ABFM Questions (Adult) 2023 Updated Exam

ABFM Questions (Adult) 2023 Updated Exam Side effect of denosumab and bisphosphonates - ANSWER- Jaw osteonecrosis Most likely to induce remission in Crohn dz - ANSWER- corticosteroids 5-ASA infliximab Bisphosphonates shouldn't be used in pts w/CLCr less than - ANSWER- 35 mL/min/1.73m2 Bisphosphonates use for 5+ years risks... - ANSWER- atypical femoral shaft fractures, recommend drug holiday Denosumab is safe in CKD because - ANSWER- not cleared by kidneys IBD diagnosis made via - ANSWER- endoscopy with biopsies First line for treating DM neuropathy - ANSWER- TCAs (amitriptyline) SNRI, pregabalin antiSz Best management for acute urticaria - ANSWER- second generation X-H1 (longer acting, less drowsy vs 1st gen) Type of symptoms of depression seen most in elderly - ANSWER- somatic symptoms (also in preg women, children, low income) Best abx treatment for diabetic foot ulcer - ANSWER- Vanc/Zosyn (Piperacillin/tazobactam) - covers MRSA, pseudomonas Percent of wt loss leading to stat-significant improvement of lipid ratios, blood glucose, CAD risk reduction - ANSWER- at least 10% Most effective weight reduction and long-term maintenance treatment for morbidly obese - ANSWER- bariatric surgery (gastric bypass had mean wt loss 71.2% at 3 year, 20% at 6 years); reduce blood glucose, resolve DMII Which are some severe CAP symptoms requiring inpatient - ANSWER- confusion, tachypnea, hypotension, multilobar infiltrates (IV ceftriaxone and oral azithromycin) Outpatient treatment for mild/mod CAP w/out many comorbidities - ANSWER- oral macrolide (azithromycin, clarithromycin, erythromycin) or doxycycline - add fluoroquins, beta-lactams if comorbidities Next drug to step up to after albuterol fails to control mild asthma - ANSWERfluticasone inhaler Shown to shorten course of Bell's palsy - ANSWER- corticosteroids (antivirals don't do a thing) Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine - ANSWERInterferon gamma release assay (QuantiFERON-TB Gold) ... - ANSWERIf blood sugar of DM pt who takes long acting insulin at night is high during breakfast/lunch/dinner, how do you switch up their insulin regimen? - ANSWER- add short acting insulin before the last meal (if high during bedtime, add insulin during dinner; if high b4 dinner, add insulin at lunch time; if high b4 lunch, add at breakfast) Post-op delirium in elderly - tx? - ANSWER- adequate pain control and reorientation, don't sedate Hoarseness that doesn't resolve in 3 months, next best step - ANSWER- laryngoscopy (sooner than 3 mo if more serious condition suspected); voice rest for 2 weeks if Hx of URI/vocal abuse Effect of long term tx for narcotic addiction w/methadone and buprenorphine - ANSWER- greater success at producing opiate abstinence than detox programs How often to monitor serum Ca and Phos level in CKD? - ANSWER- 3-6 mo for Ca2+ and 6-12 mo for Phos w/goal to normalize Tramadol should be avoided in pts w/which kind of dz - ANSWER- seizures, lower sz threshold Linear excoriation, thickened skin on forearms/legs/neck due to excessive scratching - dx? tx? - ANSWER- Lichen simplex chronicus presentation - topical steroids w/occlusive bandage Best initial approach to wt loss per USPSTF - ANSWER- behavioral counseling (high intensity) Medical conditions that reduce response to warfarin (reduce INR) - ANSWERhypothyroidism, visceral carcinoma, high vitK intake, DM, hyperlipidemia Medical conditions that increase response to warfarin (increase INR more) - ANSWERvitK def (low dietary intake), malabsorption, scurvy, malnutrition, cachexia, small body size, liver dz, renal dz, fever, hyperthyroidism, infectious dz, HF, biliary obstruction MC etiology for acute laryngitis - ANSWER- viral, tx symptoms (red oropharynx w/out exudate, mucosal congestion, can't talk) Although helpful by themselves in protecting kidneys in DM, which two drugs should not be used together - ANSWER- ACE inhibitors and ARBs; higher Cr levels, increased likelihood that dialysis will become necessary Dermatologic disease assoc with Hep C - ANSWER- lichen planus (pruritic polygonal papules) and porphyria cutanea tarda Has the legal authority to revoke/restrict a patient's driver's license - ANSWERrepresentative of state DMV (physicians can make recommendations but can't legally restrict) MC causes of CAP in healthy adolescents - ANSWER- Mycoplasma, Chlamydophilia, group A Strep (outpatient - azithromycin; inpatient - ceftriax + erythromycin/azithromycn Still suspecting subarachnoid bleed (continued worse HA) after neg/equivocal head CT, next step? - ANSWER- lumbar puncture (look for xanthochromia, its absence rules out subarachnoid bleed) Morphine should be avoided in patients with this kind of organ disease - ANSWERrenal disease; toxic metabolites of morphine are not eliminated by kidneys in this case - resp depression, myoclonus, confusion (use fentanyl, methadone in CKD) Do this if you find trace valvular regurgitation on initial echocardiogram - ANSWERnothing, normal finding (70-90% of norm individuals) Risk factor for esophageal adenocarcinoma - ANSWER- obesity - GERD Rx: Increase risk of bruising, oral candidiasis, decrease COPD exacerbations, but no effect on mortality/FEV1 - ANSWER- inhaled corticosteroids Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating syphilis - ANSWER- Jarisch-Herxheimer reaction - reassurance, pyretics Other receptors besides aldosterone that are bound by spironolactone - ANSWERandrogen and progesterone - breast tenderness/ gynecomastia (eplerenone, ++specific to aldost-R, less ADEs)