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ABFM 2021 questions and answers
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ABFM 2021 questions and answers ABFM 2021 questions and answers ABFM 2021 questions and answers
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ABFM 2021 questions and answersA 68-year-old female presents with a 2-month history of watery diarrhea. She has not had any blood
or pus in her stools, and the stools are not oily. She has not had any history of fever, chills, or weight
loss, and has not traveled recently. She smokes one pack of cigarettes per day. Her medications
include ibuprofen, sertraline (Zoloft), and pantoprazole (Protonix). A CBC, metabolic panel, C-
reactive protein level, IgA anti-tissue transglutaminase level, total IgA level, and stool guaiac test are
all normal. Which one of the following tests would be most likely to yield a diagnosis?
A) Clostridioides (Clostridium) difficile toxin
B) Colonoscopy
C) Fecal calprotectin
D) A stool culture
E) Stool examination for ova and parasites - Basically theres no mucous no blood in stool, so now we
have to look at the tissue via a COLONOSCOPY to rule out lymphocytic or collagenous colitis; C diff
ud expect abx use in the last 3 months, Fecal calprotectin ur thinking Crohns or UC, and ud expect to
see mucosy diarrhea or blood in diarrhea, Stool culture think for sure bloody diarrhea, and that
would be in setting of like shigella or salmonella, stool exam of ova and parasites think exposure thru
travel;
Also in favor of lymphocytic colitis, think typical meds like sertraline, PPI, acarbose, NSAIDs, ASA,
Ticlodipine
When can u start buprenorphine induction for Substance Use Disorder? - 8-12 hours after last opioid
use
Goal is to use it when patient is in mild to mod withdrawal, since the med is a partial agonist, and if u
use it to close to last use then ull precipitate the withdrawal
How do u treat a ganglion on the hand? - Its common, it usually goes away on its own 50% of the
time, think watchful waiting...
Aspiration of the lesion is the initial treatment, although recurrence may occur in 85% of cases.. Can
refer for excision BUT theres a 10-15% chance of recurrence
how often should patients on PO DM meds only check their glucose? - According to the Society of
General Internal Medicine in the Choosing Wisely campaign, patients with type 2 diabetes who are
not on insulin therapy should not check their blood glucose level daily.
,when do u start introducing solids to babies? - at 6 months per AAP
During a newborn examination the patient's mother asks what she can do to decrease the risk of
food allergies in her newborn son. She tells you that there is no family history of atopic dermatitis or
asthma but she has a cousin with a peanut allergy. The remainder of the examination is
unremarkable. You tell her that food allergy risk can be reduced by
A) breastfeeding for at least 1 year
B) using soy-based formula instead of cow's milk-based formula
C) introducing peanut-containing foods when solids are started
D) avoiding all house pets
E) avoiding a day care setting - Introduce peanuts when starting solids (at 6 months)
The two most common allergens are cow's milk and peanuts. The onset of symptoms is usually
within 2 hours of exposure and they resolve within several hours
National Institute of Allergy and Infectious Diseases in 2017 recommended that healthy infants
without known food allergy or who have mild to moderate eczema may be introduced to peanut-
containing foods with other solid foods. If the parents are concerned about a reaction, introduction
of peanut-containing foods may be done in the physician's office.
Infants with severe eczema, egg allergy, or both should undergo peanut-specific IgE or skin-prick
testing.
which antihypertensive med is LEAST likely to worsen ED? - ARBS!!!!!
. You are providing end-of-life care for a 53-year-old female with end-stage colon cancer. Her family
reports that she is having significant abdominal pain, nausea, and vomiting, and she is not able to
tolerate oral intake. You suspect a malignant bowel obstruction. Which one of the following
interventions would be most likely to significantly improve her symptoms?
A) Medical cannabis
B) Dexamethasone
C) Morphine
D) Octreotide (Sandostatin)
E) Polyethylene glycol (MiraLAX) - STEROIDS!!!!
,this lady has malignant bowel obstruction and steroids act as a central antiemetic (for the nausea)
antiinflammatory, antisecretory and analgesic (so will help with pain); Recommend IV Dexa 4mg 3-4x
a day
Miralax can worsen the symptoms (will draw water in and cause more pressure, and still can't go
anywhere);
3 yo with bullous impetigo on the legs, buttock, and trunk after being bitten by ants...what is the
treatment? - PO Bactrim
impetigo = s pyogenes OR s aureus, BUT BULLOUS IMPETIGO = AUREUS
PO Bactrim would cover MRSA also, hence
Avoid tetracycline in kids under 8
Mupirocin oitment wouldn't work in widespread area
Zpack wouldn't work against poss MRSA
60-year-old male with diabetes mellitus and hypertension sees you for routine follow-up. He has no
acute health concerns during today's visit. His current medications include metformin (Glucophage),
lisinopril (Prinivil, Zestril), and hydrochlorothiazide. He smokes cigarettes and has a 40-pack-year
smoking history. His vital signs and a physical examination are normal. An in-office dipstick urinalysis
reveals 1+ blood and trace protein but is otherwise normal. Which one of the following would be the
most appropriate follow-up?
A) Repeat dipstick urinalysis in 3 months
B) Microscopic urinalysis
C) Renal ultrasonography
D) CT urography
E) Referral for cystoscopy - Microscopic UA; when the presence of blood is suggested by dipstick
urinalysis, confirmation with microscopic analysis should be obtained, because the dipstick could be
a false positive (myoglobinuria, hemoglobinuria, exercise, dehydration, menses, iodine) hence u
send it for microscope, and if >3 RBCs then legit microhematuria
, If microscopic urinalysis confirms the presence of hematuria, then CT urography and cystoscopy
would be indicated, as his age, male sex, and smoking history place him at increased risk of
malignancy
He's got too many risk factors (male, age, smoking) to repeat in 3 mo, u need to know if legit or nah
33 yo G2P1 at 35w gestation, with premature rupture of membranes, decide to do expectant
management...however this will incre the risk of... - Legit expectant management in this setting
(premature rupture of membranes) DECREASES risk of C section, time spent in NICU, neonatal resp
distress, mechanical ventilation, BUT it increases risk of antepartum or postpartum maternal
hemorrhage and intrapartum fever
No differences were found between immediate delivery and expectant management in the risk of
neonatal sepsis, pneumonia, or perinatal or infant mortality.
what is a contraindication to statin use? - Pregnancy
ALSO not recommended while breastfeeding
. Statins also may be continued in the setting of myositis with a creatine kinase up to 10 times the
upper limit of normal, provided that the muscle-related symptoms are tolerable to the patient.
2yo with fever, barking cough and resp distress..what is the diagnosis - bacterial tracheitis, which
includes a high fever, barking cough, respiratory distress, and rapid deterioration.
Epiglottitis has an acute onset of dysphagia, drooling, and high fever, along with anxiety and a
muffled cough, and typically occurs in children 3-10 years of age.
Foreign body aspiration is associated with an acute onset of choking and drooling.
A peritonsillar abscess would cause a sore throat, fever, and "hot potato" voice.
A 13-year-old baseball player who is right-hand dominant is brought to your office because of a 3-
week history of pain in the right shoulder. He recalls no specific injury but has been pitching at least
weekly for the past 3 months. He has moderate tenderness about the anterior and lateral deltoid. In
addition to radiographic studies, the best initial management would include
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