ABFM IN-TRAINING EXAMINATION STUDY GUIDE QUESTIONS AND ANSWERS WITH EXPLANATION NEW UPDATE American Board of Family Medicine

ABFM IN-TRAINING EXAMINATION STUDY GUIDE QUESTIONS AND ANSWERS WITH EXPLANATION NEW UPDATE American Board of Family Medicine IN-TRAINING EXAMINATION TIME–4 HOURS 1. A 4-week-old white male is brought to your office with a 2-week history of increasing dyspnea, cough, and poor feeding. The child appears nontoxic and is afebrile. On examination you note conjunctivitis, and a chest examination reveals tachypnea and crackles. A chest film shows hyperinflation and diffuse interstitial infiltrates and a WBC count reveals eosinophilia. What is the most likely etiologic agent? A) Staphylococcus species B) Chlamydia trachomatis C) Respiratory syncytial virus D) Parainfluenza virus 2. A 36-year-old obese female presents to your office with a chief complaint of amenorrhea. On examination you note hirsutism and body acne. She is on no medications and a pregnancy test is negative. Serum testosterone is at the upper limits of normal and TSH is within normal limits. In addition to weight loss and exercise, which one of the following would be the most appropriate initial management? A) High-dose combined oral contraceptives B) Progestin-only contraceptives C) Metformin (Glucophage) D) Levothyroxine (Synthroid) 3. A factory worker sustains a forced flexion injury of the distal interphalangeal (DIP) joint, resulting in a small bone fragment at the dorsal surface of the proximal distal phalanx (mallet fracture). Which one of the following is the most appropriate management strategy? A) Buddy taping and early range of motion B) Splinting the DIP joint in extension C) Splinting the DIP joint in flexion D) Referral for surgical repair 4. Which one of the following drugs is NOT effective for maintenance therapy in bipolar disorders? A) Haloperidol B) Lamotrigine (Lamictal) C) Lithium D) Quetiapine (Seroquel) E) Valproate sodium (Depacon) 5. A 30-year-old ill-appearing male presents with right hand and arm pain and a rapidly expanding area of redness. On examination he has a temperature of 38.9°C (102.0°F), a pulse rate of 120 beats/min, and a blood pressure of 116/74 mm Hg. He also has erythema from the dorsal hand to the elbow, violaceous bullae on the dorsal hand and wrist, and severe pain with dorsiflexion of the wrist or fingers. Which one of the following is the most appropriate initial step in the management of this patient? A) Oral dicloxacillin and outpatient follow-up within the next 24 hours B) Intravenous metronidazole C) Consultation with an infectious disease specialist for antibiotic management D) Immediate surgical consultation for operative debridement E) Incision and drainage with wound cultures in the emergency department 6. Patients being treated with amiodarone (Cordarone) should be monitored periodically with serum levels of A) cortisol B) creatine phosphokinase C) creatinine D) LDH E) TSH 7. A mother brings her 2-year-old daughter to your office because the child is not using her left arm. Earlier in the day the mother left the toddler under the supervision of her 12-year-old sister while she went to the store. When she returned the toddler was playing with toys using only her right arm, and was holding the left arm slightly pronated, flexed, and close to her body. The older daughter was unaware of any injury to the girl’s arm, and the child does not seem distressed or traumatized. Physical examination of the child’s clavicle, shoulder, wrist, and hand do not elicit any signs of pain or change in function. She does seem to have some tenderness near the lateral elbow and resists your attempts to examine that area. There is no ecchymosis, swelling, or deformity of the elbow. Which one of the following would be most appropriate at this point? A) Plain radiographs of the affected elbow B) Ultrasonography of the affected elbow C) Evaluation by an orthopedic surgeon within 24 hours D) Attempted reduction of the subluxed radial head E) Placement in a splint and follow-up in the office if there is no improvement in the next 1–2 weeks 8. A 12-year-old male uses a short-acting bronchodilator three times per week to control his asthma. Lately he has been waking up about twice a week because of his symptoms. Which one of the following medications would be most appropriate? A) Inhaled medium-dose corticosteroids B) A scheduled short-acting bronchodilator C) A scheduled long-acting bronchodilator D) A leukotriene inhibitor 9. Which one of the following is the most appropriate first-line therapy for primary dysmenorrhea? A) Combined monophasic oral contraceptives B) Combined multiphasic oral contraceptives C) Subdermal etonogestrel (Nexplanon) D) Intramuscular medroxyprogesterone (Depo-Provera) E) NSAIDs 10. While performing a routine physical examination on a 42-year-old female you discover an apparent nodule in the left lobe of the thyroid measuring approximately 1 cm in diameter, which is confirmed on ultrasonography. The most appropriate next step in the evaluation of this finding is a A) serum calcitonin level B) serum free T3 level C) serum TSH level D) serum thyroglobulin level E) radionuclide thyroid scan 11. Which one of the following medications should be started at a low dosage and titrated slowly to minimize the risk of Stevens-Johnson syndrome? A) Carbamazepine (Tegretol) B) Divalproex (Depakote) C) Lamotrigine (Lamictal) D) Lithium E) Ziprasidone (Geodon) 12. You are the medical director of a long-term-care facility that has 60 residents. Several patients experience fever, cough, and upper respiratory symptoms. Two of these patients test positive for influenza A (H1N1) virus. Which one of the following is recommended by the Centers for Disease Control and Prevention (CDC) for this situation? A) Chemoprophylaxis with appropriate medications for all residents B) Treatment initiated on an individual basis once testing confirms that a resident has influenza C) Prophylaxis only for staff who have had direct patient contact with a resident with laboratory-confirmed infection D) No chemoprophylaxis for staff or residents who have been appropriately vaccinated 13. Information derived from which one of the following provides the best evidence when selecting a specific treatment plan for a patient? A) Meta-analyses B) Prospective cohort studies C) Expert opinion D) Consensus guidelines............