ABFM ITE COMPREHENSIVE EXAM QUESTIONS AND
ANSWERS RATED A+
✔✔The most common cause of chronic cough in adults is upper airway cough
syndrome. - ✔✔Patients might have nasal symptoms such as rhinorrhoea or
congestion. Physical findings can include swollen turbinates and posterior pharyngeal
cobblestoning, or they can be unremarkable. Initial treatment may include the use of
decongestants, oral or intranasal antihistamines, intranasal corticosteroids, or saline
nasal rinses.
✔✔Constipation-predominant IBS - ✔✔Polyethylene glycol, a long-chain polymer of
ethylene oxide, is a large molecule that causes water to be retained in the colon, which
softens the stool and increases the number of bowel movements.
✔✔Pain control with opioids - ✔✔Most orally administered immediate-release opioids
such as morphine, oxycodone, and hydromorphone reach their peak effect at about 1
hour, at which time additional medication can be given if the patient is still in pain.
Intravenous opioids reach their peak effect at about 10 minutes and intramuscular and
subcutaneous opioids at about 20-30 minutes.
✔✔Pulmonary hypertension secondary to COPD - ✔✔Supplemental oxygen should be
recommended when the PaO2 is <60 mm Hg, because it has been shown to improve
mortality by lowering pulmonary arterial pressures.
✔✔Type of anti-hypertensives that can reduce severity of OSA - ✔✔Aldosterone
antagonists.
Resistant hypertension is common in patients with obstructive sleep apnea. Resistant
hypertension is also associated with higher levels of aldosterone, which can lead to
secondary pharyngeal oedema, increasing
upper airway obstruction.
✔✔PCOS treatment - ✔✔Not desiring pregnancy: low-dose COCP (caution melasma),
Spironolactone, Finasteride
Desiring pregnancy: Letrozole > Clomiphene
✔✔Initial evaluation of hypogonadism - ✔✔FSH and LH
✔✔Internal tibial torsion - ✔✔Usually resolves by 5yo, surgery may be considered in
patients older than 8yo who have a severe residual deformity, especially if it is
symptomatic or cosmetically
unacceptable.
,✔✔Yersinia pestis is an aerobic fermentative gram-negative rod. It causes a zoonotic
infection with humans as the accidental host. The disease is spread by a bite from a flea
vector, direct contact with infected tissue, or inhalation of infectious aerosols from a
person with pulmonary plague. - ✔✔Plague occurs in two regions in the western United
States. One region includes northern New Mexico, northern Arizona, and southern
Colorado, and the other region includes California, southern Oregon, and far western
Nevada.
✔✔Greatest risk factor for developing osteoarthritis in older adults - ✔✔Obesity
✔✔Preferred initial evaluation of acute mesenteric ischaemia - ✔✔CT Angiography
✔✔Contraindication of oestrogen-containing contraception methods - ✔✔Smokers >35
years of age and in patients with migraine with aura.
✔✔Highest cure rate of basal cell carcinoma - ✔✔Mohs surgery
✔✔Pharmacotherapy to reduce alcohol consumption and increase abstinence -
✔✔Acamprosate
✔✔Valvular heart disease in Marfan's syndrome - ✔✔Aortic insufficiency/regurgitation in
80-100%, increases with age and is progressive. May also be associated with mitral
valve prolapse.
✔✔Haemoptysis work-up - ✔✔CXR normally but CT Chest if high risk for malignancy
(age, smoking history)
If findings are normal, patient should be observed for 2-6 weeks. If there is a recurrence
of haemoptysis further evaluation is indicated, which should include an interval history,
a repeat examination, and CT Chest.
✔✔Severe symptomatic aortic stenosis requires surgical intervention i.e. valve
replacement - ✔✔Pressure mean gradient >40 mmHg, aortic valve area <1 cm2 and
peak aortic jet velocity >4.0 m/s
- ACE inhibitors may improve symptoms in patients with aortic stenosis who are not
surgical candidates.
✔✔Rome IV criteria for IBS - ✔✔Recurrent abdominal pain associated with two or more
additional symptoms at least 1 day per week in the last 3 months. These symptoms
include pain related to defaecation, a change in stool frequency, or a change in stool
form.
✔✔Screening for GDM in pregnancy - ✔✔From 24w
,✔✔Proximal fifth metatarsal stress fracture (Jones fracture) management -
✔✔Particularly prone to non-union and completion of the fracture. Because complete
non-weight bearing or surgical intervention may be necessary with this high-risk
fracture, MRI is indicated as the most sensitive test.
- It has been shown that active patients have shorter healing times and return to activity
sooner with surgical management.
- If the nonsurgical option is chosen the patient is given an initial posterior splint and
followed up in 3-5 days, then placed in a short non-weight-bearing cast for 6 weeks, at
which time a repeat radiograph is taken. If the radiograph shows healing, the patient
can return to gradual weight bearing. If the radiograph does not show proper healing,
then the period of non-weight bearing is extended.
✔✔Adolescent physiologic gynaecomastia - ✔✔One half of all adolescent males,
usually bilateral but left sided more common if unilateral, typically resolves 6-24m after
onset.
✔✔Identify highest percentage of previously unrecognised chronic Hepatitis C -
✔✔One-time screening for all adults from 18-79 Yo
✔✔First-line treatment for persistent allergic rhinitis - ✔✔Intranasal steroids on top of
allergen avoidance and patient education
✔✔Most reliable measure to protect children from lead toxicity in the United States -
✔✔Eliminating the sources of lead in the community
✔✔What should be avoided to minimise the risk of postpartum haemorrhage? -
✔✔Routine episiotomy
✔✔Initial management for VF and pulseless VT - ✔✔Defibrillation
✔✔Mild transaminitis with negative HepB and HepC - ✔✔Serum ferritin (to check for
hereditary haemochromatosis) on top of USS Liver
✔✔Treatment of mid substance Achilles tendinopathy - ✔✔An eccentric gastrocnemius-
strengthening program
✔✔Pseudofolliculitis barbae is a common condition affecting the face and neck in
people with tightly curled hair. - ✔✔Clippers generally result in a less close shave and
contribute less.
✔✔Olecranon bursitis - ✔✔The diagnosis can be made from his history and the physical
examination, with no additional workup.
, Conservative Rx recommended as initial treatment (ice, compression dressings, and
avoidance of activities that aggravate the problem), aspiration for symptomatic relief if
there is significant enlargement or symptoms, or for diagnosis and culture if septic
bursitis is suspected.
The bursa may be injected with a corticosteroid, but this could cause skin atrophy or
infection. Surgical bursectomy can be offered for refractory cases lasting over 3 months.
✔✔Treatment of DVT/PE in pregnancy, cancer-associated thrombosis - ✔✔SC LMWH
e.g. Dalteparin, Enoxaparin
✔✔Medications to decrease mortality in patients with symptomatic heart failure -
✔✔Aldosterone antagonists, beta-blockers
✔✔Anticoagulation in those with malignancy - ✔✔SC LMWH preferred (NOACs not
studied in area of malignancy yet)
✔✔Mental health screening for refugees - ✔✔Depression, anxiety, and post-traumatic
stress disorder
✔✔AST:ALT ratio for alcoholic liver disease - ✔✔3:1
✔✔Perioperative management of chronic anticoagulation therapy - ✔✔For low-risk
patients, it is recommended that Warfarin be discontinued 5 days prior to surgery and
restarted 12-24 hours postoperatively.
✔✔Treatment for Henoch-Schonlein purpura - ✔✔Supportive
- Analgesics
- Adequate hydration
Steroids
- For GI inflammation
- Relieves pain
Seek care if
- Stomach pain is sudden or severe
- Blood in stool
- Vomiting with inability to keep fluids down
- Puffy face, hands or feet (sign of renal malfunction)
✔✔Hypoxaemia following acute illness - ✔✔Prescriptions for supplemental home
oxygen should not be renewed for patients who have recently been hospitalized for
acute illnesses without assessing them for ongoing hypoxaemia.
No apparent benefit derived from supplemental oxygen once their oxygen saturation is
88% or greater on room air.
ANSWERS RATED A+
✔✔The most common cause of chronic cough in adults is upper airway cough
syndrome. - ✔✔Patients might have nasal symptoms such as rhinorrhoea or
congestion. Physical findings can include swollen turbinates and posterior pharyngeal
cobblestoning, or they can be unremarkable. Initial treatment may include the use of
decongestants, oral or intranasal antihistamines, intranasal corticosteroids, or saline
nasal rinses.
✔✔Constipation-predominant IBS - ✔✔Polyethylene glycol, a long-chain polymer of
ethylene oxide, is a large molecule that causes water to be retained in the colon, which
softens the stool and increases the number of bowel movements.
✔✔Pain control with opioids - ✔✔Most orally administered immediate-release opioids
such as morphine, oxycodone, and hydromorphone reach their peak effect at about 1
hour, at which time additional medication can be given if the patient is still in pain.
Intravenous opioids reach their peak effect at about 10 minutes and intramuscular and
subcutaneous opioids at about 20-30 minutes.
✔✔Pulmonary hypertension secondary to COPD - ✔✔Supplemental oxygen should be
recommended when the PaO2 is <60 mm Hg, because it has been shown to improve
mortality by lowering pulmonary arterial pressures.
✔✔Type of anti-hypertensives that can reduce severity of OSA - ✔✔Aldosterone
antagonists.
Resistant hypertension is common in patients with obstructive sleep apnea. Resistant
hypertension is also associated with higher levels of aldosterone, which can lead to
secondary pharyngeal oedema, increasing
upper airway obstruction.
✔✔PCOS treatment - ✔✔Not desiring pregnancy: low-dose COCP (caution melasma),
Spironolactone, Finasteride
Desiring pregnancy: Letrozole > Clomiphene
✔✔Initial evaluation of hypogonadism - ✔✔FSH and LH
✔✔Internal tibial torsion - ✔✔Usually resolves by 5yo, surgery may be considered in
patients older than 8yo who have a severe residual deformity, especially if it is
symptomatic or cosmetically
unacceptable.
,✔✔Yersinia pestis is an aerobic fermentative gram-negative rod. It causes a zoonotic
infection with humans as the accidental host. The disease is spread by a bite from a flea
vector, direct contact with infected tissue, or inhalation of infectious aerosols from a
person with pulmonary plague. - ✔✔Plague occurs in two regions in the western United
States. One region includes northern New Mexico, northern Arizona, and southern
Colorado, and the other region includes California, southern Oregon, and far western
Nevada.
✔✔Greatest risk factor for developing osteoarthritis in older adults - ✔✔Obesity
✔✔Preferred initial evaluation of acute mesenteric ischaemia - ✔✔CT Angiography
✔✔Contraindication of oestrogen-containing contraception methods - ✔✔Smokers >35
years of age and in patients with migraine with aura.
✔✔Highest cure rate of basal cell carcinoma - ✔✔Mohs surgery
✔✔Pharmacotherapy to reduce alcohol consumption and increase abstinence -
✔✔Acamprosate
✔✔Valvular heart disease in Marfan's syndrome - ✔✔Aortic insufficiency/regurgitation in
80-100%, increases with age and is progressive. May also be associated with mitral
valve prolapse.
✔✔Haemoptysis work-up - ✔✔CXR normally but CT Chest if high risk for malignancy
(age, smoking history)
If findings are normal, patient should be observed for 2-6 weeks. If there is a recurrence
of haemoptysis further evaluation is indicated, which should include an interval history,
a repeat examination, and CT Chest.
✔✔Severe symptomatic aortic stenosis requires surgical intervention i.e. valve
replacement - ✔✔Pressure mean gradient >40 mmHg, aortic valve area <1 cm2 and
peak aortic jet velocity >4.0 m/s
- ACE inhibitors may improve symptoms in patients with aortic stenosis who are not
surgical candidates.
✔✔Rome IV criteria for IBS - ✔✔Recurrent abdominal pain associated with two or more
additional symptoms at least 1 day per week in the last 3 months. These symptoms
include pain related to defaecation, a change in stool frequency, or a change in stool
form.
✔✔Screening for GDM in pregnancy - ✔✔From 24w
,✔✔Proximal fifth metatarsal stress fracture (Jones fracture) management -
✔✔Particularly prone to non-union and completion of the fracture. Because complete
non-weight bearing or surgical intervention may be necessary with this high-risk
fracture, MRI is indicated as the most sensitive test.
- It has been shown that active patients have shorter healing times and return to activity
sooner with surgical management.
- If the nonsurgical option is chosen the patient is given an initial posterior splint and
followed up in 3-5 days, then placed in a short non-weight-bearing cast for 6 weeks, at
which time a repeat radiograph is taken. If the radiograph shows healing, the patient
can return to gradual weight bearing. If the radiograph does not show proper healing,
then the period of non-weight bearing is extended.
✔✔Adolescent physiologic gynaecomastia - ✔✔One half of all adolescent males,
usually bilateral but left sided more common if unilateral, typically resolves 6-24m after
onset.
✔✔Identify highest percentage of previously unrecognised chronic Hepatitis C -
✔✔One-time screening for all adults from 18-79 Yo
✔✔First-line treatment for persistent allergic rhinitis - ✔✔Intranasal steroids on top of
allergen avoidance and patient education
✔✔Most reliable measure to protect children from lead toxicity in the United States -
✔✔Eliminating the sources of lead in the community
✔✔What should be avoided to minimise the risk of postpartum haemorrhage? -
✔✔Routine episiotomy
✔✔Initial management for VF and pulseless VT - ✔✔Defibrillation
✔✔Mild transaminitis with negative HepB and HepC - ✔✔Serum ferritin (to check for
hereditary haemochromatosis) on top of USS Liver
✔✔Treatment of mid substance Achilles tendinopathy - ✔✔An eccentric gastrocnemius-
strengthening program
✔✔Pseudofolliculitis barbae is a common condition affecting the face and neck in
people with tightly curled hair. - ✔✔Clippers generally result in a less close shave and
contribute less.
✔✔Olecranon bursitis - ✔✔The diagnosis can be made from his history and the physical
examination, with no additional workup.
, Conservative Rx recommended as initial treatment (ice, compression dressings, and
avoidance of activities that aggravate the problem), aspiration for symptomatic relief if
there is significant enlargement or symptoms, or for diagnosis and culture if septic
bursitis is suspected.
The bursa may be injected with a corticosteroid, but this could cause skin atrophy or
infection. Surgical bursectomy can be offered for refractory cases lasting over 3 months.
✔✔Treatment of DVT/PE in pregnancy, cancer-associated thrombosis - ✔✔SC LMWH
e.g. Dalteparin, Enoxaparin
✔✔Medications to decrease mortality in patients with symptomatic heart failure -
✔✔Aldosterone antagonists, beta-blockers
✔✔Anticoagulation in those with malignancy - ✔✔SC LMWH preferred (NOACs not
studied in area of malignancy yet)
✔✔Mental health screening for refugees - ✔✔Depression, anxiety, and post-traumatic
stress disorder
✔✔AST:ALT ratio for alcoholic liver disease - ✔✔3:1
✔✔Perioperative management of chronic anticoagulation therapy - ✔✔For low-risk
patients, it is recommended that Warfarin be discontinued 5 days prior to surgery and
restarted 12-24 hours postoperatively.
✔✔Treatment for Henoch-Schonlein purpura - ✔✔Supportive
- Analgesics
- Adequate hydration
Steroids
- For GI inflammation
- Relieves pain
Seek care if
- Stomach pain is sudden or severe
- Blood in stool
- Vomiting with inability to keep fluids down
- Puffy face, hands or feet (sign of renal malfunction)
✔✔Hypoxaemia following acute illness - ✔✔Prescriptions for supplemental home
oxygen should not be renewed for patients who have recently been hospitalized for
acute illnesses without assessing them for ongoing hypoxaemia.
No apparent benefit derived from supplemental oxygen once their oxygen saturation is
88% or greater on room air.
