ABFM ITE Exam V3 (Latest Update
) | Questions & Answers
| Grade A | 100% Correct
Question:
A 21-year-old female is being evaluated for secondary causes of refractory
hypertension.
Which one of the following would be most specific for fibromuscular
dysplasia?
A) A serum creatinine level
B) An aldosterone:renin ratio
C) 24-hour urine for metanephrines
D) Renal ultrasonography
E) Magnetic resonance angiography of the renal arteries
Answer: E
In young adults diagnosed with secondary hypertension, evaluation for
fibromuscular dysplasia of the renal arteries with MR angiography or CT
angiography is indicated (SOR C). The aldosterone/renin ratio is the most
sensitive test to diagnose primary hyperaldosteronism. Renal ultrasonography
is an indirect test that is not as sensitive or specific for fibromuscular
dysplasia. Serum creatinine elevation shows renal involvement but does not
,identify the cause. Testing for metanephrines is indicated only if a
pheochromocytoma is suspected.
Question:
Of the following, which one is the greatest risk factor for developing knee
osteoarthritis as an older adult?
A) A sedentary lifestyle
B) Cigarette smoking
C) Low socioeconomic status
D) Male sex
E) Obesity
Answer: E
Because debilitating knee osteoarthritis is a frequent health concern in older
adults, physicians should try to identify and possibly modify factors that
increase the risk for this condition. Pooled data from many large studies has
been sufficient to clearly identify several major risk factors for the
development and progression of osteoarthritis of the knees. Overweight and
obesity have consistently been found to approximately double the risk for
developing knee osteoarthritis. Other factors that have been identified as risk
factors include female sex, advancing age (50-75 years of age), and previous
trauma. Smoking, inactivity, moderate physical activity, and socioeconomic
status have not been shown to affect one's risk for developing knee
osteoarthritis. However, any of these factors in the extreme may be
detrimental to joint health in general.
,Question:
A staff member at a local assisted living facility calls you about an 88-year-old
female who has chronic urinary incontinence and well controlled
hypertension. A urinalysis was obtained after the patient reported some
dizziness and malaise. She does not have dysuria and has had no change to
her incontinence. The patient is afebrile and other vital signs are normal. The
urine culture reveals >100,000 colony-forming units of Escherichia coli, with
sensitivities pending.
In addition to supportive care and hydration, which one of the following
would be indicated at this time?
A) Ciprofloxacin (Cipro)
B) Fosfomycin (Monurol)
C) Nitrofurantoin (Macrodantin)
D) Trimethoprim/sulfamethoxazole
Answer: E
This patient has asymptomatic bacteriuria and does not require antibiotic
therapy at this time. In women age 70 and older the incidence of
asymptomatic bacteriuria is 16%-18%, and in chronically incontinent and
disabled older adults rates may reach 43%. Symptoms that raise concern for a
urinary tract infection (UTI) include acute dysuria, new or worsening urinary
urgency or frequency, new incontinence, gross hematuria, and suprapubic or
costovertebral angle tenderness. General malaise in the absence of these
symptoms is unlikely to represent a UTI and unlikely to improve with
antibiotic therapy.
When antibiotic therapy is indicated for a UTI,
trimethoprim/sulfamethoxazole remains the first-line agent.
, Nitrofurantoin may be used for those with a creatinine clearance >40
mL/min/1.73 m2. Ciprofloxacin is recommended as a first-line agent only in
communities with trimethoprim/sulfamethoxazole resistance rates above
10%-20%. Fosfomycin may be used for more highly resistant organisms. The
choice of antibiotic should be guided by bacterial pathogens if they are
known.
Question:
A 61-year-old white male with type 2 diabetes mellitus sees you for a follow-up
visit. His
blood pressure is 156/94 mm Hg. At a visit 1 week ago his blood pressure was
150/92 mm Hg. Laboratory studies obtained prior to this visit show a BUN of
16 mg/dL (N 6-20), a serum creatinine level of 0.9 mg/dL (N 0.7-1.3), and
microalbuminuria on a urinalysis. His diabetes is well controlled with
metformin (Glucophage) and he is taking aspirin.
Which one of the following would you recommend?
A) Observation only
B) An ACE inhibitor
C) A -blocker
D) A calcium channel blocker
E) A diuretic
Answer: B
The panel members of the Eighth Joint National Committee for the
management of blood pressure recommended that ACE inhibitors should be
initiated for renal protection in adults with diabetes mellitus, hypertension,
) | Questions & Answers
| Grade A | 100% Correct
Question:
A 21-year-old female is being evaluated for secondary causes of refractory
hypertension.
Which one of the following would be most specific for fibromuscular
dysplasia?
A) A serum creatinine level
B) An aldosterone:renin ratio
C) 24-hour urine for metanephrines
D) Renal ultrasonography
E) Magnetic resonance angiography of the renal arteries
Answer: E
In young adults diagnosed with secondary hypertension, evaluation for
fibromuscular dysplasia of the renal arteries with MR angiography or CT
angiography is indicated (SOR C). The aldosterone/renin ratio is the most
sensitive test to diagnose primary hyperaldosteronism. Renal ultrasonography
is an indirect test that is not as sensitive or specific for fibromuscular
dysplasia. Serum creatinine elevation shows renal involvement but does not
,identify the cause. Testing for metanephrines is indicated only if a
pheochromocytoma is suspected.
Question:
Of the following, which one is the greatest risk factor for developing knee
osteoarthritis as an older adult?
A) A sedentary lifestyle
B) Cigarette smoking
C) Low socioeconomic status
D) Male sex
E) Obesity
Answer: E
Because debilitating knee osteoarthritis is a frequent health concern in older
adults, physicians should try to identify and possibly modify factors that
increase the risk for this condition. Pooled data from many large studies has
been sufficient to clearly identify several major risk factors for the
development and progression of osteoarthritis of the knees. Overweight and
obesity have consistently been found to approximately double the risk for
developing knee osteoarthritis. Other factors that have been identified as risk
factors include female sex, advancing age (50-75 years of age), and previous
trauma. Smoking, inactivity, moderate physical activity, and socioeconomic
status have not been shown to affect one's risk for developing knee
osteoarthritis. However, any of these factors in the extreme may be
detrimental to joint health in general.
,Question:
A staff member at a local assisted living facility calls you about an 88-year-old
female who has chronic urinary incontinence and well controlled
hypertension. A urinalysis was obtained after the patient reported some
dizziness and malaise. She does not have dysuria and has had no change to
her incontinence. The patient is afebrile and other vital signs are normal. The
urine culture reveals >100,000 colony-forming units of Escherichia coli, with
sensitivities pending.
In addition to supportive care and hydration, which one of the following
would be indicated at this time?
A) Ciprofloxacin (Cipro)
B) Fosfomycin (Monurol)
C) Nitrofurantoin (Macrodantin)
D) Trimethoprim/sulfamethoxazole
Answer: E
This patient has asymptomatic bacteriuria and does not require antibiotic
therapy at this time. In women age 70 and older the incidence of
asymptomatic bacteriuria is 16%-18%, and in chronically incontinent and
disabled older adults rates may reach 43%. Symptoms that raise concern for a
urinary tract infection (UTI) include acute dysuria, new or worsening urinary
urgency or frequency, new incontinence, gross hematuria, and suprapubic or
costovertebral angle tenderness. General malaise in the absence of these
symptoms is unlikely to represent a UTI and unlikely to improve with
antibiotic therapy.
When antibiotic therapy is indicated for a UTI,
trimethoprim/sulfamethoxazole remains the first-line agent.
, Nitrofurantoin may be used for those with a creatinine clearance >40
mL/min/1.73 m2. Ciprofloxacin is recommended as a first-line agent only in
communities with trimethoprim/sulfamethoxazole resistance rates above
10%-20%. Fosfomycin may be used for more highly resistant organisms. The
choice of antibiotic should be guided by bacterial pathogens if they are
known.
Question:
A 61-year-old white male with type 2 diabetes mellitus sees you for a follow-up
visit. His
blood pressure is 156/94 mm Hg. At a visit 1 week ago his blood pressure was
150/92 mm Hg. Laboratory studies obtained prior to this visit show a BUN of
16 mg/dL (N 6-20), a serum creatinine level of 0.9 mg/dL (N 0.7-1.3), and
microalbuminuria on a urinalysis. His diabetes is well controlled with
metformin (Glucophage) and he is taking aspirin.
Which one of the following would you recommend?
A) Observation only
B) An ACE inhibitor
C) A -blocker
D) A calcium channel blocker
E) A diuretic
Answer: B
The panel members of the Eighth Joint National Committee for the
management of blood pressure recommended that ACE inhibitors should be
initiated for renal protection in adults with diabetes mellitus, hypertension,
