ABFM Preparation – Complete Guide
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to CDC
guidelines, who should receive chemoprophylaxis for influenza? ✔️- In
long-term care facilities, an influenza outbreak is defined as two laboratory-
confirmed cases of influenza within 72 hours in patients on the same unit. The
CDC recommends chemoprophylaxis for all asymptomatic residents of the
affected unit. Any resident exhibiting symptoms of influenza should be treated
for influenza and not given chemoprophylaxis dosing. Chemoprophylaxis is
not recommended for residents of other units unless there are two
laboratory-confirmed cases in those units. Facility staff of the affected unit can
be considered for chemoprophylaxis if they have not been vaccinated or if
they had a recent vaccination, but chemoprophylaxis is not recommended for
all staff in the entire facility.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes ✔️- ANSWER: D
Acid suppression therapy is associated with an increased risk of community-
acquired and health care-associated pneumonia, which is related to gastric
overgrowth by gram-negative bacteria. Long-term treatment of Barrett's
esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI
therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
An 87-year-old female comes to your office for an annual health maintenance
visit. She appears cachectic and tells you that for the past 6 months she has
had a decreased appetite and generalized muscle weakness. The patient is
alert and oriented to person and place. She has a 10% weight loss, dry mucous
membranes, and tenting of the skin on the extensor surface of her hands.
While inflating the blood pressure cuff on her right arm you observe
carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia B) Hypocalcemia C) Hypokalemia
D) Hypernatremia E) Hyponatremia ✔️- ANSWER: B
,A Trousseau sign, defined as spasmodic contraction of muscles caused by
pressure on the nerves that control them, is present in up to 94% of patients
with hypocalcemia. Hypercalcemia is more likely to present with
hyperreflexia. Patients with hypokalemia, hypernatremia, or hyponatremia
may present with weakness and confusion, but tetany is not a common sign of
either sodium or potassium imbalance.
A 24-year old female presents to your office with a 3-month history of
difficulty sleeping. She says that she struggles to fall asleep and wakes up
multiple times at night at least three times a week. She tries to go to bed at
10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an
hour in bed before falling asleep and spends up to 2 hours awake in the
middle of the night trying to fall back asleep. Lately she has been feeling
fatigued and having difficulty concentrating at work. You conduct a full history
and physical examination and tell her to return in 2 weeks with a sleep diary.
At this follow-up visit you see from her diary that she is sleeping an average of
51⁄2 hours per night.
Which one of the following would be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for an hour if she wakes up at 3:00 a.m. ✔️- ANSWER: D
This patient presents with symptoms of chronic insomnia. Cognitive-
behavioral therapy for insomnia (CBT-I) and brief behavioral therapy for
insomnia (BBT-I) are effective nonpharmacologic treatments for chronic
insomnia. Modified CBT-I and BBT-I can be administered by a primary care
physician. The basic principles include stimulus control (sleep hygiene) and
sleep restriction. Reducing time in bed increases sleep efficiency. In this case,
6 hours of time in bed would improve the patient's sleep efficiency and a
bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in
bed is accomplished by postponing bedtime rather than getting up earlier.
Naps generally do not improve sleep efficiency. While getting out of bed is
recommended after being in bed for 30 minutes without falling asleep, or
being awake for 30 minutes after being asleep, staying up for a prescribed
period of time is not recommended.
A 16-year-old female presents with chronic acne on her nose, forehead, and
chin consisting of a few comedones and a few mildly inflamed papules and
,pustules. She says it is minimally improved after 12 weeks of daily adapalene
0.1% gel. There are no scars or cysts. The patient would like to try to achieve
better control.
Which one of the following would you recommend at this time?
A) Continue adapalene 0.1% gel for 12 more weeks
B) Add clindamycin (Cleocin T) 1% gel for up to 12 weeks
C) Add clindamycin 1% gel for maintenance
D) Stop adapalene 0.1% gel and start clindamycin 1% gel for maintenance
E) Stop adapalene 0.1% gel and start erythromycin 2% gel for maintenance
✔️- ANSWER: B
Family physicians are often asked to manage mild to moderate acne vulgaris.
Topical retinoids such as adapalene and benzoyl peroxide are first-line
therapy and a trial of therapy is typically 8-12 weeks. Topical antibiotics may
be added to topical retinoids or benzoyl peroxide to achieve better symptom
control. To decrease emerging antibiotic resistance, studies support limiting
antibiotic use to 12 weeks except in severe cases, not using antibiotics as
monotherapy, and using clindamycin rather than erythromycin. Adding
clindamycin gel rather than erythromycin gel for up to 12 weeks is
recommended for this patient at this time.
A 57-year-old male with a history of heart failure sees you for follow-up. He
describes symptoms of mild dyspnea on exertion with ordinary activities such
as shopping or yard work. An echocardiogram shows an ejection fraction of
37%.
According to the New York Heart Association criteria, this patient's heart
failure would be classified as which one of the following?
A) Class I
B) Class II
C) Class III
D) Class IV ✔️- ANSWER: B
The appropriate classification of heart failure is important for monitoring the
disease. The most common currently used system is the New York Heart
Association (NYHA) functional classification. In this system, class I is defined
as heart disease in a patient with no symptoms and no limitations of physical
activity. Patients with class II heart failure have mild symptoms with normal
physical activity. Class III heart failure refers to significant limitations of
activity, including symptoms with less than normal activities. Patients with
class IV heart failure have symptoms at rest and are unable to carry on activity
without discomfort.
, A 24-year-old female presents with progressively worsening vulvar pain for 3
days. On examination a 3×3-cm tender, fluctuant mass is noted on the right
labia minora. She had a similar episode of this problem last year.
Which one of the following would be the most appropriate management?
A) Expectant management
B) Fine-needle aspiration
C) Incision and drainage
D) Marsupialization
E) Excision under general anesthesia ✔️- ANSWER: D
The most appropriate management of a recurrent Bartholin gland abscess
would be marsupialization, which has a 0% recurrence rate at 6 months. Local
anesthesia can be used in the office to effectively treat Bartholin gland
abscesses and sedation is not required (SOR A). If the Bartholin gland abscess
is >5 cm, referral to a gynecologist is recommended. Expectant management,
fine-needle aspiration, or incision and drainage would likely lead to
recurrence.
A 34-year-old female at 32 weeks gestation presents with a right-sided,
pounding headache that began 8 hours ago and is similar to headaches she has
had in the past. She is sensitive to light and sound, and has vomited several
times since the onset of pain. She has taken acetaminophen without relief. She
takes prenatal vitamins but no other routine medications. On examination her
blood pressure is normal.
Which one of the following would be the most appropriate treatment for this
patient?
A) Dihydroergotamine
B) Metoclopramide (Reglan)
C) Naproxen
D) Oxycodone (OxyContin)
E) Sumatriptan (Imitrex) ✔️- ANSWER: B
Metoclopramide and acetaminophen are the only two medications considered
safe for abortive migraine treatment during pregnancy (SOR B). The
dopamine antagonist antiemetics are considered second-line abortive
treatments in the general population. Dihydroergotamine should not be used
during pregnancy due to its oxytocic properties and the potential risk of
intrauterine growth restriction with its use. NSAIDs are not considered safe
during pregnancy, particularly in the first and third trimesters. Opioids are
only moderately useful for migraine treatment and should be avoided during
During rounds at the nursing home, you are informed that there are two
residents on the unit with laboratory-confirmed influenza. According to CDC
guidelines, who should receive chemoprophylaxis for influenza? ✔️- In
long-term care facilities, an influenza outbreak is defined as two laboratory-
confirmed cases of influenza within 72 hours in patients on the same unit. The
CDC recommends chemoprophylaxis for all asymptomatic residents of the
affected unit. Any resident exhibiting symptoms of influenza should be treated
for influenza and not given chemoprophylaxis dosing. Chemoprophylaxis is
not recommended for residents of other units unless there are two
laboratory-confirmed cases in those units. Facility staff of the affected unit can
be considered for chemoprophylaxis if they have not been vaccinated or if
they had a recent vaccination, but chemoprophylaxis is not recommended for
all staff in the entire facility.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes ✔️- ANSWER: D
Acid suppression therapy is associated with an increased risk of community-
acquired and health care-associated pneumonia, which is related to gastric
overgrowth by gram-negative bacteria. Long-term treatment of Barrett's
esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI
therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
An 87-year-old female comes to your office for an annual health maintenance
visit. She appears cachectic and tells you that for the past 6 months she has
had a decreased appetite and generalized muscle weakness. The patient is
alert and oriented to person and place. She has a 10% weight loss, dry mucous
membranes, and tenting of the skin on the extensor surface of her hands.
While inflating the blood pressure cuff on her right arm you observe
carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia B) Hypocalcemia C) Hypokalemia
D) Hypernatremia E) Hyponatremia ✔️- ANSWER: B
,A Trousseau sign, defined as spasmodic contraction of muscles caused by
pressure on the nerves that control them, is present in up to 94% of patients
with hypocalcemia. Hypercalcemia is more likely to present with
hyperreflexia. Patients with hypokalemia, hypernatremia, or hyponatremia
may present with weakness and confusion, but tetany is not a common sign of
either sodium or potassium imbalance.
A 24-year old female presents to your office with a 3-month history of
difficulty sleeping. She says that she struggles to fall asleep and wakes up
multiple times at night at least three times a week. She tries to go to bed at
10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an
hour in bed before falling asleep and spends up to 2 hours awake in the
middle of the night trying to fall back asleep. Lately she has been feeling
fatigued and having difficulty concentrating at work. You conduct a full history
and physical examination and tell her to return in 2 weeks with a sleep diary.
At this follow-up visit you see from her diary that she is sleeping an average of
51⁄2 hours per night.
Which one of the following would be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for an hour if she wakes up at 3:00 a.m. ✔️- ANSWER: D
This patient presents with symptoms of chronic insomnia. Cognitive-
behavioral therapy for insomnia (CBT-I) and brief behavioral therapy for
insomnia (BBT-I) are effective nonpharmacologic treatments for chronic
insomnia. Modified CBT-I and BBT-I can be administered by a primary care
physician. The basic principles include stimulus control (sleep hygiene) and
sleep restriction. Reducing time in bed increases sleep efficiency. In this case,
6 hours of time in bed would improve the patient's sleep efficiency and a
bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in
bed is accomplished by postponing bedtime rather than getting up earlier.
Naps generally do not improve sleep efficiency. While getting out of bed is
recommended after being in bed for 30 minutes without falling asleep, or
being awake for 30 minutes after being asleep, staying up for a prescribed
period of time is not recommended.
A 16-year-old female presents with chronic acne on her nose, forehead, and
chin consisting of a few comedones and a few mildly inflamed papules and
,pustules. She says it is minimally improved after 12 weeks of daily adapalene
0.1% gel. There are no scars or cysts. The patient would like to try to achieve
better control.
Which one of the following would you recommend at this time?
A) Continue adapalene 0.1% gel for 12 more weeks
B) Add clindamycin (Cleocin T) 1% gel for up to 12 weeks
C) Add clindamycin 1% gel for maintenance
D) Stop adapalene 0.1% gel and start clindamycin 1% gel for maintenance
E) Stop adapalene 0.1% gel and start erythromycin 2% gel for maintenance
✔️- ANSWER: B
Family physicians are often asked to manage mild to moderate acne vulgaris.
Topical retinoids such as adapalene and benzoyl peroxide are first-line
therapy and a trial of therapy is typically 8-12 weeks. Topical antibiotics may
be added to topical retinoids or benzoyl peroxide to achieve better symptom
control. To decrease emerging antibiotic resistance, studies support limiting
antibiotic use to 12 weeks except in severe cases, not using antibiotics as
monotherapy, and using clindamycin rather than erythromycin. Adding
clindamycin gel rather than erythromycin gel for up to 12 weeks is
recommended for this patient at this time.
A 57-year-old male with a history of heart failure sees you for follow-up. He
describes symptoms of mild dyspnea on exertion with ordinary activities such
as shopping or yard work. An echocardiogram shows an ejection fraction of
37%.
According to the New York Heart Association criteria, this patient's heart
failure would be classified as which one of the following?
A) Class I
B) Class II
C) Class III
D) Class IV ✔️- ANSWER: B
The appropriate classification of heart failure is important for monitoring the
disease. The most common currently used system is the New York Heart
Association (NYHA) functional classification. In this system, class I is defined
as heart disease in a patient with no symptoms and no limitations of physical
activity. Patients with class II heart failure have mild symptoms with normal
physical activity. Class III heart failure refers to significant limitations of
activity, including symptoms with less than normal activities. Patients with
class IV heart failure have symptoms at rest and are unable to carry on activity
without discomfort.
, A 24-year-old female presents with progressively worsening vulvar pain for 3
days. On examination a 3×3-cm tender, fluctuant mass is noted on the right
labia minora. She had a similar episode of this problem last year.
Which one of the following would be the most appropriate management?
A) Expectant management
B) Fine-needle aspiration
C) Incision and drainage
D) Marsupialization
E) Excision under general anesthesia ✔️- ANSWER: D
The most appropriate management of a recurrent Bartholin gland abscess
would be marsupialization, which has a 0% recurrence rate at 6 months. Local
anesthesia can be used in the office to effectively treat Bartholin gland
abscesses and sedation is not required (SOR A). If the Bartholin gland abscess
is >5 cm, referral to a gynecologist is recommended. Expectant management,
fine-needle aspiration, or incision and drainage would likely lead to
recurrence.
A 34-year-old female at 32 weeks gestation presents with a right-sided,
pounding headache that began 8 hours ago and is similar to headaches she has
had in the past. She is sensitive to light and sound, and has vomited several
times since the onset of pain. She has taken acetaminophen without relief. She
takes prenatal vitamins but no other routine medications. On examination her
blood pressure is normal.
Which one of the following would be the most appropriate treatment for this
patient?
A) Dihydroergotamine
B) Metoclopramide (Reglan)
C) Naproxen
D) Oxycodone (OxyContin)
E) Sumatriptan (Imitrex) ✔️- ANSWER: B
Metoclopramide and acetaminophen are the only two medications considered
safe for abortive migraine treatment during pregnancy (SOR B). The
dopamine antagonist antiemetics are considered second-line abortive
treatments in the general population. Dihydroergotamine should not be used
during pregnancy due to its oxytocic properties and the potential risk of
intrauterine growth restriction with its use. NSAIDs are not considered safe
during pregnancy, particularly in the first and third trimesters. Opioids are
only moderately useful for migraine treatment and should be avoided during
