ABFM ITE EXAM STUDY GUIDE QUESTIONS AND
ANSWERS VERIFIED 100% CORRECT| Well
Explained|
1. You perform the initial newborn examination on a male on his first day of life,
following an uncomplicated vaginal delivery at an estimated gestational age of 37
weeks and 6 days. The prenatal course was significant for the initial presentation
for prenatal care at 22 weeks gestation. You note that the infant's upper lip is thin
and the philtrum is somewhat flat.
Which additional finding would increase your concern for fetal alcohol syndrome?
A) Curvature of the fifth digit of the hand (clinodactyly)
B) A supernumerary digit of the hand
C) Flattening of the head (plagiocephaly)
D) Metatarsus adductus in one foot
E) Syndactyly of the toes (webbed feet) - ANSWER -ANSWER: A
In addition to clinodactyly, fetal alcohol syndrome is associated with
camptodactyly (flexion deformity of the fingers), other flexion contractures,
radioulnar synostosis, scoliosis, and spinal malformations. It is also associated with
many neurologic, behavioral, and cardiovascular abnormalities, as well as other
types of abnormalities. Plagiocephaly, supernumerary digits, syndactyly, and
metatarsus adductus are common in newborns but are not related to fetal alcohol
spectrum disorders.
2. An otherwise healthy 3-year-old child with no allergies is found to have otitis
media with effusion in the right ear. Which one of the following would you
recommend?
A) No treatment, and follow-up in 3 months
B) Amoxicillin
C) Oral antihistamines
D) Nasal corticosteroids
E) Tympanostomy tube placement - ANSWER -ANSWER: A
This child has otitis media with effusion, and the recommended course of action is
to follow up in 3 months. Medications, including decongestants, antihistamines,
antibiotics, and corticosteroids, are not recommended.
, 3. A 32-year-old male presents with a 4-week history of persistent low back pain.
He started feeling tightness in his low back after helping a friend move into a new
apartment. The pain does not radiate, there is no associated paresthesia or
numbness, and he has not had any bowel or bladder incontinence. The pain is
constant and worsens with prolonged sitting. He rates the pain as 6 on a scale of
10. Ibuprofen has provided minimal relief.
Examination of the lumbar area over the paraspinous muscles reveals minimal
tenderness. A neurovascular examination and a straight leg raise are normal in both
lower extremities.
Which one of the following would be most appropriate at this point?
A) Imaging studies of the lumbar spine
B) A short course of an oral corticosteroid
C) Gabapentin (Neurontin) started at a low dose and titrated to effect
D) A skeletal muscle relaxant and an NSAID
E) A short-acting opioid and an NSAID - ANSWER -ANSWER: D
This patient has acute to subacute nonspecific low back pain. Combination
treatment with an NSAID and a skeletal muscle relaxant is recommended as
second-line therapy when an NSAID is ineffective as monotherapy. Opioids have
not been shown to have significant benefit when added to an NSAID and would
not be recommended as a second-line treatment. Systemic corticosteroids do not
have evidence to support their use in the treatment of acute nonspecific back pain.
Gabapentin does not have evidence to support its use in treating acute back pain
and has been shown to produce only minimal improvement in chronic back pain.
This patient has no red-flag symptoms so imaging studies are not recommended at
this time.
4. A 48-year-old female with GERD treated with a proton pump inhibitor for the
past 2 years sees you for a routine visit. She reports that she has paresthesia and
numbness in both feet. Her hemoglobin A1c is 5.8%, her hemoglobin level is 10.4
g/dL (N 12.0-16.0), and her mean corpuscular volume is 102 m3 (N 81-99).
Microfilament testing shows decreased sensation in both feet.
Which one of the following is the most likely cause of her peripheral neuropathy?
A) Charcot-Marie-Tooth disease
B) Diabetic peripheral neuropathy
C) Hyperthyroidism
D) Tarsal tunnel syndrome
E) Vitamin B12 deficiency - ANSWER -ANSWER: E
,This patient has polyneuropathy, macrocytic anemia, and a history of chronic
proton pump inhibitor use.
The most likely cause is vitamin B12 deficiency and a serum level is indicated. Her
hemoglobin A1c is
5.8%, which puts her at risk of developing diabetes mellitus but is not indicative of
diabetes.
Charcot-Marie-Tooth disease is a rare cause of polyneuropathy and unlikely in this
case. Hypothyroidism,
and not hyperthyroidism,
5. A 60-year-old male presents with a several-month history of a dry cough and
progressive shortness of breath with exertion. On examination he has tachypnea
and bibasilar end-inspiratory dry crackles, and a chest radiograph reveals
interstitial opacities.
Which one of the following patient occupations would most likely support a
diagnosis of silicosis?
A) Baker
B) Firefighter
C) Stone cutter
D) Goat dairy farmer
E) High-tech electronics fabricator - ANSWER -ANSWER: C
Family physicians should be aware of the environmental exposures associated with
pulmonary disease.
Stone cutting, sand blasting, mining, and quarrying expose patients to silica, which
is an inorganic dust
that causes pulmonary fibrosis (silicosis). Occupational exposure to beryllium,
which is also an inorganic
dust, occurs in the high-tech electronics manufacturing industry and results in
chronic beryllium lung
disease. Exposure to organic agricultural dusts (fungal spores, vegetable products,
insect fragments, animal
dander, animal feces, microorganisms, and pollens) can result in "farmer's lung," a
hypersensitivity
pneumonitis. Other organic dust exposures, such as exposures to grain dust in
bakers, can lead to asthma,
chronic bronchitis, and COPD. Firefighters are at risk of smoke inhalation and are
exposed to toxic
chemicals that can cause many acute and chronic respiratory symptoms.
, 6. A 28-year-old female presents with a 3-month history of fatigue and postural
lightheadedness. On examination she is diffusely hyperpigmented, especially her
skin creases and areolae. A CBC and basic metabolic panel are normal except for
an elevated potassium level. You order a corticotropin stimulation test.
Prior to the corticotropin injection, you should order which one of the following
tests to confirm that this patient has a primary insufficiency and not a secondary
(pituitary) disorder?
A) ACTH
B) Aldosterone
C) Melanocyte-stimulating hormone
D) Renin
E) TSH - ANSWER -ANSWER: A
A plasma ACTH level is recommended to establish primary adrenal insufficiency.
The sample can be
obtained at the same time as the baseline sample in the corticotropin test. A plasma
ACTH greater than
twice the upper limit of the reference range is consistent with primary adrenal
insufficiency. Aldosterone
and renin levels should be obtained to establish the presence of adrenocortical
insufficiency, but these do
not differentiate primary from secondary adrenal insufficiency. The
hyperpigmentation of Addison's
disease is caused by the melanocyte-stimulating hormone (MSH)-like effect of the
elevated plasma levels
of ACTH. ACTH shares some amino acids with MSH and also produces an
increase in MSH in the blood.
TSH is not part of the feedback loop of adrenal insufficiency.
7. You see a 3-year-old female with a 2-day history of intermittent abdominal
cramps, two episodes of emesis yesterday, and about five watery, nonbloody stools
each day. She does not have a fever, her other vital signs are normal, and she has
not traveled recently. Today she has tolerated sips of fluid but still has mild fatigue
and thirst. An examination is normal except for mildly dry lips. A friend at
preschool had a similar illness recently.
Which one of the following would be the most appropriate initial management of
this patient?
A) A sports drink and food on demand
B) Half-strength apple juice and food on demand
ANSWERS VERIFIED 100% CORRECT| Well
Explained|
1. You perform the initial newborn examination on a male on his first day of life,
following an uncomplicated vaginal delivery at an estimated gestational age of 37
weeks and 6 days. The prenatal course was significant for the initial presentation
for prenatal care at 22 weeks gestation. You note that the infant's upper lip is thin
and the philtrum is somewhat flat.
Which additional finding would increase your concern for fetal alcohol syndrome?
A) Curvature of the fifth digit of the hand (clinodactyly)
B) A supernumerary digit of the hand
C) Flattening of the head (plagiocephaly)
D) Metatarsus adductus in one foot
E) Syndactyly of the toes (webbed feet) - ANSWER -ANSWER: A
In addition to clinodactyly, fetal alcohol syndrome is associated with
camptodactyly (flexion deformity of the fingers), other flexion contractures,
radioulnar synostosis, scoliosis, and spinal malformations. It is also associated with
many neurologic, behavioral, and cardiovascular abnormalities, as well as other
types of abnormalities. Plagiocephaly, supernumerary digits, syndactyly, and
metatarsus adductus are common in newborns but are not related to fetal alcohol
spectrum disorders.
2. An otherwise healthy 3-year-old child with no allergies is found to have otitis
media with effusion in the right ear. Which one of the following would you
recommend?
A) No treatment, and follow-up in 3 months
B) Amoxicillin
C) Oral antihistamines
D) Nasal corticosteroids
E) Tympanostomy tube placement - ANSWER -ANSWER: A
This child has otitis media with effusion, and the recommended course of action is
to follow up in 3 months. Medications, including decongestants, antihistamines,
antibiotics, and corticosteroids, are not recommended.
, 3. A 32-year-old male presents with a 4-week history of persistent low back pain.
He started feeling tightness in his low back after helping a friend move into a new
apartment. The pain does not radiate, there is no associated paresthesia or
numbness, and he has not had any bowel or bladder incontinence. The pain is
constant and worsens with prolonged sitting. He rates the pain as 6 on a scale of
10. Ibuprofen has provided minimal relief.
Examination of the lumbar area over the paraspinous muscles reveals minimal
tenderness. A neurovascular examination and a straight leg raise are normal in both
lower extremities.
Which one of the following would be most appropriate at this point?
A) Imaging studies of the lumbar spine
B) A short course of an oral corticosteroid
C) Gabapentin (Neurontin) started at a low dose and titrated to effect
D) A skeletal muscle relaxant and an NSAID
E) A short-acting opioid and an NSAID - ANSWER -ANSWER: D
This patient has acute to subacute nonspecific low back pain. Combination
treatment with an NSAID and a skeletal muscle relaxant is recommended as
second-line therapy when an NSAID is ineffective as monotherapy. Opioids have
not been shown to have significant benefit when added to an NSAID and would
not be recommended as a second-line treatment. Systemic corticosteroids do not
have evidence to support their use in the treatment of acute nonspecific back pain.
Gabapentin does not have evidence to support its use in treating acute back pain
and has been shown to produce only minimal improvement in chronic back pain.
This patient has no red-flag symptoms so imaging studies are not recommended at
this time.
4. A 48-year-old female with GERD treated with a proton pump inhibitor for the
past 2 years sees you for a routine visit. She reports that she has paresthesia and
numbness in both feet. Her hemoglobin A1c is 5.8%, her hemoglobin level is 10.4
g/dL (N 12.0-16.0), and her mean corpuscular volume is 102 m3 (N 81-99).
Microfilament testing shows decreased sensation in both feet.
Which one of the following is the most likely cause of her peripheral neuropathy?
A) Charcot-Marie-Tooth disease
B) Diabetic peripheral neuropathy
C) Hyperthyroidism
D) Tarsal tunnel syndrome
E) Vitamin B12 deficiency - ANSWER -ANSWER: E
,This patient has polyneuropathy, macrocytic anemia, and a history of chronic
proton pump inhibitor use.
The most likely cause is vitamin B12 deficiency and a serum level is indicated. Her
hemoglobin A1c is
5.8%, which puts her at risk of developing diabetes mellitus but is not indicative of
diabetes.
Charcot-Marie-Tooth disease is a rare cause of polyneuropathy and unlikely in this
case. Hypothyroidism,
and not hyperthyroidism,
5. A 60-year-old male presents with a several-month history of a dry cough and
progressive shortness of breath with exertion. On examination he has tachypnea
and bibasilar end-inspiratory dry crackles, and a chest radiograph reveals
interstitial opacities.
Which one of the following patient occupations would most likely support a
diagnosis of silicosis?
A) Baker
B) Firefighter
C) Stone cutter
D) Goat dairy farmer
E) High-tech electronics fabricator - ANSWER -ANSWER: C
Family physicians should be aware of the environmental exposures associated with
pulmonary disease.
Stone cutting, sand blasting, mining, and quarrying expose patients to silica, which
is an inorganic dust
that causes pulmonary fibrosis (silicosis). Occupational exposure to beryllium,
which is also an inorganic
dust, occurs in the high-tech electronics manufacturing industry and results in
chronic beryllium lung
disease. Exposure to organic agricultural dusts (fungal spores, vegetable products,
insect fragments, animal
dander, animal feces, microorganisms, and pollens) can result in "farmer's lung," a
hypersensitivity
pneumonitis. Other organic dust exposures, such as exposures to grain dust in
bakers, can lead to asthma,
chronic bronchitis, and COPD. Firefighters are at risk of smoke inhalation and are
exposed to toxic
chemicals that can cause many acute and chronic respiratory symptoms.
, 6. A 28-year-old female presents with a 3-month history of fatigue and postural
lightheadedness. On examination she is diffusely hyperpigmented, especially her
skin creases and areolae. A CBC and basic metabolic panel are normal except for
an elevated potassium level. You order a corticotropin stimulation test.
Prior to the corticotropin injection, you should order which one of the following
tests to confirm that this patient has a primary insufficiency and not a secondary
(pituitary) disorder?
A) ACTH
B) Aldosterone
C) Melanocyte-stimulating hormone
D) Renin
E) TSH - ANSWER -ANSWER: A
A plasma ACTH level is recommended to establish primary adrenal insufficiency.
The sample can be
obtained at the same time as the baseline sample in the corticotropin test. A plasma
ACTH greater than
twice the upper limit of the reference range is consistent with primary adrenal
insufficiency. Aldosterone
and renin levels should be obtained to establish the presence of adrenocortical
insufficiency, but these do
not differentiate primary from secondary adrenal insufficiency. The
hyperpigmentation of Addison's
disease is caused by the melanocyte-stimulating hormone (MSH)-like effect of the
elevated plasma levels
of ACTH. ACTH shares some amino acids with MSH and also produces an
increase in MSH in the blood.
TSH is not part of the feedback loop of adrenal insufficiency.
7. You see a 3-year-old female with a 2-day history of intermittent abdominal
cramps, two episodes of emesis yesterday, and about five watery, nonbloody stools
each day. She does not have a fever, her other vital signs are normal, and she has
not traveled recently. Today she has tolerated sips of fluid but still has mild fatigue
and thirst. An examination is normal except for mildly dry lips. A friend at
preschool had a similar illness recently.
Which one of the following would be the most appropriate initial management of
this patient?
A) A sports drink and food on demand
B) Half-strength apple juice and food on demand
