ABFM ITE UPDATED LATEST ANSWERS AND
QUESTIONS SET A+
✔✔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.
✔✔Leser-Trelat sign - ✔✔Abrupt onset of multiple seborrheic keratoses, which is an
unusual finding that often indicates an underlying malignancy, most commonly an
adenocarcinoma of the stomach.
✔✔Rocky Mountain Spotted Fever - ✔✔Caused by Rickettsia rickettsii, spread by ticks
- Sx: petechial rash on palms and soles (migrating to wrists, ankles, then trunk),
headache, fever. Endemic to East Coast (in spite of its name).
- Rx: Doxycycline
✔✔History of pancreatitis in patients with diabetes - ✔✔Both Sitagliptin, a DPP-4
inhibitor, and Liraglutide, a GLP-1 receptor agonist, should be avoided or used with
caution.
✔✔Head lice in children - ✔✔If suspected, the child should remain in class and should
not be treated unless there is a clear
diagnosis and live lice are seen. They should however, be discouraged from close
contact with others until treated appropriately with a pediculicide.
,Nits are louse eggs and do not necessarily represent an active, infectious case of head
lice.
After first cycle of treatment, apart from home eradication measures and regular nit
combing, patient may return to class with retreatment in a week's time.
✔✔Falsely lowers HbA1c in diabetics - ✔✔Haemolytic anaemia, HAART for HIV,
chronic liver disease, pregnancy, Vit C and E, acute blood loss
✔✔Lithium toxicity, more prevalent in the elderly - ✔✔Often presents with signs and
symptoms related to the gastrointestinal tract (nausea, vomiting, and diarrhoea, which
can further worsen toxicity), heart (arrhythmias and conduction delays), and central
nervous system (coarse tremors, ataxia, agitation, and confusion).
✔✔Common cause of neonatal sepsis - ✔✔GBS, E coli
✔✔Most common cause of tinnitus - ✔✔SNHL
✔✔Pearly Penile Papules (PPP) - ✔✔Common and benign, and present as small, skin
coloured, dome-shaped papules in a circular pattern around the coronal sulcus.
✔✔Angiokeratomas (may appear solely on the glans of the penis, but are also found on
the scrotum, abdomen, thighs, groin, and extremities) - ✔✔Usually asymptomatic,
circumscribed, red or bluish papules.
When found on shaft of the penis, the suprapubic region, or the sacral region; can be
associated with Fabry disease.
✔✔Chronic tension-type headaches - ✔✔Amitriptyline may reduce headache duration
and severity
✔✔Painful diabetic peripheral neuropathy - ✔✔Pregabalin
✔✔In sepsis, a serum lactate value >36 g/dL (4 mmol/L) is correlated with increased
severity of illness and poorer outcomes even if hypotension is not yet present. -
✔✔Patients should receive isotonic intravenous fluids such as normal saline or lactated
Hartmann's solution at an initial rate of 30 mL/kg in the first 3 hours using small boluses
of approximately 500 mL.
✔✔MRI Breasts - ✔✔Reserved for women at very high risk for breast cancer such as
those with genetic mutations, a history of breast irradiation, or a very high-risk family
history.
, ✔✔To reduce dosing error in children, apart from appropriate education to parents -
✔✔Oral syringe should be provided
✔✔In treatment of Bipolar Disorder, treatment with SSRI as monotherapy should be
avoided - ✔✔A combination of antidepressants such as an SSRI, plus a mood
stabilizer, which includes anticonvulsants (Lamotrigine, Divalproex), atypical
antipsychotics (Quetiapine) - as typical antipsychotics increases risk of QT prolongation,
or Lithium, but this is considered second-line therapy.
Long-term maintenance therapy with a mood stabilizer is recommended in patients with
bipolar I disorder due to the high risk of recurrent mania. NOT Haloperidol.
✔✔Leading cause of cancer death in men in the United States - ✔✔Lung cancer
✔✔A useful adjunct to Buprenorphine in the treatment of opioid use disorder to help
increase the rates of abstinence and decrease stress-related opioid cravings -
✔✔Clonidine (0.1-0.3 mg every 6-8 hours)
✔✔The presence of RBC casts on microscopic examination of a spun urine sediment is
pathognomonic for - ✔✔Acute glomerulonephritis
✔✔Mallet finger - ✔✔The inability to actively extend the DIP joint is a hallmark.
The inability to passively extend the DIP joint completely may be an indication of
trapped soft tissue or bone that may require surgery.
Up to one-third of distal extensor tendon injuries are associated with an avulsion
fracture, and if the avulsion is greater than 30% of the joint space, referral to an
orthopaedic is recommended. Otherwise, immobilization of the DIP joint in extension for
6-8 weeks.
✔✔Pneumococcal vaccination - ✔✔Both PCV13 and PPSV23 are recommended for
patients with chronic renal failure. Indications for PPSV23 alone in immunocompetent
persons younger than 65 include chronic lung disease, diabetes mellitus, chronic heart
disease, smoking, and alcoholism.
✔✔Treatment of acute Bell's palsy - ✔✔Antiviral medication along with corticosteroids is
significantly more effective than corticosteroids alone. The medications are most
effective if started within 72 hours of symptom onset.
✔✔Test to confirm diagnosis of Cushing's - ✔✔24h urinary free cortisol
✔✔Obesity hypoventilation syndrome (carbon dioxide retention - PaCO2 >45 mm Hg, in
an individual with a BMI > 30 kg/m2) - ✔✔Restrictive pattern on spirometry
QUESTIONS SET A+
✔✔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.
✔✔Leser-Trelat sign - ✔✔Abrupt onset of multiple seborrheic keratoses, which is an
unusual finding that often indicates an underlying malignancy, most commonly an
adenocarcinoma of the stomach.
✔✔Rocky Mountain Spotted Fever - ✔✔Caused by Rickettsia rickettsii, spread by ticks
- Sx: petechial rash on palms and soles (migrating to wrists, ankles, then trunk),
headache, fever. Endemic to East Coast (in spite of its name).
- Rx: Doxycycline
✔✔History of pancreatitis in patients with diabetes - ✔✔Both Sitagliptin, a DPP-4
inhibitor, and Liraglutide, a GLP-1 receptor agonist, should be avoided or used with
caution.
✔✔Head lice in children - ✔✔If suspected, the child should remain in class and should
not be treated unless there is a clear
diagnosis and live lice are seen. They should however, be discouraged from close
contact with others until treated appropriately with a pediculicide.
,Nits are louse eggs and do not necessarily represent an active, infectious case of head
lice.
After first cycle of treatment, apart from home eradication measures and regular nit
combing, patient may return to class with retreatment in a week's time.
✔✔Falsely lowers HbA1c in diabetics - ✔✔Haemolytic anaemia, HAART for HIV,
chronic liver disease, pregnancy, Vit C and E, acute blood loss
✔✔Lithium toxicity, more prevalent in the elderly - ✔✔Often presents with signs and
symptoms related to the gastrointestinal tract (nausea, vomiting, and diarrhoea, which
can further worsen toxicity), heart (arrhythmias and conduction delays), and central
nervous system (coarse tremors, ataxia, agitation, and confusion).
✔✔Common cause of neonatal sepsis - ✔✔GBS, E coli
✔✔Most common cause of tinnitus - ✔✔SNHL
✔✔Pearly Penile Papules (PPP) - ✔✔Common and benign, and present as small, skin
coloured, dome-shaped papules in a circular pattern around the coronal sulcus.
✔✔Angiokeratomas (may appear solely on the glans of the penis, but are also found on
the scrotum, abdomen, thighs, groin, and extremities) - ✔✔Usually asymptomatic,
circumscribed, red or bluish papules.
When found on shaft of the penis, the suprapubic region, or the sacral region; can be
associated with Fabry disease.
✔✔Chronic tension-type headaches - ✔✔Amitriptyline may reduce headache duration
and severity
✔✔Painful diabetic peripheral neuropathy - ✔✔Pregabalin
✔✔In sepsis, a serum lactate value >36 g/dL (4 mmol/L) is correlated with increased
severity of illness and poorer outcomes even if hypotension is not yet present. -
✔✔Patients should receive isotonic intravenous fluids such as normal saline or lactated
Hartmann's solution at an initial rate of 30 mL/kg in the first 3 hours using small boluses
of approximately 500 mL.
✔✔MRI Breasts - ✔✔Reserved for women at very high risk for breast cancer such as
those with genetic mutations, a history of breast irradiation, or a very high-risk family
history.
, ✔✔To reduce dosing error in children, apart from appropriate education to parents -
✔✔Oral syringe should be provided
✔✔In treatment of Bipolar Disorder, treatment with SSRI as monotherapy should be
avoided - ✔✔A combination of antidepressants such as an SSRI, plus a mood
stabilizer, which includes anticonvulsants (Lamotrigine, Divalproex), atypical
antipsychotics (Quetiapine) - as typical antipsychotics increases risk of QT prolongation,
or Lithium, but this is considered second-line therapy.
Long-term maintenance therapy with a mood stabilizer is recommended in patients with
bipolar I disorder due to the high risk of recurrent mania. NOT Haloperidol.
✔✔Leading cause of cancer death in men in the United States - ✔✔Lung cancer
✔✔A useful adjunct to Buprenorphine in the treatment of opioid use disorder to help
increase the rates of abstinence and decrease stress-related opioid cravings -
✔✔Clonidine (0.1-0.3 mg every 6-8 hours)
✔✔The presence of RBC casts on microscopic examination of a spun urine sediment is
pathognomonic for - ✔✔Acute glomerulonephritis
✔✔Mallet finger - ✔✔The inability to actively extend the DIP joint is a hallmark.
The inability to passively extend the DIP joint completely may be an indication of
trapped soft tissue or bone that may require surgery.
Up to one-third of distal extensor tendon injuries are associated with an avulsion
fracture, and if the avulsion is greater than 30% of the joint space, referral to an
orthopaedic is recommended. Otherwise, immobilization of the DIP joint in extension for
6-8 weeks.
✔✔Pneumococcal vaccination - ✔✔Both PCV13 and PPSV23 are recommended for
patients with chronic renal failure. Indications for PPSV23 alone in immunocompetent
persons younger than 65 include chronic lung disease, diabetes mellitus, chronic heart
disease, smoking, and alcoholism.
✔✔Treatment of acute Bell's palsy - ✔✔Antiviral medication along with corticosteroids is
significantly more effective than corticosteroids alone. The medications are most
effective if started within 72 hours of symptom onset.
✔✔Test to confirm diagnosis of Cushing's - ✔✔24h urinary free cortisol
✔✔Obesity hypoventilation syndrome (carbon dioxide retention - PaCO2 >45 mm Hg, in
an individual with a BMI > 30 kg/m2) - ✔✔Restrictive pattern on spirometry
