ABFM Questions (Adult)
Side effect of denosumab and bisphosphonates - Answer Jaw osteonecrosis
Most likely to induce remission in Crohn dz - Answer corticosteroids > 5-ASA >
infliximab
Bisphosphonates shouldn't be used in pts w/CLCr less than - Answer 35
mL/min/1.73m2
Bisphosphonates use for 5+ years risks... - Answer atypical femoral shaft fractures,
recommend drug holiday
Denosumab is safe in CKD because - Answer not cleared by kidneys
IBD diagnosis made via - Answer endoscopy with biopsies
First line for treating DM neuropathy - Answer TCAs (amitriptyline) > SNRI, pregabalin >
antiSz
Best management for acute urticaria - Answer second generation X-H1 (longer acting,
less drowsy vs 1st gen)
Type of symptoms of depression seen most in elderly - Answer somatic symptoms (also
in preg women, children, low income)
Best abx treatment for diabetic foot ulcer - Answer Vanc/Zosyn (Piperacillin/tazobactam)
-> covers MRSA, pseudomonas
Percent of wt loss leading to stat-significant improvement of lipid ratios, blood glucose,
CAD risk reduction - Answer at least 10%
Most effective weight reduction and long-term maintenance treatment for morbidly
obese - Answer bariatric surgery (gastric bypass had mean wt loss 71.2% at 3 year,
20% at 6 years); reduce blood glucose, resolve DMII
Which are some severe CAP symptoms requiring inpatient - Answer confusion,
tachypnea, hypotension, multilobar infiltrates (IV ceftriaxone and oral azithromycin)
Outpatient treatment for mild/mod CAP w/out many comorbidities - Answer oral
macrolide (azithromycin, clarithromycin, erythromycin) or doxycycline -> add
fluoroquins, beta-lactams if comorbidities
Next drug to step up to after albuterol fails to control mild asthma - Answer fluticasone
inhaler
,Shown to shorten course of Bell's palsy - Answer corticosteroids (antivirals don't do a
thing)
Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine - Answer
Interferon gamma release assay (QuantiFERON-TB Gold)
... - Answer
If blood sugar of DM pt who takes long acting insulin at night is high during
breakfast/lunch/dinner, how do you switch up their insulin regimen? - Answer add short
acting insulin before the last meal (if high during bedtime, add insulin during dinner; if
high b4 dinner, add insulin at lunch time; if high b4 lunch, add at breakfast)
Post-op delirium in elderly -> tx? - Answer adequate pain control and reorientation, don't
sedate
Hoarseness that doesn't resolve in 3 months, next best step - Answer laryngoscopy
(sooner than 3 mo if more serious condition suspected); voice rest for 2 weeks if Hx of
URI/vocal abuse
Effect of long term tx for narcotic addiction w/methadone and buprenorphine - Answer
greater success at producing opiate abstinence than detox programs
How often to monitor serum Ca and Phos level in CKD? - Answer 3-6 mo for Ca2+ and
6-12 mo for Phos w/goal to normalize
Tramadol should be avoided in pts w/which kind of dz - Answer seizures, lower sz
threshold
Linear excoriation, thickened skin on forearms/legs/neck due to excessive scratching ->
dx? tx? - Answer Lichen simplex chronicus presentation -> topical steroids w/occlusive
bandage
Best initial approach to wt loss per USPSTF - Answer behavioral counseling (high
intensity)
Medical conditions that reduce response to warfarin (reduce INR) - Answer
hypothyroidism, visceral carcinoma, high vitK intake, DM, hyperlipidemia
Medical conditions that increase response to warfarin (increase INR more) - Answer
vitK def (low dietary intake), malabsorption, scurvy, malnutrition, cachexia, small body
size, liver dz, renal dz, fever, hyperthyroidism, infectious dz, HF, biliary obstruction
MC etiology for acute laryngitis - Answer viral, tx symptoms (red oropharynx w/out
exudate, mucosal congestion, can't talk)
, Although helpful by themselves in protecting kidneys in DM, which two drugs should not
be used together - Answer ACE inhibitors and ARBs; higher Cr levels, increased
likelihood that dialysis will become necessary
Dermatologic disease assoc with Hep C - Answer lichen planus (pruritic polygonal
papules) and porphyria cutanea tarda
Has the legal authority to revoke/restrict a patient's driver's license - Answer
representative of state DMV (physicians can make recommendations but can't legally
restrict)
MC causes of CAP in healthy adolescents - Answer Mycoplasma, Chlamydophilia,
group A Strep (outpatient -> azithromycin; inpatient -> ceftriax +
erythromycin/azithromycn
Still suspecting subarachnoid bleed (continued worse HA) after neg/equivocal head CT,
next step? - Answer lumbar puncture (look for xanthochromia, its absence rules out
subarachnoid bleed)
Morphine should be avoided in patients with this kind of organ disease - Answer renal
disease; toxic metabolites of morphine are not eliminated by kidneys in this case -> resp
depression, myoclonus, confusion (use fentanyl, methadone in CKD)
Do this if you find trace valvular regurgitation on initial echocardiogram - Answer
nothing, normal finding (70-90% of norm individuals)
Risk factor for esophageal adenocarcinoma - Answer obesity -> GERD
Rx: Increase risk of bruising, oral candidiasis, decrease COPD exacerbations, but no
effect on mortality/FEV1 - Answer inhaled corticosteroids
Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating syphilis - Answer
Jarisch-Herxheimer reaction -> reassurance, pyretics
Other receptors besides aldosterone that are bound by spironolactone - Answer
androgen and progesterone -> breast tenderness/ gynecomastia (eplerenone, +
+specific to aldost-R, less ADEs)
Hematospermia in pts younger than 40, next best step after examining testes and
prostate - Answer STD screen (no imaging, PSA levels, or referral to uro unless Hx or
exam suggests unusual cause)
Best kind of nutrition for patients with severe pancreatitis and prolonged bowel rest -
Answer enteral nutrition (assoc w/shorter stay)
Side effect of denosumab and bisphosphonates - Answer Jaw osteonecrosis
Most likely to induce remission in Crohn dz - Answer corticosteroids > 5-ASA >
infliximab
Bisphosphonates shouldn't be used in pts w/CLCr less than - Answer 35
mL/min/1.73m2
Bisphosphonates use for 5+ years risks... - Answer atypical femoral shaft fractures,
recommend drug holiday
Denosumab is safe in CKD because - Answer not cleared by kidneys
IBD diagnosis made via - Answer endoscopy with biopsies
First line for treating DM neuropathy - Answer TCAs (amitriptyline) > SNRI, pregabalin >
antiSz
Best management for acute urticaria - Answer second generation X-H1 (longer acting,
less drowsy vs 1st gen)
Type of symptoms of depression seen most in elderly - Answer somatic symptoms (also
in preg women, children, low income)
Best abx treatment for diabetic foot ulcer - Answer Vanc/Zosyn (Piperacillin/tazobactam)
-> covers MRSA, pseudomonas
Percent of wt loss leading to stat-significant improvement of lipid ratios, blood glucose,
CAD risk reduction - Answer at least 10%
Most effective weight reduction and long-term maintenance treatment for morbidly
obese - Answer bariatric surgery (gastric bypass had mean wt loss 71.2% at 3 year,
20% at 6 years); reduce blood glucose, resolve DMII
Which are some severe CAP symptoms requiring inpatient - Answer confusion,
tachypnea, hypotension, multilobar infiltrates (IV ceftriaxone and oral azithromycin)
Outpatient treatment for mild/mod CAP w/out many comorbidities - Answer oral
macrolide (azithromycin, clarithromycin, erythromycin) or doxycycline -> add
fluoroquins, beta-lactams if comorbidities
Next drug to step up to after albuterol fails to control mild asthma - Answer fluticasone
inhaler
,Shown to shorten course of Bell's palsy - Answer corticosteroids (antivirals don't do a
thing)
Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine - Answer
Interferon gamma release assay (QuantiFERON-TB Gold)
... - Answer
If blood sugar of DM pt who takes long acting insulin at night is high during
breakfast/lunch/dinner, how do you switch up their insulin regimen? - Answer add short
acting insulin before the last meal (if high during bedtime, add insulin during dinner; if
high b4 dinner, add insulin at lunch time; if high b4 lunch, add at breakfast)
Post-op delirium in elderly -> tx? - Answer adequate pain control and reorientation, don't
sedate
Hoarseness that doesn't resolve in 3 months, next best step - Answer laryngoscopy
(sooner than 3 mo if more serious condition suspected); voice rest for 2 weeks if Hx of
URI/vocal abuse
Effect of long term tx for narcotic addiction w/methadone and buprenorphine - Answer
greater success at producing opiate abstinence than detox programs
How often to monitor serum Ca and Phos level in CKD? - Answer 3-6 mo for Ca2+ and
6-12 mo for Phos w/goal to normalize
Tramadol should be avoided in pts w/which kind of dz - Answer seizures, lower sz
threshold
Linear excoriation, thickened skin on forearms/legs/neck due to excessive scratching ->
dx? tx? - Answer Lichen simplex chronicus presentation -> topical steroids w/occlusive
bandage
Best initial approach to wt loss per USPSTF - Answer behavioral counseling (high
intensity)
Medical conditions that reduce response to warfarin (reduce INR) - Answer
hypothyroidism, visceral carcinoma, high vitK intake, DM, hyperlipidemia
Medical conditions that increase response to warfarin (increase INR more) - Answer
vitK def (low dietary intake), malabsorption, scurvy, malnutrition, cachexia, small body
size, liver dz, renal dz, fever, hyperthyroidism, infectious dz, HF, biliary obstruction
MC etiology for acute laryngitis - Answer viral, tx symptoms (red oropharynx w/out
exudate, mucosal congestion, can't talk)
, Although helpful by themselves in protecting kidneys in DM, which two drugs should not
be used together - Answer ACE inhibitors and ARBs; higher Cr levels, increased
likelihood that dialysis will become necessary
Dermatologic disease assoc with Hep C - Answer lichen planus (pruritic polygonal
papules) and porphyria cutanea tarda
Has the legal authority to revoke/restrict a patient's driver's license - Answer
representative of state DMV (physicians can make recommendations but can't legally
restrict)
MC causes of CAP in healthy adolescents - Answer Mycoplasma, Chlamydophilia,
group A Strep (outpatient -> azithromycin; inpatient -> ceftriax +
erythromycin/azithromycn
Still suspecting subarachnoid bleed (continued worse HA) after neg/equivocal head CT,
next step? - Answer lumbar puncture (look for xanthochromia, its absence rules out
subarachnoid bleed)
Morphine should be avoided in patients with this kind of organ disease - Answer renal
disease; toxic metabolites of morphine are not eliminated by kidneys in this case -> resp
depression, myoclonus, confusion (use fentanyl, methadone in CKD)
Do this if you find trace valvular regurgitation on initial echocardiogram - Answer
nothing, normal finding (70-90% of norm individuals)
Risk factor for esophageal adenocarcinoma - Answer obesity -> GERD
Rx: Increase risk of bruising, oral candidiasis, decrease COPD exacerbations, but no
effect on mortality/FEV1 - Answer inhaled corticosteroids
Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating syphilis - Answer
Jarisch-Herxheimer reaction -> reassurance, pyretics
Other receptors besides aldosterone that are bound by spironolactone - Answer
androgen and progesterone -> breast tenderness/ gynecomastia (eplerenone, +
+specific to aldost-R, less ADEs)
Hematospermia in pts younger than 40, next best step after examining testes and
prostate - Answer STD screen (no imaging, PSA levels, or referral to uro unless Hx or
exam suggests unusual cause)
Best kind of nutrition for patients with severe pancreatitis and prolonged bowel rest -
Answer enteral nutrition (assoc w/shorter stay)
