ABFM 2025/2026 Questions || Final Exam Edition:
Pass with A+ Accuracy!!
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? correct answers 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? correct answers 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? correct answers 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? correct answers 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?
correct answers 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? correct answers age
Most appropriate initial pharmacotherapy for a temoporomandibular disorder in an otherwise
healthy 54 yo male? correct answers 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? correct answers 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? correct
answers Hashimotos
What kinds of medications are linked to thyroiditis? correct answers 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? correct answers s. Postpartum thyroiditis occurs
within 1 year of delivery, miscarriage, or medical abortion, not 2-3 years
How do you treat subacute thyroiditis? correct answers 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)
Sometimes corticosteroids, a beta-blocker, or both
Mild discomfort (eg, sore throat, mild neck tenderness, muscle aches, low-grade fever) is
treated with high doses of aspirin or NSAIDs. In moderately or severely symptomatic cases
(eg, high fever, tachycardia, shortness of breath), corticosteroids (eg, prednisone 15 to 30 mg
orally once a day, gradually decreasing the dose over 3 to 4 weeks) eradicate all symptoms
within 48 hours.
Bothersome symptoms of hyperthyroidism may be treated with a short course of a beta-
blocker. If hypothyroidism is pronounced or persists, thyroid hormone replacement therapy
may be required, rarely permanently.
testicular cancer screening? correct answers Although testicular cancer is the most common
solid cancer in men ages 15-34, with effective treatment and an overall survival rate of 97%,
the U.S. Preventive Services Task Force recommends against screening for testicular cancer
in asymptomatic adolescent or adult males (D recommendation). A detailed history and
physical examination should be obtained in symptomatic patients, followed by scrotal
ultrasonography if there are positive findings on history and physical examination. Tumor
markers and CT of the abdomen and pelvis are required for staging, treatment
recommendations, and surveillance, but not for screening purposes.
82-year-old female in your palliative care service who has stage 4 breast cancer is
experiencing frequent episodes of delirium. Her pain is well controlled on long-acting oral
opioid therapy. Additionally, no other reversible causes of delirium are noted. Her delirium is
not responding to conservative measures, and her family asks if there are any medications
that can effectively manage her symptoms? correct answers The first step in managing
delirium in end-of-life care is to assess for any reversible or treatable causes, including
uncontrolled pain, constipation, urinary retention, infections (e.g., urinary tract infections),
and medication side effects. Antipsychotic medications, such as haloperidol and risperidone,
are recommended if conservative measures fail to control the symptoms of delirium.
Benzodiazepines should be used with caution as they can worsen delirium, especially in older
patients. Melatonin is not indicated in the management of delirium
Black female presents with multiple insect bites on her arms and legs. This patient is at risk
for developing which one of the following conditions? correct answers Patients with dark
skin are at greater risk for postinflammatory hyperpigmentation, a reactive hypermelanosis.
These are irregular hyperpigmented macules or patches that can occur after endogenous
inflammation (e.g., acne vulgaris, pseudofolliculitis barbae, atopic dermatitis, lichen planus,
psoriasis, contact dermatitis) and external injuries (e.g., insect bites, chemical peels,
cryotherapy, laser surgery). This condition can occur at any age and is particularly noticeable
in Fitzpatrick skin phototypes III, IV, V, and VI. Fitzpatrick skin phototype is used to classify
the skin color spectrum and is based on an individual's propensity for sunburn
(photodermatitis). It is not a surrogate marker for race or ethnicity. Broad-spectrum, water-
based sunscreen with SPF 30 should be used to prevent postinflammatory hyperpigmentation
Pass with A+ Accuracy!!
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? correct answers 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? correct answers 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? correct answers 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? correct answers 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?
correct answers 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? correct answers age
Most appropriate initial pharmacotherapy for a temoporomandibular disorder in an otherwise
healthy 54 yo male? correct answers 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? correct answers 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? correct
answers Hashimotos
What kinds of medications are linked to thyroiditis? correct answers 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? correct answers s. Postpartum thyroiditis occurs
within 1 year of delivery, miscarriage, or medical abortion, not 2-3 years
How do you treat subacute thyroiditis? correct answers 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)
Sometimes corticosteroids, a beta-blocker, or both
Mild discomfort (eg, sore throat, mild neck tenderness, muscle aches, low-grade fever) is
treated with high doses of aspirin or NSAIDs. In moderately or severely symptomatic cases
(eg, high fever, tachycardia, shortness of breath), corticosteroids (eg, prednisone 15 to 30 mg
orally once a day, gradually decreasing the dose over 3 to 4 weeks) eradicate all symptoms
within 48 hours.
Bothersome symptoms of hyperthyroidism may be treated with a short course of a beta-
blocker. If hypothyroidism is pronounced or persists, thyroid hormone replacement therapy
may be required, rarely permanently.
testicular cancer screening? correct answers Although testicular cancer is the most common
solid cancer in men ages 15-34, with effective treatment and an overall survival rate of 97%,
the U.S. Preventive Services Task Force recommends against screening for testicular cancer
in asymptomatic adolescent or adult males (D recommendation). A detailed history and
physical examination should be obtained in symptomatic patients, followed by scrotal
ultrasonography if there are positive findings on history and physical examination. Tumor
markers and CT of the abdomen and pelvis are required for staging, treatment
recommendations, and surveillance, but not for screening purposes.
82-year-old female in your palliative care service who has stage 4 breast cancer is
experiencing frequent episodes of delirium. Her pain is well controlled on long-acting oral
opioid therapy. Additionally, no other reversible causes of delirium are noted. Her delirium is
not responding to conservative measures, and her family asks if there are any medications
that can effectively manage her symptoms? correct answers The first step in managing
delirium in end-of-life care is to assess for any reversible or treatable causes, including
uncontrolled pain, constipation, urinary retention, infections (e.g., urinary tract infections),
and medication side effects. Antipsychotic medications, such as haloperidol and risperidone,
are recommended if conservative measures fail to control the symptoms of delirium.
Benzodiazepines should be used with caution as they can worsen delirium, especially in older
patients. Melatonin is not indicated in the management of delirium
Black female presents with multiple insect bites on her arms and legs. This patient is at risk
for developing which one of the following conditions? correct answers Patients with dark
skin are at greater risk for postinflammatory hyperpigmentation, a reactive hypermelanosis.
These are irregular hyperpigmented macules or patches that can occur after endogenous
inflammation (e.g., acne vulgaris, pseudofolliculitis barbae, atopic dermatitis, lichen planus,
psoriasis, contact dermatitis) and external injuries (e.g., insect bites, chemical peels,
cryotherapy, laser surgery). This condition can occur at any age and is particularly noticeable
in Fitzpatrick skin phototypes III, IV, V, and VI. Fitzpatrick skin phototype is used to classify
the skin color spectrum and is based on an individual's propensity for sunburn
(photodermatitis). It is not a surrogate marker for race or ethnicity. Broad-spectrum, water-
based sunscreen with SPF 30 should be used to prevent postinflammatory hyperpigmentation
