBuilds a tower of 6 blocks, copies a circle, and feeds themselves with a spoon without sp…
• DStands holding onto furniture, uses a pincer grasp, and waves 'bye-bye'.

A 28-year-old pregnant woman at 11 weeks of gestation attends your clinic for her first prenatal visit. She is interested in screening for Down Syndrome. Which of the following is the most sensitive and specific screening option currently available?

• ASecond-trimester triple test (AFP, hCG, and unconjugated estriol)
• BFirst-trimester combined test (Nuchal Translucency, maternal serum PAPP-A and free beta-h…
• CNon-Invasive Prenatal Testing (NIPT) analyzing cell-free fetal DNA
• DAmniocentesis

A 2-week-old breastfed infant is brought to your clinic with persistent jaundice. The baby is feeding well, gaining weight, and has normal clay-colored stools. On examination, the infant appears jaundiced to the mid-abdomen but is otherwise active and alert. Which of the following is the most critical initial investigation to rule out a pathological cause like biliary atresia?

• ATranscutaneous bilirubin measurement only
• BTotal and fractionated (conjugated/direct) bilirubin level
• CSerum G6PD activity level
• DMaternal-infant blood group compatibility testing

A breastfeeding mother presents with a urinary tract infection. You want to prescribe Nitrofurantoin but she is concerned about drug transfer in breast milk. Which of the following is the most appropriate clinical advice?

• AShe must stop breastfeeding immediately and discard her breast milk during the course of…
• BMost antibiotics, including Nitrofurantoin, are compatible with breastfeeding; she can sa…
• CBreastfeeding should be suspended for 24 hours after each dose of Nitrofurantoin.
• DSwitch the infant to formula permanently as antibiotic exposure in breast milk causes imm…

A 6-week postpartum woman presents for her routine maternal check-up. She reports feeling tearful, exhausted, and anxious about caring for her newborn. Which of the following is the recommended screening tool and threshold for assessing postpartum depression?

• APHQ-9 with a threshold score of 5
• BEdinburgh Postnatal Depression Scale (EPDS) with a threshold score of 10 or 13
• CBeck Depression Inventory (BDI) with a threshold score of 20
• DGeneralized Anxiety Disorder 7 (GAD-7) with a threshold score of 10

Under the Hong Kong Childhood Immunisation Programme, at what age is the first dose of measles-containing vaccine (the MMR vaccine) routinely administered?

• AAt birth
• B6 months
• C12 months
• D18 months