ABFM ITE EXAM WITH QUESTIONS AND
CORRECT ANSWERS
Page 1 of 408
,Question 1
A 45-year-old female presents with a lesion on her mid-back (shown below) that
measures 1.2 mm in diameter. A punch biopsy confirms nodular basal cell carcinoma.
She is otherwise healthy
and does not take any daily medications. She is concerned about the cosmetic
appearance after
treatment.
Which one of the following would be the most appropriate treatment strategy?
A) No further management
B) Topical fluorouracil 5% (Efudex)
C) Cryotherapy
D) Curettage and electrodesiccation
E) Standard excision with 4-mm margins
Correct Answer
ANSWER: E
Standard excision with 4-mm margins
Surgical excision is indicated for the management of larger basal cell carcinomas.
Although this patient
had a punch biopsy, that is not considered curative and excision with wide margins
is indicated. Topical therapy and cryotherapy are reserved for patients who decline
surgery or for cases in which surgery is
contraindicated. The combination of curettage and electrodesiccation is a
management option, but the cosmetic results are not as desirable as with excision.
Page 2 of 408
,Question 2
A 30-year-old female presents for evaluation of chronic abdominal bloating,
cramping, diarrhea, and recent weight loss. An abdominal examination is
unremarkable, and stool guaiac testing is negative. She requests testing for celiac
disease.
Which one of the following would be most likely to cause a false-negative result on
serologic testing for celiac disease?
A) A recent increase in dietary wheat consumption
B) Recent use of loperamide (Imodium A-D)
C) A skin rash consistent with dermatitis herpetiformis
D) IgA deficiency
E) Iron deficiency anemia
Correct Answer
ANSWER: D IgA deficiency
Celiac disease is a chronic malabsorptive disorder with an estimated worldwide
prevalence of 1.4%. The preferred initial diagnostic test includes a serum IgA
transglutaminase-2 (TG2) antibody level, which has
a 98% sensitivity and 98% specificity for the diagnosis of celiac disease. False-
negative serologic results
may occur in patients with an IgA deficiency, which includes up to 3% of patients
with celiac disease. Therefore, when a diagnosis of celiac disease is strongly
suspected despite a negative IgA TG2 antibody test, a total IgA level should be
obtained. Diagnostic confirmation for patients with positive serologic testing is
accomplished with endoscopic mucosal biopsy.
Dietary elimination of gluten, not an increase in gluten intake, prior to serologic
testing may lead to false-negative results. Recent use of medications, including
loperamide, would not be expected to interfere with the accuracy of serologic
testing for celiac disease. Dermatitis herpetiformis is a widespread pruritic
papulovesicular rash that occurs in less than 10% of patients with celiac disease,
although is essentially pathognomonic for the condition, as nearly all patients with
this rash have evidence of celiac disease on an intestinal biopsy. Iron deficiency
anemia often occurs in patients with celiac disease due to poor iron absorption,
although the presence of iron deficiency anemia does not decrease the sensitivity of
serologic testing.
Page 3 of 408
, Question 3
A 64-year-old female presents to the emergency department with a 10-day history of
increasing shortness of breath and mild tachycardia. On examination she has an
oxygen saturation of 75%
on room air.
Which one of the following additional findings would suggest a diagnosis of acute
respiratory distress syndrome (ARDS)?
A) Improved oxygen saturation with supplemental oxygen
B) Improvement of her symptoms with diuretic therapy
C) Bilateral airspace opacities seen on a chest radiograph
D) A flattened diaphragm seen on a chest radiograph
E) A right lower lobe infiltrate seen on a chest radiograph
Correct Answer
ANSWER: C
Bilateral airspace opacities seen on a chest radiograph
Acute respiratory distress syndrome (ARDS) will often present similarly to
pneumonia and heart failure with dyspnea, hypoxemia, and tachypnea. ARDS
typically does not respond to supplemental oxygen or
diuretic therapy. Patients decompensate quickly and usually require mechanical
ventilation. Chest
radiographic findings include bilateral airspace opacities but not a localized infiltrate
as with pneumonia, venous congestion or cardiac enlargement as with heart failure,
or a flattened diaphragm (associated with COPD).
Page 4 of 408
CORRECT ANSWERS
Page 1 of 408
,Question 1
A 45-year-old female presents with a lesion on her mid-back (shown below) that
measures 1.2 mm in diameter. A punch biopsy confirms nodular basal cell carcinoma.
She is otherwise healthy
and does not take any daily medications. She is concerned about the cosmetic
appearance after
treatment.
Which one of the following would be the most appropriate treatment strategy?
A) No further management
B) Topical fluorouracil 5% (Efudex)
C) Cryotherapy
D) Curettage and electrodesiccation
E) Standard excision with 4-mm margins
Correct Answer
ANSWER: E
Standard excision with 4-mm margins
Surgical excision is indicated for the management of larger basal cell carcinomas.
Although this patient
had a punch biopsy, that is not considered curative and excision with wide margins
is indicated. Topical therapy and cryotherapy are reserved for patients who decline
surgery or for cases in which surgery is
contraindicated. The combination of curettage and electrodesiccation is a
management option, but the cosmetic results are not as desirable as with excision.
Page 2 of 408
,Question 2
A 30-year-old female presents for evaluation of chronic abdominal bloating,
cramping, diarrhea, and recent weight loss. An abdominal examination is
unremarkable, and stool guaiac testing is negative. She requests testing for celiac
disease.
Which one of the following would be most likely to cause a false-negative result on
serologic testing for celiac disease?
A) A recent increase in dietary wheat consumption
B) Recent use of loperamide (Imodium A-D)
C) A skin rash consistent with dermatitis herpetiformis
D) IgA deficiency
E) Iron deficiency anemia
Correct Answer
ANSWER: D IgA deficiency
Celiac disease is a chronic malabsorptive disorder with an estimated worldwide
prevalence of 1.4%. The preferred initial diagnostic test includes a serum IgA
transglutaminase-2 (TG2) antibody level, which has
a 98% sensitivity and 98% specificity for the diagnosis of celiac disease. False-
negative serologic results
may occur in patients with an IgA deficiency, which includes up to 3% of patients
with celiac disease. Therefore, when a diagnosis of celiac disease is strongly
suspected despite a negative IgA TG2 antibody test, a total IgA level should be
obtained. Diagnostic confirmation for patients with positive serologic testing is
accomplished with endoscopic mucosal biopsy.
Dietary elimination of gluten, not an increase in gluten intake, prior to serologic
testing may lead to false-negative results. Recent use of medications, including
loperamide, would not be expected to interfere with the accuracy of serologic
testing for celiac disease. Dermatitis herpetiformis is a widespread pruritic
papulovesicular rash that occurs in less than 10% of patients with celiac disease,
although is essentially pathognomonic for the condition, as nearly all patients with
this rash have evidence of celiac disease on an intestinal biopsy. Iron deficiency
anemia often occurs in patients with celiac disease due to poor iron absorption,
although the presence of iron deficiency anemia does not decrease the sensitivity of
serologic testing.
Page 3 of 408
, Question 3
A 64-year-old female presents to the emergency department with a 10-day history of
increasing shortness of breath and mild tachycardia. On examination she has an
oxygen saturation of 75%
on room air.
Which one of the following additional findings would suggest a diagnosis of acute
respiratory distress syndrome (ARDS)?
A) Improved oxygen saturation with supplemental oxygen
B) Improvement of her symptoms with diuretic therapy
C) Bilateral airspace opacities seen on a chest radiograph
D) A flattened diaphragm seen on a chest radiograph
E) A right lower lobe infiltrate seen on a chest radiograph
Correct Answer
ANSWER: C
Bilateral airspace opacities seen on a chest radiograph
Acute respiratory distress syndrome (ARDS) will often present similarly to
pneumonia and heart failure with dyspnea, hypoxemia, and tachypnea. ARDS
typically does not respond to supplemental oxygen or
diuretic therapy. Patients decompensate quickly and usually require mechanical
ventilation. Chest
radiographic findings include bilateral airspace opacities but not a localized infiltrate
as with pneumonia, venous congestion or cardiac enlargement as with heart failure,
or a flattened diaphragm (associated with COPD).
Page 4 of 408
