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ABFM CKSA 22-23 exam with complete solutions 2024
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ABFM CKSA 22-23 exam with complete solutions 2024
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ABFM CKSA 22-23 exam with completej j j j j
solutions 2024
j j
A j56-year-old jmale jwith ja jhistory jof jhepatitis jC jcirrhosis jis jadmitted jto jthe
jhospital jwith jGI jbleeding. jThe jpatient jhas jbeen jstable, jtaking jonly jfurosemide
jand jspironolactone. jUpper jGI jendoscopy jconfirms jvariceal jbleeding jand jthe
jgastroenterologist jperforms jappropriate jvariceal jbanding. jA jnurse jcalls jyou
jbecause jlaboratory jstudies jordered jin jthe jemergency jdepartment jreveal ja
jserum jammonia jlevel jof j120 jµg/dL j(N j39-90). jThe jpatient jhas jno jsigns jof
jconfusion, jinsomnia, jor jdecreased jmental jalertness. jA jphysical jexamination
jreveals jmild jascites jbut jno jother jabnormalities. jWhich jone jof jthe jfollowing
jwould jbe jmost jappropriate jfor jaddressing jthe jelevated jammonia jlevel?
A. jLactulose
B. jNo jadditional jtreatment
C. jMethotrexate
D. jNeomycin
E. jPrednisone j- jANSWER✓✓-ANSWER: jB
Elevated jammonia jlevels jmay joccur jin jmultiple jclinical jscenarios j(i.e.
jportosystemic jshunting, jUTI jfrom jurease-producing jorganisms, jGI jbleeding,
jshock, jrenal jdisease, jparenteral jnutrition, jsalicylate jintoxication, jalcohol juse).
jIn jpatients jwith jchronic jliver jdisease, jhepatic jencephalopathy jis jdiagnosed
jbased jon jthe joverall jclinical jpresentation jand jnot jby jan jammonia jlevel. jIt jis
jimportant jto jremember jthat ja jnormal jammonia jlevel jneither jexcludes jnor
jconfirms jthe jdiagnosis jof jhepatic jencephalopathy. jThis jpatient jhad jan jelevated
jserum jammonia jlevel jthat jwas jfound jincidentally jduring jhis jhospital jadmission
jfor jgastrointestinal jbleeding. jBecause jthere jis jno jclinically jsignificant
jencephalopathy, jtreatment jbased jon jammonia jlevels jis jnot jindicated.
jLactulose, jmethotrexate, jneomycin, jor jprednisone jwould jnot jbe jappropriate.
A j33-year-old jfemale jpresents jwith jpalpitations jand jexcessive jsweating. jA
jphysical jexamination jis jnormal. jLaboratory jfindings jinclude ja jTSH j(thyrotropin)
jlevel jof j0.02 jµU/mL j(N j0.40-4.00) jand ja jfree jT4 jlevel jof j3.9 jng/dL j(N j0.7-1.9).
,jRadionuclide jscanning jreveals jno juptake. jWhich jone jof jthe jfollowing jwould
jexplain jthese jfindings?
A. jThyroid jhormone jresistance
B. jGraves jdisease
C. jA jtoxic jnodular jgoiter
D. jExcess jthyroid jhormone jintake
E. jA jthyrotropin-secreting jpituitary jtumor j- jANSWER✓✓-ANSWER: jD
Excess jthyroid jhormone jintake jwould jcause ja jlow jTSH j(thyrotropin) jlevel jwith
ja jhigh jfree jT4 jlevel jand jno juptake jon jradionuclide jscan. jOther jpossibilities
jinclude jan jhCG-secreting jtumor jand jthe jthyrotoxic jphase jof jsubacute
jthyroiditis. j
An jelevated jTSH j(thyrotropin) jlevel jwould jbe jseen jwith jthyroid-hormone
jresistance jor ja jthyrotropin-secreting jpituitary jtumor. jGraves jdisease jcauses ja
jhomogeneous jincreased jthyroid juptake jon jradionuclide jscanning, jwhereas ja
jhot jnodule jwould jbe jexpected jwith ja jtoxic jnodular jgoiter.
A j60-year-old jmale jwith jtype j2 jdiabetes jcomes jto jyour joffice jwith jan jacute
jonset jof jfever, jchills, jand jmalaise. jHe jsays jthat jhe jis jfeeling jprogressively
jworse. jHis jtemperature jis j40.0°C j(104.0°F). jAn jexamination jreveals jredness,
jtenderness, jand jswelling jof jthe jpenis, jscrotum, jand jperineal jarea. jWhich jone
jof jthe jfollowing jmedications jis jmost jlikely jto jpredispose jthis jpatient jto jthis
jcondition?
A. jEmpagliflozin
B. jExenatide
C. jInsulin jglargine
D. jPioglitazone
E. jSitagliptin j- jANSWER✓✓-ANSWER: jA
SGLT2 jinhibitors j(canagliflozin, jdapagliflozin, jempagliflozin, jand jertugliflozin)
jare jassociated jwith ja jhigher jrate jof jgenitourinary jinfections. jMost joften jthese
jare jfungal jin jetiology, jhowever jthere jare jassociations jwith jmore jserious
jinfections jincluding jnecrotizing jfasciitis jof jthe jperineum j(Fournier's jgangrene).
jWhile jrare, jthis jis ja jlife-threatening jinfection jassociated jwith jthis jclass jof
jmedication jthat jis jbeing jused jmore jfrequently jto jtreat jdiabetes jmellitus jand
jother jcardiac jconditions. jBecause jof jthis jrisk, jthe jFDA jissued ja jDrug jSafety
jWarning jin j2018. j
The jdrug jclasses jthat jinclude jexenatide, jinsulin jglargine, jpioglitazone, jand
jsitagliptin jare jnot jassociated jwith jgenitourinary jinfections.
,A j5-year-old jmale jis jbrought jto jyour joffice jafter jpassing jan jintestinal jworm. jHe
jlives jon ja jfarm jwith jcattle, jpigs, jand jdogs. jHe jhas jnever jtraveled jvery jfar jfrom
jhome. jHe jdoes jnot jhave jany jrespiratory jsymptoms jor jdiarrhea, jbut jhas
jexperienced jsome jabdominal jbloating. jHis jparents jbring ja jpicture jof jthe jworm
j(shown jbelow). jWhich jone jof jthe jfollowing jis jthe jinfecting jorganism? j-
jANSWER✓✓-A. jAscaris jlumbricoides j(roundworm)
B. jEnterobius jvermicularis j(pinworm)
C. jGiardia jlamblia
D. jNecator jamericanus j(hookworm)
E. jTaenia jsolium j(tapeworm)
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ANSWER: jA j
This jcase jand jimage jare jconsistent jwith jAscaris jlumbricoides jinfestation. jA.
jlumbricoides jis ja jlarge jroundworm jthat jtypically jinfects jthe jileum. jSymptoms
jare jvariable jbut jlarge jinfections jcan jlead jto jintestinal jobstruction. j
, Pinworms j(Enterobius jvermicularis) jare jmuch jsmaller jand jtypically jpresent jwith
janal jpruritus. jGiardia jlamblia jis ja jmicroscopic jprotozoan jparasite jthat jis jnot
jvisible jon jgross jexamination. jHookworms j(Necator jamericanus) jare jalso jround,
jbut jare jtypically j6-12 jmm jin jlength. jThey jare ja jsignificant jcause jof janemia jin
jchildren jglobally. jTapeworms jcan jbe jlarge, jbut jare jflat jand jsegmental jin
jappearance, jand jare jtypically jfound jin jthe jstool jas jsegments jcalled
jproglottids.
A j58-year-old jmale jwith ja jhistory jof jtobacco juse jdisorder jand jalcohol juse
jdisorder jpresents jwith jthe jsudden jonset jof jmany jwell jcircumscribed jbrown,
joval, jrough jpapules jwith ja j"stuck-on" jappearance jon jhis jtrunk jand jproximal
jextremities j(see jimage). jOn jexamination jyou jalso jnote jan junintentional j6-kg
j(13-lb) jweight jloss jover jthe jlast j3 jmonths jand jconjunctival jpallor. jA jreview jof
jsystems jis jpositive jfor jabdominal jpain, jdecreased jappetite, jand jmild jfatigue.
jYou jorder ja jlaboratory jworkup. jWhich jone jof jthe jfollowing jwould jbe jmost
jappropriate jat jthis jpoint? j- jANSWER✓✓-A. jReassurance jthat jthe jskin jlesions
jare jbenign
B. jA jskin jbiopsy
C. jReferral jto ja jdermatologist
D. jCT jof jthe jabdomen jand jpelvis
E. jUpper jand jlower jendoscopy
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