ABFM Questions (Adult) study test
guide with complete solution
Side effect of denosumab and bisphosphonates - ANS Jaw osteonecrosis
Most likely to induce remission in Crohn dz - ANS corticosteroids > 5-ASA > infliximab
Bisphosphonates shouldn't be used in pts w/CLCr less than - ANS 35 mL/min/1.73m2
Bisphosphonates use for 5+ years risks... - ANS atypical femoral shaft fractures, recommend
drug holiday
Denosumab is safe in CKD because - ANS not cleared by kidneys
IBD diagnosis made via - ANS endoscopy with biopsies
First line for treating DM neuropathy - ANS TCAs (amitriptyline) > SNRI, pregabalin > antiSz
Best management for acute urticaria - ANS second generation X-H1 (longer acting, less
drowsy vs 1st gen)
Type of symptoms of depression seen most in elderly - ANS somatic symptoms (also in preg
women, children, low income)
Best abx treatment for diabetic foot ulcer - ANS Vanc/Zosyn (Piperacillin/tazobactam) ->
covers MRSA, pseudomonas
Percent of wt loss leading to stat-significant improvement of lipid ratios, blood glucose, CAD risk
reduction - ANS at least 10%
Most effective weight reduction and long-term maintenance treatment for morbidly obese - ANS
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 - ANS confusion, tachypnea,
hypotension, multilobar infiltrates (IV ceftriaxone and oral azithromycin)
,Outpatient treatment for mild/mod CAP w/out many comorbidities - ANS 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 - ANS fluticasone inhaler
Shown to shorten course of Bell's palsy - ANS corticosteroids (antivirals don't do a thing)
Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine - ANS Interferon gamma
release assay (QuantiFERON-TB Gold)
... - ANS
If 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? - ANS 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? - ANS adequate pain control and reorientation, don't sedate
Hoarseness that doesn't resolve in 3 months, next best step - ANS 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 - ANS greater
success at producing opiate abstinence than detox programs
How often to monitor serum Ca and Phos level in CKD? - ANS 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 - ANS seizures, lower sz threshold
Linear excoriation, thickened skin on forearms/legs/neck due to excessive scratching -> dx? tx?
- ANS Lichen simplex chronicus presentation -> topical steroids w/occlusive bandage
Best initial approach to wt loss per USPSTF - ANS behavioral counseling (high intensity)
Medical conditions that reduce response to warfarin (reduce INR) - ANS hypothyroidism,
visceral carcinoma, high vitK intake, DM, hyperlipidemia
Medical conditions that increase response to warfarin (increase INR more) - ANS vitK 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 - ANS 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 - ANS ACE inhibitors and ARBs; higher Cr levels, increased likelihood that
dialysis will become necessary
Dermatologic disease assoc with Hep C - ANS lichen planus (pruritic polygonal papules) and
porphyria cutanea tarda
Has the legal authority to revoke/restrict a patient's driver's license - ANS representative of
state DMV (physicians can make recommendations but can't legally restrict)
MC causes of CAP in healthy adolescents - ANS 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? - ANS lumbar puncture (look for xanthochromia, its absence rules out subarachnoid
bleed)
Morphine should be avoided in patients with this kind of organ disease - ANS renal 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 - ANS nothing, normal
finding (70-90% of norm individuals)
Risk factor for esophageal adenocarcinoma - ANS obesity -> GERD
Rx: Increase risk of bruising, oral candidiasis, decrease COPD exacerbations, but no effect on
mortality/FEV1 - ANS inhaled corticosteroids
Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating syphilis - ANS
Jarisch-Herxheimer reaction -> reassurance, pyretics
Other receptors besides aldosterone that are bound by spironolactone - ANS androgen and
progesterone -> breast tenderness/ gynecomastia (eplerenone, ++specific to aldost-R, less
ADEs)
Hematospermia in pts younger than 40, next best step after examining testes and prostate -
ANS STD screen (no imaging, PSA levels, or referral to uro unless Hx or exam suggests
unusual cause)
guide with complete solution
Side effect of denosumab and bisphosphonates - ANS Jaw osteonecrosis
Most likely to induce remission in Crohn dz - ANS corticosteroids > 5-ASA > infliximab
Bisphosphonates shouldn't be used in pts w/CLCr less than - ANS 35 mL/min/1.73m2
Bisphosphonates use for 5+ years risks... - ANS atypical femoral shaft fractures, recommend
drug holiday
Denosumab is safe in CKD because - ANS not cleared by kidneys
IBD diagnosis made via - ANS endoscopy with biopsies
First line for treating DM neuropathy - ANS TCAs (amitriptyline) > SNRI, pregabalin > antiSz
Best management for acute urticaria - ANS second generation X-H1 (longer acting, less
drowsy vs 1st gen)
Type of symptoms of depression seen most in elderly - ANS somatic symptoms (also in preg
women, children, low income)
Best abx treatment for diabetic foot ulcer - ANS Vanc/Zosyn (Piperacillin/tazobactam) ->
covers MRSA, pseudomonas
Percent of wt loss leading to stat-significant improvement of lipid ratios, blood glucose, CAD risk
reduction - ANS at least 10%
Most effective weight reduction and long-term maintenance treatment for morbidly obese - ANS
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 - ANS confusion, tachypnea,
hypotension, multilobar infiltrates (IV ceftriaxone and oral azithromycin)
,Outpatient treatment for mild/mod CAP w/out many comorbidities - ANS 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 - ANS fluticasone inhaler
Shown to shorten course of Bell's palsy - ANS corticosteroids (antivirals don't do a thing)
Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine - ANS Interferon gamma
release assay (QuantiFERON-TB Gold)
... - ANS
If 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? - ANS 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? - ANS adequate pain control and reorientation, don't sedate
Hoarseness that doesn't resolve in 3 months, next best step - ANS 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 - ANS greater
success at producing opiate abstinence than detox programs
How often to monitor serum Ca and Phos level in CKD? - ANS 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 - ANS seizures, lower sz threshold
Linear excoriation, thickened skin on forearms/legs/neck due to excessive scratching -> dx? tx?
- ANS Lichen simplex chronicus presentation -> topical steroids w/occlusive bandage
Best initial approach to wt loss per USPSTF - ANS behavioral counseling (high intensity)
Medical conditions that reduce response to warfarin (reduce INR) - ANS hypothyroidism,
visceral carcinoma, high vitK intake, DM, hyperlipidemia
Medical conditions that increase response to warfarin (increase INR more) - ANS vitK 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 - ANS 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 - ANS ACE inhibitors and ARBs; higher Cr levels, increased likelihood that
dialysis will become necessary
Dermatologic disease assoc with Hep C - ANS lichen planus (pruritic polygonal papules) and
porphyria cutanea tarda
Has the legal authority to revoke/restrict a patient's driver's license - ANS representative of
state DMV (physicians can make recommendations but can't legally restrict)
MC causes of CAP in healthy adolescents - ANS 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? - ANS lumbar puncture (look for xanthochromia, its absence rules out subarachnoid
bleed)
Morphine should be avoided in patients with this kind of organ disease - ANS renal 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 - ANS nothing, normal
finding (70-90% of norm individuals)
Risk factor for esophageal adenocarcinoma - ANS obesity -> GERD
Rx: Increase risk of bruising, oral candidiasis, decrease COPD exacerbations, but no effect on
mortality/FEV1 - ANS inhaled corticosteroids
Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating syphilis - ANS
Jarisch-Herxheimer reaction -> reassurance, pyretics
Other receptors besides aldosterone that are bound by spironolactone - ANS androgen and
progesterone -> breast tenderness/ gynecomastia (eplerenone, ++specific to aldost-R, less
ADEs)
Hematospermia in pts younger than 40, next best step after examining testes and prostate -
ANS STD screen (no imaging, PSA levels, or referral to uro unless Hx or exam suggests
unusual cause)
