1|Page
ABFM CKSA 22-23, STUDY GUIDE WITH
COMPLETE SOLUTIONS
A 43-year-old female presents to your office with a 3-month history of left low
back and posterior hip pain. She does not recall an injury but says she was very
active during a move to a new home prior to the onset of the pain. An
examination reveals that her gait, lower extremity strength, and hip and knee
range of motion are normal. A straight leg raising test is negative, and a log roll
test is also normal. A flexion, abduction, and external rotation (FABER) test
produces pain in the low back area. Which one of the following is the most likely
diagnosis?
A) Femoroacetabular impingement
B) Greater trochanteric pain syndrome
C) Osteoarthritis
D) Piriformis syndrome
E) Sacroiliac joint dysfunction -correct-answer-ANSWER: E
The cause of hip pain is generally determined from the patient's history and a
physical examination. A positive flexion, abduction, and external rotation (FABER)
test that produces pain at the sacroiliac joint, lumbar spine, and posterior hip is
associated with sacroiliac joint dysfunction.
The log roll test involves passive supine internal and external rotation of the hip.
When this test is positive for pain it is associated with hip joint disease. While
,2|Page
femoroacetabular impingement may be associated with a positive FABER test, it
would produce pain in the groin, not the low back.
Greater trochanteric pain syndrome results in lateral hip pain rather than
posterior hip pain.
Osteoarthritis is usually associated with a limited range of motion and groin pain.
Piriformis syndrome is evaluated with the seated piriformis stretch test.
A 4-year-old male is brought to your office by his maternal aunt, who is his new
guardian. She is concerned that he is exhibiting problems with behavior and
attention. On examination you note long, wide, protruding ears, an elongated
face, and frontal bossing. Which one of the following is the most likely cause of
these dysmorphic features?
A) Angelman syndrome
B) Fragile X syndrome
C) Klinefelter syndrome
D) Marfan syndrome
E) Prader-Willi syndrome -correct-answer-ANSWER: B
The prepubescent male child with fragile X syndrome can be recognized by large
ears, an elongated face, macrocephaly, or frontal bossing. Other features of fragile
X syndrome include increased risk for chronic otitis media, esotropia,
hyperextensible finger joints, high-arched palate, low muscle tone, and,
,3|Page
occasionally, seizures. This presentation can be subtle in young children, with an
average age at diagnosis of 8 years. After puberty, a prominent jaw and macro-
orchidism are characteristic. Behavioral aspects seen may include poor eye
contact, excessive shyness, anxiety, hand flapping, hand biting, aggression, tactile
defensiveness, attention deficits, hyperactivity, impulsivity, hyperarousal to
sensory stimuli, and autism spectrum disorder.
Facial dysmorphic features associated with Angelman syndrome include
microbrachycephaly, maxillary hypoplasia, a large mouth, and prognathism.
Prepubescent boys with Klinefelter syndrome do not have facial dysmorphic
features. They appear similar to prepubescent boys with normal karyotypes.
Although a child with Marfan syndrome has an elongated face, the frontal bossing
and large ears are not characteristic of that condition. Facial dysmorphic features
associated with Prader-Willi syndrome include a narrow distance between the
temples, almond-shaped eyes, and a thin upper lip.
A 46-year-old runner presents with left heel pain that has been occurring mostly
while running, but more recently also with walking. On examination there is
tenderness and a palpable nodule on the mid-substance of the left Achilles
tendon. Which one of the following is the best therapeutic option for initial
treatment?
A) Oral NSAIDs
B) Eccentric calf muscle contraction exercises
C) Corticosteroid injection of the Achilles tendon sheath
D) Surgical debridement or excision of the tendon nodule
E) Immobilization in a walking boot for 30-60 days -correct-answer-ANSWER: B
, 4|Page
Achilles tendinopathy is among the most common injuries in middle-aged distance
runners, and the most effective treatment overall is exercise rehabilitation.
Achilles tendon injuries can be separated into insertional tendinopathy (about
25% of injuries), midportion tendinopathy (about 50% of injuries), and proximal
musculotendinous junction (about 25% of injuries). Recovery from Achilles
tendinopathy may take up to a year, especially if treatment is delayed or reinjury
occurs. Various Achilles tendon loading programs are recommended. Complete
rest can be detrimental and prolong recovery, and immobilization is not
recommended. Historically, eccentric muscle contractions have been used, but
protocols involving isolated concentric or combination concentric and eccentric
contractions have also produced benefit. More recently, isometric exercise has
been recommended as the initial treatment for tendinopathy, so contraction and
movement of the muscle seems to be the key.
Oral NSAIDs may be helpful for temporary pain relief, but they contribute little to
recovery from this injury. Corticosteroid injection into the peritendinous space has
little evidence of benefit and is associated with a risk of tendon rupture. Surgical
debridement may be considered as a last resort for difficult cases.
A 75-year-old patient is admitted to the hospital. The Joint Commission National
Patient Safety Goals program requires medication reconciliation for this patient
both on admission and at the time of discharge. The primary intent of this
reconciliation is to detect:
A. potentially inappropriate medication use in the elderly
B. high-risk medication use
C. medication discrepancies
ABFM CKSA 22-23, STUDY GUIDE WITH
COMPLETE SOLUTIONS
A 43-year-old female presents to your office with a 3-month history of left low
back and posterior hip pain. She does not recall an injury but says she was very
active during a move to a new home prior to the onset of the pain. An
examination reveals that her gait, lower extremity strength, and hip and knee
range of motion are normal. A straight leg raising test is negative, and a log roll
test is also normal. A flexion, abduction, and external rotation (FABER) test
produces pain in the low back area. Which one of the following is the most likely
diagnosis?
A) Femoroacetabular impingement
B) Greater trochanteric pain syndrome
C) Osteoarthritis
D) Piriformis syndrome
E) Sacroiliac joint dysfunction -correct-answer-ANSWER: E
The cause of hip pain is generally determined from the patient's history and a
physical examination. A positive flexion, abduction, and external rotation (FABER)
test that produces pain at the sacroiliac joint, lumbar spine, and posterior hip is
associated with sacroiliac joint dysfunction.
The log roll test involves passive supine internal and external rotation of the hip.
When this test is positive for pain it is associated with hip joint disease. While
,2|Page
femoroacetabular impingement may be associated with a positive FABER test, it
would produce pain in the groin, not the low back.
Greater trochanteric pain syndrome results in lateral hip pain rather than
posterior hip pain.
Osteoarthritis is usually associated with a limited range of motion and groin pain.
Piriformis syndrome is evaluated with the seated piriformis stretch test.
A 4-year-old male is brought to your office by his maternal aunt, who is his new
guardian. She is concerned that he is exhibiting problems with behavior and
attention. On examination you note long, wide, protruding ears, an elongated
face, and frontal bossing. Which one of the following is the most likely cause of
these dysmorphic features?
A) Angelman syndrome
B) Fragile X syndrome
C) Klinefelter syndrome
D) Marfan syndrome
E) Prader-Willi syndrome -correct-answer-ANSWER: B
The prepubescent male child with fragile X syndrome can be recognized by large
ears, an elongated face, macrocephaly, or frontal bossing. Other features of fragile
X syndrome include increased risk for chronic otitis media, esotropia,
hyperextensible finger joints, high-arched palate, low muscle tone, and,
,3|Page
occasionally, seizures. This presentation can be subtle in young children, with an
average age at diagnosis of 8 years. After puberty, a prominent jaw and macro-
orchidism are characteristic. Behavioral aspects seen may include poor eye
contact, excessive shyness, anxiety, hand flapping, hand biting, aggression, tactile
defensiveness, attention deficits, hyperactivity, impulsivity, hyperarousal to
sensory stimuli, and autism spectrum disorder.
Facial dysmorphic features associated with Angelman syndrome include
microbrachycephaly, maxillary hypoplasia, a large mouth, and prognathism.
Prepubescent boys with Klinefelter syndrome do not have facial dysmorphic
features. They appear similar to prepubescent boys with normal karyotypes.
Although a child with Marfan syndrome has an elongated face, the frontal bossing
and large ears are not characteristic of that condition. Facial dysmorphic features
associated with Prader-Willi syndrome include a narrow distance between the
temples, almond-shaped eyes, and a thin upper lip.
A 46-year-old runner presents with left heel pain that has been occurring mostly
while running, but more recently also with walking. On examination there is
tenderness and a palpable nodule on the mid-substance of the left Achilles
tendon. Which one of the following is the best therapeutic option for initial
treatment?
A) Oral NSAIDs
B) Eccentric calf muscle contraction exercises
C) Corticosteroid injection of the Achilles tendon sheath
D) Surgical debridement or excision of the tendon nodule
E) Immobilization in a walking boot for 30-60 days -correct-answer-ANSWER: B
, 4|Page
Achilles tendinopathy is among the most common injuries in middle-aged distance
runners, and the most effective treatment overall is exercise rehabilitation.
Achilles tendon injuries can be separated into insertional tendinopathy (about
25% of injuries), midportion tendinopathy (about 50% of injuries), and proximal
musculotendinous junction (about 25% of injuries). Recovery from Achilles
tendinopathy may take up to a year, especially if treatment is delayed or reinjury
occurs. Various Achilles tendon loading programs are recommended. Complete
rest can be detrimental and prolong recovery, and immobilization is not
recommended. Historically, eccentric muscle contractions have been used, but
protocols involving isolated concentric or combination concentric and eccentric
contractions have also produced benefit. More recently, isometric exercise has
been recommended as the initial treatment for tendinopathy, so contraction and
movement of the muscle seems to be the key.
Oral NSAIDs may be helpful for temporary pain relief, but they contribute little to
recovery from this injury. Corticosteroid injection into the peritendinous space has
little evidence of benefit and is associated with a risk of tendon rupture. Surgical
debridement may be considered as a last resort for difficult cases.
A 75-year-old patient is admitted to the hospital. The Joint Commission National
Patient Safety Goals program requires medication reconciliation for this patient
both on admission and at the time of discharge. The primary intent of this
reconciliation is to detect:
A. potentially inappropriate medication use in the elderly
B. high-risk medication use
C. medication discrepancies
