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-TRAININGEXAMINATION 2
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q2 TIME–4 HOURS q2




1. A 4-week-old white male is brought to your office with a 2-week history of increasing
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dyspnea, cough, and poor feeding. The child appears nontoxic and is afebrile. On
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examination you note conjunctivitis, and a chest examination reveals tachypnea and
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crackles. A chest film shows hyperinflation and diffuse interstitial infiltrates and a WBC
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count reveals eosinophilia.
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What is the most likely etiologic agent?
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A) Staphylococcus species q2




B) Chlamydia trachomatis q2 q 2




C) Respiratory syncytial virus q2 q2




D) Parainfluenza virus q2




2. A 36-year-old obese female presents to your office with a chief complaint of amenorrhea.
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On examination you note hirsutism and body acne. She is on no medications and a
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pregnancy test is negative. Serum testosterone is at the upper limits of normal and TSH
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is within normal limits.
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In addition to weight loss and exercise, which one of the following would
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qbe the most appropriate initial management?
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A) High-dose combined oral contraceptives q2 q2 q2




B) Progestin-only contraceptives q2




C) Metformin (Glucophage) q 2 q 2




D) Levothyroxine (Synthroid) q2




3. A factory worker sustains a forced flexion injury of the distal interphalangeal (DIP) joint,
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resulting in a small bone fragment at the dorsal surface of the proximal distal phalanx
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(mallet fracture). Which one of the following is the most appropriate management
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strategy?
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A) Buddy taping and early range of motion q2 q 2 q2 q2 q 2 q 2




B) Splinting the DIP joint in extension q2 q2 q2 q2 q2 q 2




C) Splinting the DIP joint in flexion q2 q2 q2 q2 q2




1

, D) Referral for surgical repair
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4. WhichoneofthefollowingdrugsisNOTeffectiveformaintenancetherapyinbipolar
2
q 2
q 2
q 2
q 2
q 2
q 2
q 2
q 2
q 2
q 2
q 2
q 2
q




disorders?
q2




A) Haloperidol q 2




B) Lamotrigine (Lamictal) q2




C) Lithium
D) Quetiapine(Seroquel) 2
q




E) Valproate sodium (Depacon)
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2

,5. A 30-year-old ill-appearing male presents with right hand and arm pain and a rapidly
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expanding area of redness. On examination he has a temperature of 38.9°C (102.0°F), a
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pulse rate of 120 beats/min, and a blood pressure of 116/74 mm Hg. He also has erythema
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from the dorsal hand to the elbow, violaceous bullae on the dorsal hand and wrist, and
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severe pain with dorsiflexion of the wrist or fingers.
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Which one of the following is the most appropriate initial step in the management of this
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patient?
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A) Oral dicloxacillin and outpatient follow-up within the next 24 hours
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B) Intravenous metronidazole q 2




C) Consultation with an infectious disease specialist for antibiotic management q2 q2 q2 q2 q2 q2 q2 q2




D) Immediate surgical consultation for operative debridement q2 q2 q2 q2 q2 q 2




E) Incision and drainage with wound cultures in the emergency department q2 q 2 q2 q2 q2 q 2 q2 q2 q2




6. Patients being treated with amiodarone (Cordarone) should be monitored periodically with
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serum levels of
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A) cortisol
B) creatine phosphokinase q 2




C) creatinine
D) LDH
E) TSH q 2




7. A mother brings her 2-year-old daughter to your office because the child is not using her left
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arm. Earlier in the day the mother left the toddler under the supervision of her 12-year-old
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sister while she went to the store. When she returned the toddler was playing with toys
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using only her right arm, and was holding the left arm slightly pronated, flexed, and close to
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her body. The older daughter was unaware of any injury to the girl’s arm, and the child does
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not seem distressed or traumatized.
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Physical examination of the child’s clavicle, shoulder, wrist, and hand do not elicit any signs
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of pain or change in function. She does seem to have some tenderness near the lateral
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elbow and resists your attempts to examine that area. There is no ecchymosis, swelling, or
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deformity of the elbow.
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Which one of the following would be most appropriate at this point?
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A) Plain radiographs of the affected elbow q 2 q 2 q 2 q2 q 2




B) Ultrasonography of the affected elbow q 2 q 2 q 2 q 2




C) Evaluation by an orthopedic surgeon within 24 hours q2 q2 q 2 q2 q2 q 2 q2




D) Attempted reduction of the subluxed radial head q2 q2 q2 q2 q 2 q2 q 2




E) Placement in a splint and follow-up in the office if there is no improvement in the q2 q2 q2 q2 q2 q2 q2 q2 q2 q2 q2 q2 q2 q2 q2




next 1–2 weeks
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3

, 8. A 12-year-old male uses a short-acting bronchodilator three times per week
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to control his asthma. Lately he has been waking up about twice a week because of his
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symptoms.
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Which one of the following medications would be most appropriate?
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A) Inhaled medium-dose corticosteroids q2 q2 q 2




B) A scheduled short-acting bronchodilator
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C) A scheduled long-acting bronchodilator
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D) A leukotriene inhibitor
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9. Which oneof the following isthemostappropriatefirst-linetherapyfor primary
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q q2 2
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dysmenorrhea?
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A) Combined monophasic oral contraceptives q2 q2 q2




B) Combined multiphasic oral contraceptives q2 q2 q2




C) Subdermal etonogestrel (Nexplanon) q2 q2




D) Intramuscular medroxyprogesterone (Depo-Provera) q 2 q2




E) NSAIDs q 2




10. While performing a routine physical examination on a 42-year-old female you discover an
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apparent nodule in the left lobe of the thyroid measuring approximately 1 cm in diameter,
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which is confirmed on ultrasonography. The most appropriate next step in the evaluation of
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this finding is a
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A) serum calcitonin level q2 q2




B) serum free T3 level q 2 q 2 q 2




C) serum TSH level q 2 q 2 q 2




D) serum thyroglobulin level q2 q2




E) radionuclide thyroid scan q2 q2




11. Which one of the following medications should be started at a low dosage and titrated
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slowly to minimize the risk of Stevens-Johnson syndrome?
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A) Carbamazepine (Tegretol) q2




B) Divalproex (Depakote) q2




C) Lamotrigine (Lamictal) q2 q 2




D) Lithium
E) Ziprasidone (Geodon) q 2




4