ABFM ACTUAL QUESTIONS AND CORRECT
ANSWERS
◉ Which one of the following statements regarding hormone
therapy for transgender patients is true?
A) Hormone therapy to facilitate development of secondary sex
characteristics is generally reversible
B) Patients who receive hormone therapy generally report improved
quality of life, higher self-esteem, and decreased anxiety
C) Masculinizing hormone therapy is associated with reduced
muscle mass and fat redistribution
D) Patients receiving feminizing hormone therapy are at increased
risk for erythrocytosis.
Answer: ANSWER: B
Hormone therapy is not required for all transgender patients, but
those who receive treatment generally report improved quality of
life, higher self-esteem, and decreased anxiety. Feminizing and
masculinizing hormone therapies, including the use of estrogen
and/or androgen therapies such as testosterone, are partially
irreversible. Thus, it is important to make a reasonable, educated
decision and use informed consent prior to treatment. Patients who
receive masculinizing therapy are at increased risk for
erythrocytosis and those who receive feminizing hormone therapy
often experience reduced muscle mass and fat redistribution.
,◉ Which one of the following is the most common cause of prerenal
acute kidney injury in the intensive-care setting?
A) ACE inhibitor use
B) NSAID use
C) Membranoproliferative glomerulonephritis
D) Polyarteritis nodosa
E) Sepsis.
Answer: ANSWER: E
Acute kidney injury (AKI) is defined by a rapid decline in glomerular
filtration rate (GFR) and an increase in metabolic waste products. It
is associated with an increased risk of cardiovascular events,
progression to chronic kidney disease, and mortality. AKI is
categorized as prerenal, intrinsic renal, and postrenal. Diagnosing
the underlying cause is vital to successful management.
Management includes determining volume status, treating acute
volume changes with diuretics and fluid resuscitation, adjusting
medications according to renal function, and discontinuing
nephrotoxic medications. Prerenal AKI is caused by a depletion of
intravascular volume, which leads to decreased renal perfusion and
GFR. In the intensive-care setting, sepsis is the most common cause
of prerenal AKI. Angiotensin receptor blockers, ACE inhibitors, and
NSAIDs lower renal perfusion, causing the kidneys to activate
compensatory mechanisms to maintain the GFR. For those with
chronic kidney disease, this increases the risk for AKI.
Membranoproliferative glomerulonephritis and polyarteritis nodosa
are intrinsic renal causes for AKI. Postrenal causes include lower
,and upper urinary tract disorders such as infections, carcinoma, and
nephrolithiasis. Systemic postrenal causes include diabetes mellitus,
stroke, and multiple sclerosis.
◉ A 37-year-old female presents to your clinic with a long-standing
history of abnormal menstrual cycles, often occurring irregularly
more than 40 days apart. She has ongoing struggles with weight
gain, acne, and facial hair growth. She states that she is not currently
sexually active. Her last Papanicolaou smear 2 years ago was normal.
Her vital signs and a physical examination are unremarkable other
than a BMI of 36 kg/m2. An office urine pregnancy test is negative.
Laboratory evaluation reveals a hemoglobin A1c of 6.2%, and
normal TSH, prolactin, and 17-hydroxyprogesterone levels.
Which one of the following is required to confirm the most likely
diagnosis?
A) No additional evaluation
B) A serum C-peptide test
C) A dexamethasone suppression test
D) Ultrasonography of the pelvis
E) CT of the abdomen and pelvis.
Answer: ANSWER: A
This patient has signs and symptoms consistent with polycystic
ovary syndrome (PCOS). The Rotterdam 2003 criteria are the most
widely used diagnostic criteria for PCOS, endorsed by multiple
, national and international professional societies. These criteria
require the presence of two out of the following three features:
oligomenorrhea, hyperandrogenism, and the presence of polycystic
ovaries on ultrasonography. When the first two of these criteria are
clearly met, ultrasonography to establish the presence of polycystic
ovaries is not required. Therefore, a diagnosis is already warranted
for this patient and additional evaluation is not needed. When
patients require imaging, pelvic ultrasonography is the preferred
modality rather than CT. While this patient has evidence of insulin
resistance, as is common for patients with PCOS, a C-peptide test is
not indicated. Dexamethasone suppression testing is not indicated
because this patient does not have any other clinical signs and
symptoms that would be consistent with Cushing syndrome.
◉ A 56-year-old male presents to your office with a new onset of
nonvalvular atrial fibrillation. His CHA2DS2-VASc score is 3 based on
his previous history of hypertension, diabetes mellitus, and heart
failure. He has no major risk factors for bleeding.
Which one of the following would be recommended for the
prevention of ischemic stroke secondary to atrial fibrillation in this
patient?
A) No antithrombotic therapy
B) Apixaban (Eliquis), 5 mg twice daily
C) Aspirin only, 81 mg daily
D) Aspirin only, 325 mg daily
ANSWERS
◉ Which one of the following statements regarding hormone
therapy for transgender patients is true?
A) Hormone therapy to facilitate development of secondary sex
characteristics is generally reversible
B) Patients who receive hormone therapy generally report improved
quality of life, higher self-esteem, and decreased anxiety
C) Masculinizing hormone therapy is associated with reduced
muscle mass and fat redistribution
D) Patients receiving feminizing hormone therapy are at increased
risk for erythrocytosis.
Answer: ANSWER: B
Hormone therapy is not required for all transgender patients, but
those who receive treatment generally report improved quality of
life, higher self-esteem, and decreased anxiety. Feminizing and
masculinizing hormone therapies, including the use of estrogen
and/or androgen therapies such as testosterone, are partially
irreversible. Thus, it is important to make a reasonable, educated
decision and use informed consent prior to treatment. Patients who
receive masculinizing therapy are at increased risk for
erythrocytosis and those who receive feminizing hormone therapy
often experience reduced muscle mass and fat redistribution.
,◉ Which one of the following is the most common cause of prerenal
acute kidney injury in the intensive-care setting?
A) ACE inhibitor use
B) NSAID use
C) Membranoproliferative glomerulonephritis
D) Polyarteritis nodosa
E) Sepsis.
Answer: ANSWER: E
Acute kidney injury (AKI) is defined by a rapid decline in glomerular
filtration rate (GFR) and an increase in metabolic waste products. It
is associated with an increased risk of cardiovascular events,
progression to chronic kidney disease, and mortality. AKI is
categorized as prerenal, intrinsic renal, and postrenal. Diagnosing
the underlying cause is vital to successful management.
Management includes determining volume status, treating acute
volume changes with diuretics and fluid resuscitation, adjusting
medications according to renal function, and discontinuing
nephrotoxic medications. Prerenal AKI is caused by a depletion of
intravascular volume, which leads to decreased renal perfusion and
GFR. In the intensive-care setting, sepsis is the most common cause
of prerenal AKI. Angiotensin receptor blockers, ACE inhibitors, and
NSAIDs lower renal perfusion, causing the kidneys to activate
compensatory mechanisms to maintain the GFR. For those with
chronic kidney disease, this increases the risk for AKI.
Membranoproliferative glomerulonephritis and polyarteritis nodosa
are intrinsic renal causes for AKI. Postrenal causes include lower
,and upper urinary tract disorders such as infections, carcinoma, and
nephrolithiasis. Systemic postrenal causes include diabetes mellitus,
stroke, and multiple sclerosis.
◉ A 37-year-old female presents to your clinic with a long-standing
history of abnormal menstrual cycles, often occurring irregularly
more than 40 days apart. She has ongoing struggles with weight
gain, acne, and facial hair growth. She states that she is not currently
sexually active. Her last Papanicolaou smear 2 years ago was normal.
Her vital signs and a physical examination are unremarkable other
than a BMI of 36 kg/m2. An office urine pregnancy test is negative.
Laboratory evaluation reveals a hemoglobin A1c of 6.2%, and
normal TSH, prolactin, and 17-hydroxyprogesterone levels.
Which one of the following is required to confirm the most likely
diagnosis?
A) No additional evaluation
B) A serum C-peptide test
C) A dexamethasone suppression test
D) Ultrasonography of the pelvis
E) CT of the abdomen and pelvis.
Answer: ANSWER: A
This patient has signs and symptoms consistent with polycystic
ovary syndrome (PCOS). The Rotterdam 2003 criteria are the most
widely used diagnostic criteria for PCOS, endorsed by multiple
, national and international professional societies. These criteria
require the presence of two out of the following three features:
oligomenorrhea, hyperandrogenism, and the presence of polycystic
ovaries on ultrasonography. When the first two of these criteria are
clearly met, ultrasonography to establish the presence of polycystic
ovaries is not required. Therefore, a diagnosis is already warranted
for this patient and additional evaluation is not needed. When
patients require imaging, pelvic ultrasonography is the preferred
modality rather than CT. While this patient has evidence of insulin
resistance, as is common for patients with PCOS, a C-peptide test is
not indicated. Dexamethasone suppression testing is not indicated
because this patient does not have any other clinical signs and
symptoms that would be consistent with Cushing syndrome.
◉ A 56-year-old male presents to your office with a new onset of
nonvalvular atrial fibrillation. His CHA2DS2-VASc score is 3 based on
his previous history of hypertension, diabetes mellitus, and heart
failure. He has no major risk factors for bleeding.
Which one of the following would be recommended for the
prevention of ischemic stroke secondary to atrial fibrillation in this
patient?
A) No antithrombotic therapy
B) Apixaban (Eliquis), 5 mg twice daily
C) Aspirin only, 81 mg daily
D) Aspirin only, 325 mg daily
