UPDATED 2024 ABFM CKSA 22-
23(GUARANTEED ANSWERS
, UPDATED 2024 ABFM CKSA 22-
23(GUARANTEED ANSWERS)
A. Adhesive capsulitis
B. Osteoarthritis of the shoulder
C. Superior labral anterior to posterior (SLAP) lesion
D. Infraspinatus tendinopathy
E. Supraspinatus tendinopathy - CORRECT ANSWERSANSWER: A
Adhesive capsulitis is characterized by worsening shoulder pain that is hard to localize. The underlying
pathology is contraction of the glenohumeral capsule resulting in decreased active and passive range of
motion. It is an idiopathic condition but has an increased prevalence in patients with diabetes mellitus
and hypothyroidism. Adhesive capsulitis is often self-limited but can persist for years in some patients.
Nonsurgical treatment options include physical therapy, oral or intra-articular corticosteroids,
acupuncture, and hydrodilatation.
A 56-year-old male with a history of hepatitis C cirrhosis is admitted to the hospital with GI bleeding. The
patient has been stable, taking only furosemide and spironolactone. Upper GI endoscopy confirms
variceal bleeding and the gastroenterologist performs appropriate variceal banding. A nurse calls you
because laboratory studies ordered in the emergency department reveal a serum ammonia level of 120
µg/dL (N 39-90). The patient has no signs of confusion, insomnia, or decreased mental alertness. A
physical examination reveals mild ascites but no other abnormalities. Which one of the following would
be most appropriate for addressing the elevated ammonia level?
A. Lactulose
B. No additional treatment
C. Methotrexate
D. Neomycin
E. Prednisone - CORRECT ANSWERSANSWER: B
Elevated ammonia levels may occur in multiple clinical scenarios (i.e. portosystemic shunting, UTI from
urease-producing organisms, GI bleeding, shock, renal disease, parenteral nutrition, salicylate
intoxication, alcohol use). In patients with chronic liver disease, hepatic encephalopathy is diagnosed
based on the overall clinical presentation and not by an ammonia level. It is important to remember that
,a normal ammonia level neither excludes nor confirms the diagnosis of hepatic encephalopathy. This
patient had an elevated serum ammonia level that was found incidentally during his hospital admission
for gastrointestinal bleeding. Because there is no clinically significant encephalopathy, treatment based
on ammonia levels is not indicated. Lactulose, methotrexate, neomycin, or prednisone would not be
appropriate.
A 33-year-old female presents with palpitations and excessive sweating. A physical examination is
normal. Laboratory findings include a TSH (thyrotropin) level of 0.02 µU/mL (N 0.40-4.00) and a free T4
level of 3.9 ng/dL (N 0.7-1.9). Radionuclide scanning reveals no uptake. Which one of the following
would explain these findings?
A. Thyroid hormone resistance
B. Graves disease
C. A toxic nodular goiter
D. Excess thyroid hormone intake
E. A thyrotropin-secreting pituitary tumor - CORRECT ANSWERSANSWER: D
Excess thyroid hormone intake would cause a low TSH (thyrotropin) level with a high free T4 level and
no uptake on radionuclide scan. Other possibilities include an hCG-secreting tumor and the thyrotoxic
phase of subacute thyroiditis.
An elevated TSH (thyrotropin) level would be seen with thyroid-hormone resistance or a thyrotropin-
secreting pituitary tumor. Graves disease causes a homogeneous increased thyroid uptake on
radionuclide scanning, whereas a hot nodule would be expected with a toxic nodular goiter.
A 60-year-old male with type 2 diabetes comes to your office with an acute onset of fever, chills, and
malaise. He says that he is feeling progressively worse. His temperature is 40.0°C (104.0°F). An
examination reveals redness, tenderness, and swelling of the penis, scrotum, and perineal area. Which
one of the following medications is most likely to predispose this patient to this condition?
A. Empagliflozin
B. Exenatide
C. Insulin glargine
D. Pioglitazone
E. Sitagliptin - CORRECT ANSWERSANSWER: A
, SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) are associated with a
higher rate of genitourinary infections. Most often these are fungal in etiology, however there are
associations with more serious infections including necrotizing fasciitis of the perineum (Fournier's
gangrene). While rare, this is a life-threatening infection associated with this class of medication that is
being used more frequently to treat diabetes mellitus and other cardiac conditions. Because of this risk,
the FDA issued a Drug Safety Warning in 2018.
The drug classes that include exenatide, insulin glargine, pioglitazone, and sitagliptin are not associated
with genitourinary infections.
A 5-year-old male is brought to your office after passing an intestinal worm. He lives on a farm with
cattle, pigs, and dogs. He has never traveled very far from home. He does not have any respiratory
symptoms or diarrhea, but has experienced some abdominal bloating. His parents bring a picture of the
worm (shown below). Which one of the following is the infecting organism? - CORRECT ANSWERSA.
Ascaris lumbricoides (roundworm)
B. Enterobius vermicularis (pinworm)
C. Giardia lamblia
D. Necator americanus (hookworm)
E. Taenia solium (tapeworm)
.
.
.
.
.
.
.
.
.
.
.
.
.
23(GUARANTEED ANSWERS
, UPDATED 2024 ABFM CKSA 22-
23(GUARANTEED ANSWERS)
A. Adhesive capsulitis
B. Osteoarthritis of the shoulder
C. Superior labral anterior to posterior (SLAP) lesion
D. Infraspinatus tendinopathy
E. Supraspinatus tendinopathy - CORRECT ANSWERSANSWER: A
Adhesive capsulitis is characterized by worsening shoulder pain that is hard to localize. The underlying
pathology is contraction of the glenohumeral capsule resulting in decreased active and passive range of
motion. It is an idiopathic condition but has an increased prevalence in patients with diabetes mellitus
and hypothyroidism. Adhesive capsulitis is often self-limited but can persist for years in some patients.
Nonsurgical treatment options include physical therapy, oral or intra-articular corticosteroids,
acupuncture, and hydrodilatation.
A 56-year-old male with a history of hepatitis C cirrhosis is admitted to the hospital with GI bleeding. The
patient has been stable, taking only furosemide and spironolactone. Upper GI endoscopy confirms
variceal bleeding and the gastroenterologist performs appropriate variceal banding. A nurse calls you
because laboratory studies ordered in the emergency department reveal a serum ammonia level of 120
µg/dL (N 39-90). The patient has no signs of confusion, insomnia, or decreased mental alertness. A
physical examination reveals mild ascites but no other abnormalities. Which one of the following would
be most appropriate for addressing the elevated ammonia level?
A. Lactulose
B. No additional treatment
C. Methotrexate
D. Neomycin
E. Prednisone - CORRECT ANSWERSANSWER: B
Elevated ammonia levels may occur in multiple clinical scenarios (i.e. portosystemic shunting, UTI from
urease-producing organisms, GI bleeding, shock, renal disease, parenteral nutrition, salicylate
intoxication, alcohol use). In patients with chronic liver disease, hepatic encephalopathy is diagnosed
based on the overall clinical presentation and not by an ammonia level. It is important to remember that
,a normal ammonia level neither excludes nor confirms the diagnosis of hepatic encephalopathy. This
patient had an elevated serum ammonia level that was found incidentally during his hospital admission
for gastrointestinal bleeding. Because there is no clinically significant encephalopathy, treatment based
on ammonia levels is not indicated. Lactulose, methotrexate, neomycin, or prednisone would not be
appropriate.
A 33-year-old female presents with palpitations and excessive sweating. A physical examination is
normal. Laboratory findings include a TSH (thyrotropin) level of 0.02 µU/mL (N 0.40-4.00) and a free T4
level of 3.9 ng/dL (N 0.7-1.9). Radionuclide scanning reveals no uptake. Which one of the following
would explain these findings?
A. Thyroid hormone resistance
B. Graves disease
C. A toxic nodular goiter
D. Excess thyroid hormone intake
E. A thyrotropin-secreting pituitary tumor - CORRECT ANSWERSANSWER: D
Excess thyroid hormone intake would cause a low TSH (thyrotropin) level with a high free T4 level and
no uptake on radionuclide scan. Other possibilities include an hCG-secreting tumor and the thyrotoxic
phase of subacute thyroiditis.
An elevated TSH (thyrotropin) level would be seen with thyroid-hormone resistance or a thyrotropin-
secreting pituitary tumor. Graves disease causes a homogeneous increased thyroid uptake on
radionuclide scanning, whereas a hot nodule would be expected with a toxic nodular goiter.
A 60-year-old male with type 2 diabetes comes to your office with an acute onset of fever, chills, and
malaise. He says that he is feeling progressively worse. His temperature is 40.0°C (104.0°F). An
examination reveals redness, tenderness, and swelling of the penis, scrotum, and perineal area. Which
one of the following medications is most likely to predispose this patient to this condition?
A. Empagliflozin
B. Exenatide
C. Insulin glargine
D. Pioglitazone
E. Sitagliptin - CORRECT ANSWERSANSWER: A
, SGLT2 inhibitors (canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin) are associated with a
higher rate of genitourinary infections. Most often these are fungal in etiology, however there are
associations with more serious infections including necrotizing fasciitis of the perineum (Fournier's
gangrene). While rare, this is a life-threatening infection associated with this class of medication that is
being used more frequently to treat diabetes mellitus and other cardiac conditions. Because of this risk,
the FDA issued a Drug Safety Warning in 2018.
The drug classes that include exenatide, insulin glargine, pioglitazone, and sitagliptin are not associated
with genitourinary infections.
A 5-year-old male is brought to your office after passing an intestinal worm. He lives on a farm with
cattle, pigs, and dogs. He has never traveled very far from home. He does not have any respiratory
symptoms or diarrhea, but has experienced some abdominal bloating. His parents bring a picture of the
worm (shown below). Which one of the following is the infecting organism? - CORRECT ANSWERSA.
Ascaris lumbricoides (roundworm)
B. Enterobius vermicularis (pinworm)
C. Giardia lamblia
D. Necator americanus (hookworm)
E. Taenia solium (tapeworm)
.
.
.
.
.
.
.
.
.
.
.
.
.
