ABFM EXAM Questions
25-year-old male presents for a pretravel consultation prior to embarking on a 10-day mission trip to
Central America with his church. His past medical history includes GERD, irritable bowel syndrome, and
generalized anxiety disorder. The last time he traveled internationally he experienced a prolonged bout
of traveler's diarrhea, despite his best efforts at practicing good hand hygiene and careful food and drink
selection. He asks if there are any medications that he can take to prevent a similar experience this time.
Which one of the following is most appropriate for prophylactic use in this situation? - Answer-Bismuth
subsalicylate has been shown to decrease the risk of contracting traveler's diarrhea by 50%-65% and
may be considered for patients who are at increased risk. Drawbacks include the frequent dosing of four
times daily and the risk of developing a black tongue and black stool. Bismuth subsalicylate is
contraindicated in the setting of aspirin allergy, kidney disease, breastfeeding, or concurrent
anticoagulant use. Medications that decrease gastric acidity, such as proton pump inhibitors, H2-
blockers, and antacids, substantially increase one's risk of contracting traveler's diarrhea. Therefore,
avoiding calcium carbonate and omeprazole would be preferable for this patient. Prophylactic
antibiotics typically are not recommended in this situation although may be considered for those who
are at particularly high risk of health complications from a gastrointestinal illness. If a prophylactic
antibiotic is desired, rifaximin should be considered. Fluoroquinolones such as ciprofloxacin, however,
should be avoided for prophylactic use due to risks of inducing antibiotic resistance and causing central
nervous system side effects, QTc prolongation, medication interactions, and tendon injuries. Probiotics
have insufficient evidence of benefit for preventing traveler's diarrhea
facial swelling + dyspnea in a patient with non Hodgkin lymphoma, with Chest Xray notable for large
hilar mass; In addition to hospitalization what would be the most appropriate urgent next step? -
Answer-Radiation; This is an oncologic emergency with the patient presenting symptoms of superior
vena cava syndrome
After ensuring that the patient is hospitalized and stable, the initial treatment options include
intravenous corticosteroids, chemotherapy, radiation, and occasionally intravascular stenting.
What is hyperviscocity syndrome? - Answer-Hyperviscosity syndrome is an oncologic emergency
associated with leukemia, multiple myeloma, and Waldenström macroglobulinemia. It is treated with
chemotherapy and plasmapheresis
,What medications are involved in SMART therapy for asthma? - Answer-single maintenance and reliever
therapy (SMART) approach for asthma control, combination therapy with an inhaled corticosteroid and
a long-acting bronchodilator is used as both controller and rescue medication
Formoterol is the only medication available in the United States recommended for use in SMART
therapy due to its rapid onset of action (Budesonide/Formoterol, Symbicort)
What is an indication for long term rather than short term proton pump inhibitor therapy? - Answer-
Gastroprotection in users of high dose NSAIDs at high risk for GI bleeding
In 2022 the American Gastroenterological Association published 10 best practice statements to assist
clinicians in addressing this issue. Key recommendations include regular review and documentation of
the indication for any ongoing PPI use, and to consider discontinuing PPIs for any patient without a clear
indication.
Strategies for PPI discontinuation include tapering or abrupt discontinuation. Rebound acid
hypersecretion can lead to a temporary increase in symptoms in either approach. If deprescribing is
attempted but not tolerated, patients may reasonably be continued on the lowest effective dose
in, in some situations the benefits of PPIs do clearly outweigh the risks. Such indications include Barrett
esophagus, severe erosive esophagitis, eosinophilic esophagitis, and high risk for upper gastrointestinal
(GI) bleeding.
Risk factors for GI bleeding include prior ulcer, age >65, high-dose NSAID therapy, or concurrent use of
aspirin, corticosteroids, or anticoagulants. Such patients should be advised to use PPIs indefinitely.
Greatest risk factor for alzheimers? - Answer-age
, Most appropriate initial pharmacotherapy for a temoporomandibular disorder in an otherwise healthy
54 yo male? - Answer-The initial first-line pharmacologic therapy for temporomandibular disorders is
naproxen. Cyclobenzaprine may also be added if there is evidence of muscle spasm (A
recommendation). If this is unsuccessful, other options include a trial of amitriptyline or gabapentin.
Opioid therapy is not appropriate first-line treatment for temporomandibular disorders. Corticosteroid
injections should be avoided due to potential cartilage damage (B recommendation).
Most common causes of thyroiditis? - Answer-Thyroiditis, a general term for inflammation of the thyroid
gland, is associated with thyroid gland dysfunction. It is classified based on clinical symptoms: painless or
painful, acute or subacute, and underlying etiology (medication-induced, infection, radiation-induced, or
autoimmune). The most common forms of thyroiditis include Hashimoto, subacute, and postpartum.
Thyroiditis often results in a triphasic disease pattern of thyroid dysfunction: hyperthyroidism due to the
release of preformed thyroid hormone from damaged thyroid cells followed by hypothyroidism when
the thyroid stores are depleted. Eventually normal thyroid function is restored, or the patient develops
permanent hypothyroidism. This patient presents with symptoms commonly seen in thyroid disease.
Further testing reveals elevated TSH and thyroid peroxidase (TPO) levels. Elevated TPO levels are found
in 95% of patients with Hashimoto thyroiditis. In addition, this patient's family history includes
rheumatoid arthritis, another autoimmune disease, making Hashimoto thyroiditis the most likely
diagnosis. Treatment is lifelong thyroid hormone therapy
Elevated TPO levels are found in 95% of patients with what type of thyroiditis? - Answer-Hashimotos
What kinds of medications are linked to thyroiditis? - Answer-Several medications are linked to
thyroiditis, including lithium, amiodarone, interferon-alfa, interleukin-2, immune checkpoint inhibitors,
and tyrosine kinase inhibitors
When would post partum thyroiditis occur? - Answer-s. Postpartum thyroiditis occurs within 1 year of
delivery, miscarriage, or medical abortion, not 2-3 years
How do you treat subacute thyroiditis? - Answer-Subacute thyroiditis is self-limited and often occurs
after upper respiratory infections, causing thyroid pain and dysphagia due to inflammatory destruction
of thyroid follicles.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
25-year-old male presents for a pretravel consultation prior to embarking on a 10-day mission trip to
Central America with his church. His past medical history includes GERD, irritable bowel syndrome, and
generalized anxiety disorder. The last time he traveled internationally he experienced a prolonged bout
of traveler's diarrhea, despite his best efforts at practicing good hand hygiene and careful food and drink
selection. He asks if there are any medications that he can take to prevent a similar experience this time.
Which one of the following is most appropriate for prophylactic use in this situation? - Answer-Bismuth
subsalicylate has been shown to decrease the risk of contracting traveler's diarrhea by 50%-65% and
may be considered for patients who are at increased risk. Drawbacks include the frequent dosing of four
times daily and the risk of developing a black tongue and black stool. Bismuth subsalicylate is
contraindicated in the setting of aspirin allergy, kidney disease, breastfeeding, or concurrent
anticoagulant use. Medications that decrease gastric acidity, such as proton pump inhibitors, H2-
blockers, and antacids, substantially increase one's risk of contracting traveler's diarrhea. Therefore,
avoiding calcium carbonate and omeprazole would be preferable for this patient. Prophylactic
antibiotics typically are not recommended in this situation although may be considered for those who
are at particularly high risk of health complications from a gastrointestinal illness. If a prophylactic
antibiotic is desired, rifaximin should be considered. Fluoroquinolones such as ciprofloxacin, however,
should be avoided for prophylactic use due to risks of inducing antibiotic resistance and causing central
nervous system side effects, QTc prolongation, medication interactions, and tendon injuries. Probiotics
have insufficient evidence of benefit for preventing traveler's diarrhea
facial swelling + dyspnea in a patient with non Hodgkin lymphoma, with Chest Xray notable for large
hilar mass; In addition to hospitalization what would be the most appropriate urgent next step? -
Answer-Radiation; This is an oncologic emergency with the patient presenting symptoms of superior
vena cava syndrome
After ensuring that the patient is hospitalized and stable, the initial treatment options include
intravenous corticosteroids, chemotherapy, radiation, and occasionally intravascular stenting.
What is hyperviscocity syndrome? - Answer-Hyperviscosity syndrome is an oncologic emergency
associated with leukemia, multiple myeloma, and Waldenström macroglobulinemia. It is treated with
chemotherapy and plasmapheresis
,What medications are involved in SMART therapy for asthma? - Answer-single maintenance and reliever
therapy (SMART) approach for asthma control, combination therapy with an inhaled corticosteroid and
a long-acting bronchodilator is used as both controller and rescue medication
Formoterol is the only medication available in the United States recommended for use in SMART
therapy due to its rapid onset of action (Budesonide/Formoterol, Symbicort)
What is an indication for long term rather than short term proton pump inhibitor therapy? - Answer-
Gastroprotection in users of high dose NSAIDs at high risk for GI bleeding
In 2022 the American Gastroenterological Association published 10 best practice statements to assist
clinicians in addressing this issue. Key recommendations include regular review and documentation of
the indication for any ongoing PPI use, and to consider discontinuing PPIs for any patient without a clear
indication.
Strategies for PPI discontinuation include tapering or abrupt discontinuation. Rebound acid
hypersecretion can lead to a temporary increase in symptoms in either approach. If deprescribing is
attempted but not tolerated, patients may reasonably be continued on the lowest effective dose
in, in some situations the benefits of PPIs do clearly outweigh the risks. Such indications include Barrett
esophagus, severe erosive esophagitis, eosinophilic esophagitis, and high risk for upper gastrointestinal
(GI) bleeding.
Risk factors for GI bleeding include prior ulcer, age >65, high-dose NSAID therapy, or concurrent use of
aspirin, corticosteroids, or anticoagulants. Such patients should be advised to use PPIs indefinitely.
Greatest risk factor for alzheimers? - Answer-age
, Most appropriate initial pharmacotherapy for a temoporomandibular disorder in an otherwise healthy
54 yo male? - Answer-The initial first-line pharmacologic therapy for temporomandibular disorders is
naproxen. Cyclobenzaprine may also be added if there is evidence of muscle spasm (A
recommendation). If this is unsuccessful, other options include a trial of amitriptyline or gabapentin.
Opioid therapy is not appropriate first-line treatment for temporomandibular disorders. Corticosteroid
injections should be avoided due to potential cartilage damage (B recommendation).
Most common causes of thyroiditis? - Answer-Thyroiditis, a general term for inflammation of the thyroid
gland, is associated with thyroid gland dysfunction. It is classified based on clinical symptoms: painless or
painful, acute or subacute, and underlying etiology (medication-induced, infection, radiation-induced, or
autoimmune). The most common forms of thyroiditis include Hashimoto, subacute, and postpartum.
Thyroiditis often results in a triphasic disease pattern of thyroid dysfunction: hyperthyroidism due to the
release of preformed thyroid hormone from damaged thyroid cells followed by hypothyroidism when
the thyroid stores are depleted. Eventually normal thyroid function is restored, or the patient develops
permanent hypothyroidism. This patient presents with symptoms commonly seen in thyroid disease.
Further testing reveals elevated TSH and thyroid peroxidase (TPO) levels. Elevated TPO levels are found
in 95% of patients with Hashimoto thyroiditis. In addition, this patient's family history includes
rheumatoid arthritis, another autoimmune disease, making Hashimoto thyroiditis the most likely
diagnosis. Treatment is lifelong thyroid hormone therapy
Elevated TPO levels are found in 95% of patients with what type of thyroiditis? - Answer-Hashimotos
What kinds of medications are linked to thyroiditis? - Answer-Several medications are linked to
thyroiditis, including lithium, amiodarone, interferon-alfa, interleukin-2, immune checkpoint inhibitors,
and tyrosine kinase inhibitors
When would post partum thyroiditis occur? - Answer-s. Postpartum thyroiditis occurs within 1 year of
delivery, miscarriage, or medical abortion, not 2-3 years
How do you treat subacute thyroiditis? - Answer-Subacute thyroiditis is self-limited and often occurs
after upper respiratory infections, causing thyroid pain and dysphagia due to inflammatory destruction
of thyroid follicles.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
