ABFM TEST BANK 2026 SOLVED QUESTIONS
AND EXAM SCRIPT FULL SOLUTION
▶ A 48-year-old male with a history of type 2 diabetes, obesity, and
tobacco use disorder presents to your office for evaluation of a 4-day
history of fever, malaise, and a productive cough. He smokes a half-pack of
cigarettes per day but does not use recreational drugs or drink alcohol in
excess. He has no known medication allergies. Aside from a temperature
of 38.2°C (100.8°F) and a BMI of 32 kg/m2 , his vital signs, including
oxygen saturation, are normal. On physical examination he appears mildly
ill although well hydrated and is breathing comfortably. Lung auscultation
reveals focal right-sided crackles and decreased breath sounds. Which one
of the following oral treatment options would be best in this situation?.
Answer: This patient presents with symptoms and examination findings that
are consistent with community-acquired pneumonia (CAP) with significant
medical comorbidity, and he is stable for outpatient treatment. Medical
comorbidities in this context include chronic heart, lung, liver, or kidney
disease; diabetes mellitus; alcohol use disorder; cancer; or asplenia. One
option for treatment in this situation is monotherapy with a respiratory
fluoroquinolone, such as levofloxacin or moxifloxacin. Other options for
outpatient treatment of CAP in adults with comorbidities include either the -
lactam amoxicillin/clavulanate or a cephalosporin (specifically cefpodoxime,
a third-generation cephalosporin, or cefuroxime, a second-generation
cephalosporin), in combination with either doxycycline or a macrolide (SOR
A). Of the available choices, only amoxicillin/clavulanate plus azithromycin
would provide the appropriate spectrum of antimicrobial coverage.
Amoxicillin or doxycycline monotherapy would be appropriate outpatient
CAP treatment for an adult without a significant medical comorbidity.
Another option in such a case is a macrolide such as azithromycin if the
local pneumococcal resistance rate to macrolides is known to be less than
25% (SOR B). Oral cefuroxime would be appropriate in combination with
either doxycycline or azithromycin in this scenario, but it would not provide
broad enough coverage as monotherapy. Sulfamethoxazole/trimethoprim
has encountered increasing pneumococcal resistance over the past several
decades and therefore does not factor into current management for CAP,
either alone or in combination with cephalexin, a first-generation
,cephalosporin that provides coverage against skin flora but not against
typical CAP pathogens
▶ healthy 78-year-old female with no history of osteoporosis has a family
history of hip fracture. Bone density screening reveals a lumbar T-score of -
2.0 and a right hip T-score of -1.5. Her FRAX score is calculated at a 20%
risk of major osteoporotic fracture and an 11% risk of hip fracture. She is
concerned about the possibility of breaking her hip. Which one of the
following interventions would be most appropriate?. Answer: National
Osteoporosis Foundation supports treatment of postmenopausal women
with low bone mass and a 10-year risk >20% for any major fracture or 3%
for hip fracture. First-line treatment options include bisphosphonates
(alendronate, ibandronate, risedronate, and zoledronic acid), teriparatide,
and denosumab. These medications are considered first line due to their
proven efficacy in reducing both hip and vertebral fractures. Hormonal
treatment such as raloxifene and hormone replacement therapy is not
recommended as first-line treatment due to associated risk and side effects
as well as lack of evidence supporting efficacy in preventing hip fractures.
Women with a 10-year fracture risk <20% but who have osteopenia and/or
risk factors for bone loss can be monitored with periodic bone density
scans, though the optimal intervals for repeat evaluation have not been
definitively established.
▶ Which one of the following tests has the highest negative predictive
value to rule out celiac disease?. Answer: The likelihood that a person who
has a negative test result indeed does not have the disease, condition,
biomarker, or mutation (change) in the gene being tested. The negative
predictive value is a way of measuring how accurate a specific test is. Also
called NPV
Celiac disease occurs almost exclusively in people with HLA-DQ2 or HLA-
DQ8 genotypes. Though not routinely performed, a negative result has
more than a 99% negative predictive value for the disease.
A positive IgA tissue transglutaminase (tTG) antibody test is helpful in
making a diagnosis if symptoms are present and has 95% sensitivity and
specificity for active disease, but a negative IgA tTG test does not rule out
future risk. A negative antigliadin antibody test has lower sensitivity and
specificity than IgA tTG, and is used to diagnose the disease in the
presence of symptoms rather than to rule out future risk.
, Negative C-reactive protein and fecal calprotectin levels make active
inflammatory bowel disease less likely.
▶ 42-year-old male with a history of chronic low back pain managed with
extended-release morphine sulfate (MS Contin) comes to your office to
discuss fatigue. Among other causes, you consider the impact that long-
term opioid therapy may have on the endocrine system. Which one of the
following endocrine conditions is most commonly associated with long-term
opioid therapy?. Answer: Hypogonadism; . A 2020 systematic review and
meta-analysis that included 52 studies on the endocrine effects of opioids
found hypogonadism in 69% of male patients. Lower androgen levels were
also found in women, while estradiol was not affected. Menstrual cycle
disorders were noted in 87% of premenopausal women taking opioids
chronically. Seven of the included studies assessed prolactin levels, which
were elevated in 40% of participants. Adrenal insufficiency was noted in
24% of patients. Parathyroid disorders were not included in this manuscript
and have not been reported to have an association with opioid use. Two
included studies showed lower free T4 levels in those taking opioids, with
an estimated incidence of 34%.
▶ unhoused 63-year-old male is brought to the emergency department in a
state of agitation and confusion. He is found to be hypothermic with a body
temperature of 31.1°C (88.0°F). He has a blood pressure of 90/70 mm Hg
and a heart rate of 120 beats/min. While undergoing warming, which one of
the following should be given to this patient? A) Normal saline at room
temperature B) Normal saline that has been warmed C) Lactated Ringer
solution at room temperature D) Lactated Ringer solution that has been
warmed E) 50% dextrose in water at room temperature. Answer: When
fluid resuscitation is necessary in hypothermia, normal saline is preferred
because hypothermic patients cannot metabolize lactate. The fluid should
be warmed to 38°C-42°C (100.4°F-107.6°F.) Lactated Ringer solution and
50% dextrose in water would not be appropriate.
The contents of Ringer's lactate include sodium, chloride, potassium,
calcium, and lactate in the form of sodium lactate, mixed into a solution with
an osmolarity of 273 mOsm/L and pH of about 6.5.
▶ According to the American Diabetes Association, which one of the
following hemoglobin A1c measurements fits the criteria for prediabetes?.
Answer: Classifying prediabetes is important because it identifies a
AND EXAM SCRIPT FULL SOLUTION
▶ A 48-year-old male with a history of type 2 diabetes, obesity, and
tobacco use disorder presents to your office for evaluation of a 4-day
history of fever, malaise, and a productive cough. He smokes a half-pack of
cigarettes per day but does not use recreational drugs or drink alcohol in
excess. He has no known medication allergies. Aside from a temperature
of 38.2°C (100.8°F) and a BMI of 32 kg/m2 , his vital signs, including
oxygen saturation, are normal. On physical examination he appears mildly
ill although well hydrated and is breathing comfortably. Lung auscultation
reveals focal right-sided crackles and decreased breath sounds. Which one
of the following oral treatment options would be best in this situation?.
Answer: This patient presents with symptoms and examination findings that
are consistent with community-acquired pneumonia (CAP) with significant
medical comorbidity, and he is stable for outpatient treatment. Medical
comorbidities in this context include chronic heart, lung, liver, or kidney
disease; diabetes mellitus; alcohol use disorder; cancer; or asplenia. One
option for treatment in this situation is monotherapy with a respiratory
fluoroquinolone, such as levofloxacin or moxifloxacin. Other options for
outpatient treatment of CAP in adults with comorbidities include either the -
lactam amoxicillin/clavulanate or a cephalosporin (specifically cefpodoxime,
a third-generation cephalosporin, or cefuroxime, a second-generation
cephalosporin), in combination with either doxycycline or a macrolide (SOR
A). Of the available choices, only amoxicillin/clavulanate plus azithromycin
would provide the appropriate spectrum of antimicrobial coverage.
Amoxicillin or doxycycline monotherapy would be appropriate outpatient
CAP treatment for an adult without a significant medical comorbidity.
Another option in such a case is a macrolide such as azithromycin if the
local pneumococcal resistance rate to macrolides is known to be less than
25% (SOR B). Oral cefuroxime would be appropriate in combination with
either doxycycline or azithromycin in this scenario, but it would not provide
broad enough coverage as monotherapy. Sulfamethoxazole/trimethoprim
has encountered increasing pneumococcal resistance over the past several
decades and therefore does not factor into current management for CAP,
either alone or in combination with cephalexin, a first-generation
,cephalosporin that provides coverage against skin flora but not against
typical CAP pathogens
▶ healthy 78-year-old female with no history of osteoporosis has a family
history of hip fracture. Bone density screening reveals a lumbar T-score of -
2.0 and a right hip T-score of -1.5. Her FRAX score is calculated at a 20%
risk of major osteoporotic fracture and an 11% risk of hip fracture. She is
concerned about the possibility of breaking her hip. Which one of the
following interventions would be most appropriate?. Answer: National
Osteoporosis Foundation supports treatment of postmenopausal women
with low bone mass and a 10-year risk >20% for any major fracture or 3%
for hip fracture. First-line treatment options include bisphosphonates
(alendronate, ibandronate, risedronate, and zoledronic acid), teriparatide,
and denosumab. These medications are considered first line due to their
proven efficacy in reducing both hip and vertebral fractures. Hormonal
treatment such as raloxifene and hormone replacement therapy is not
recommended as first-line treatment due to associated risk and side effects
as well as lack of evidence supporting efficacy in preventing hip fractures.
Women with a 10-year fracture risk <20% but who have osteopenia and/or
risk factors for bone loss can be monitored with periodic bone density
scans, though the optimal intervals for repeat evaluation have not been
definitively established.
▶ Which one of the following tests has the highest negative predictive
value to rule out celiac disease?. Answer: The likelihood that a person who
has a negative test result indeed does not have the disease, condition,
biomarker, or mutation (change) in the gene being tested. The negative
predictive value is a way of measuring how accurate a specific test is. Also
called NPV
Celiac disease occurs almost exclusively in people with HLA-DQ2 or HLA-
DQ8 genotypes. Though not routinely performed, a negative result has
more than a 99% negative predictive value for the disease.
A positive IgA tissue transglutaminase (tTG) antibody test is helpful in
making a diagnosis if symptoms are present and has 95% sensitivity and
specificity for active disease, but a negative IgA tTG test does not rule out
future risk. A negative antigliadin antibody test has lower sensitivity and
specificity than IgA tTG, and is used to diagnose the disease in the
presence of symptoms rather than to rule out future risk.
, Negative C-reactive protein and fecal calprotectin levels make active
inflammatory bowel disease less likely.
▶ 42-year-old male with a history of chronic low back pain managed with
extended-release morphine sulfate (MS Contin) comes to your office to
discuss fatigue. Among other causes, you consider the impact that long-
term opioid therapy may have on the endocrine system. Which one of the
following endocrine conditions is most commonly associated with long-term
opioid therapy?. Answer: Hypogonadism; . A 2020 systematic review and
meta-analysis that included 52 studies on the endocrine effects of opioids
found hypogonadism in 69% of male patients. Lower androgen levels were
also found in women, while estradiol was not affected. Menstrual cycle
disorders were noted in 87% of premenopausal women taking opioids
chronically. Seven of the included studies assessed prolactin levels, which
were elevated in 40% of participants. Adrenal insufficiency was noted in
24% of patients. Parathyroid disorders were not included in this manuscript
and have not been reported to have an association with opioid use. Two
included studies showed lower free T4 levels in those taking opioids, with
an estimated incidence of 34%.
▶ unhoused 63-year-old male is brought to the emergency department in a
state of agitation and confusion. He is found to be hypothermic with a body
temperature of 31.1°C (88.0°F). He has a blood pressure of 90/70 mm Hg
and a heart rate of 120 beats/min. While undergoing warming, which one of
the following should be given to this patient? A) Normal saline at room
temperature B) Normal saline that has been warmed C) Lactated Ringer
solution at room temperature D) Lactated Ringer solution that has been
warmed E) 50% dextrose in water at room temperature. Answer: When
fluid resuscitation is necessary in hypothermia, normal saline is preferred
because hypothermic patients cannot metabolize lactate. The fluid should
be warmed to 38°C-42°C (100.4°F-107.6°F.) Lactated Ringer solution and
50% dextrose in water would not be appropriate.
The contents of Ringer's lactate include sodium, chloride, potassium,
calcium, and lactate in the form of sodium lactate, mixed into a solution with
an osmolarity of 273 mOsm/L and pH of about 6.5.
▶ According to the American Diabetes Association, which one of the
following hemoglobin A1c measurements fits the criteria for prediabetes?.
Answer: Classifying prediabetes is important because it identifies a
