ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
1. A 67-year old male sees you for ANSWER: A
a Medicare annual wellness visit. No additional testing for stroke risk Carotid artery dis-
He tells you that his best friend ease affects extra cranial carotid arteries and is caused
had a stroke and he asks about by atherosclerosis.
his risk for stroke. He has a family
history of cardiovascular disease This patient is asymptomatic and has no history of an
in his father, who had a myocar- ischemic stroke, neurology symptoms referable to the
dial infarction at age 65 and died carotid arteries such as amaurosis fugal, or TIA. He has
from a thrombotic stroke at age risk factors for cardiovascular disease (age, male sex,
71. The patient exercises regular- hyperlipidemia_, but the USPSTF recommends against
ly and has a BMI of 27 kg/m2. specific screening asymptomatic carotid artery steno-
His only current medical condition sis (D recommendation) which a low prevalence in the
is hyperlipidemia, and his choles- general adult population. Stroke is a leading cause
terol level is at goal on rosuvas- of disability and death in the US, but asymptomatic
tatin (Crestor), 10 mg daily. He carotid artery stenosis causes a relatively small portion of
also takes aspirin, 81 mg daily. Hisstrokes. Auscultation of the carotid arteries for bruits has
blood pressure 125/78 mmHg. been found to have poor accuracy for detecting carotid
stenosis and is not a reasonable screening approach.
Based on US Preventive Services Appropriate modalities for detecting carotid stenosis
Task Force guidelines, which one include carotid duplex ultrasonography, magnetic res-
of the following would be most ap- onance angiography, and computed tomography, but
propriate at this time? there are not recommended for screening asympto-
A. No additional testing for stroke matic patients.
risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonogra-
phy
D. Magnetic resonance angiogra-
phy
E. CT angiography of the carotid
arteries
, ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
2. A 28 year old female presents ANSWER: B
for evaluation of nasal congestion, Intranasal corticosteroid monotherapy
sneezing, watery eyes, and post-
nasal drip. This has been an inter- This patient has seasonal allergic rhinitis. A joint guide-
mittent issue for her every spring line statement from the American Academy of Allergy,
and she would like to manage it Asthma, and Immunology/American College of Aller-
more effectively. gy, Asthma and Immunology Joint Task Force on Prac-
tice Parameters recommends that mono therapy with
Which one of the following treat- intranasal corticosteroids would be prescribed initial-
ments has been shown to be the ly in patients equal to or more than 12 years of age
most effective and best tolerated rather than combined treatment with oral antihistamines
first-line therapy for this patient's because data has not shown an additional benefit to
condition? adding the antihistamine. Higher patient adherence
A. A leukotriene receptor agonist and tolerance and fewer side effects were seen with
B. Intranasal corticosteroid the mono therapy regimen. High quality evidence indi-
monotherapy cates that intranasal corticosteroids were more effective
C. Intranasal corticosteroids plus than leukotriene receptor antagonists. Inhaled corticos-
an oral antihistamine teroids and triamcinolone injections are not appropriate
D. Inhaled corticosteroids first line options for the treatment of seasonal allergic
E. Annual triamcinolone injections rhinitis
3. A 68 year old female presents with ANSWER: B
a 2 month history of watery diar- Colonoscopy
rhea. She has not had any blood
or pus in her stools, and the stools In patients with chronic nonbloody diarrhea, the dif-
are not oily. She has not had any ferential diagnosis includes microscopic (lymphocytic
history of fever, chills, or weight or collagenous) colitis. The mucosa appears normal on
loss, and has not traveled recently. colonoscopy but a biopsy will show lymphocytic infiltra-
She smokes one pack of cigarettes tion of the epithelium. The etiology is unknown but there
per day. Her medications include are several risk factors to consider, including older age,
ibuprofen, sertraline and panto- female sex, and smoking status. Drugs with a high level
prazole. A CBC, metabolic panel, of evidence causing microscopic colitis include NSAIDs,
, ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
CRP, IgA anti tissue transglutam- PPIs, sertraline, acarbose, aspirin, and ticlopidine. C.
inase level, total IgA level, and diff should be suspected in individuals who have taken
stool guaiac test are all normal. antibiotics in the past 3 months. Fecal calprotectin is ele-
vated in inflammatory diarrhea such as Crohn's disease
Which one of the following tests or ulcerative colitis. A stool culture would be indicated
would be mostly likely to yield a if there is a suspicion of an infectious bacterial diarrhea
diagnosis? such as Shigella or Salmonella, but these bacteria tend
A. C difficile toxin to cause bloody diarrhea. Checking for a parasitic infec-
B. Colonoscopy tion should be considered for patients with a history of
C. Fecal calprotectin recent travel or exposure to unpurified water.
D. A stool culture
E. Stool exam for ova and para-
sites
4. A 23 year old male with opioid ANSWER: C
use disorder requests buprenor- 8-12 hours after his last opioid use
phine therapy. He is still active-
ly using immediate release oxy- Buprenorphine is a partial opioid agonist. In order to
codone and he took a dose 2 reduce the risk of precipitated withdrawal, buprenor-
hours ago. phine induction should begin once the patient is ex-
hibiting signs of mild to moderate withdrawal, usually
This patient should begin 8-12 hours after the last opioid use. Waiting until a
buprenorphine induction patient goes through a full withdrawal increases the
A. Now chances that the patient will revert back to using opioids.
B. In 2 hours
C. 8-12 hours after his last opioid
use
D. 24 hours after his last opioid
use
E. 1 week after his last opioid use
5.
, ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
A 45 year old left hand domi- ANSWER: A. Re-examination if she develops numbness,
nant female presents to your of- weakness or increased pain
fice with a lump on her hand. She
first noticed the lump 2 weeks ago This patient has a ganglion cyst, which is common and
and thinks it has gotten bigger. resolves spontaneously in 50% of cases, and watchful
She does not recall any injury. She waiting would be most appropriate at this time. Treat-
has not had any numbness, weak- ment is indicated if the cyst is causing significant symp-
ness, or tingling. She has minimal toms such as pain, numbness, or weakness, or for cos-
discomfort when she presses on metic symptoms. Aspiration of the lesion is the initial
the lump, and it does not affect treatment, although recurrence may occur in 85% of
her activity. On examination her cases. Immobilizing the wrist with a splint or brace is
left wrist is neurovascularly intact.sometimes helpful in the short term if the patient is
bothered by the symptoms, but immobilization does not
Which one of the following man- provide lasting relief and could cause muscle atrophy.
agement options would you rec- Corticosteroid injections have not shown any benefit.
ommend? Referral for excision is appropriate if there has been no
A. Re-examination if she devel- improvement. Patients should be advised that there is a
ops numbness, weakness, or in- 10%-15% recurrence rate even after excision.
creased pain
B. Immobilization of the wrist for 6
weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the
lesion with a corticosteroid
E. Referral for excision of the le-
sion
6. A 57 year old female with dia- ANSWER: E. Refer her to a diabetes educator for medical
betes mellitus comes to your of- nutrition therapy
fice for a routine follow up. Her
current medications include met- Counseling by a diabetic educator or a team of edu-
formin 1000 mg twice daily. She cators for medical nutrition therapy lowers HbA1c by
Study online at https://quizlet.com/_atzan2
1. A 67-year old male sees you for ANSWER: A
a Medicare annual wellness visit. No additional testing for stroke risk Carotid artery dis-
He tells you that his best friend ease affects extra cranial carotid arteries and is caused
had a stroke and he asks about by atherosclerosis.
his risk for stroke. He has a family
history of cardiovascular disease This patient is asymptomatic and has no history of an
in his father, who had a myocar- ischemic stroke, neurology symptoms referable to the
dial infarction at age 65 and died carotid arteries such as amaurosis fugal, or TIA. He has
from a thrombotic stroke at age risk factors for cardiovascular disease (age, male sex,
71. The patient exercises regular- hyperlipidemia_, but the USPSTF recommends against
ly and has a BMI of 27 kg/m2. specific screening asymptomatic carotid artery steno-
His only current medical condition sis (D recommendation) which a low prevalence in the
is hyperlipidemia, and his choles- general adult population. Stroke is a leading cause
terol level is at goal on rosuvas- of disability and death in the US, but asymptomatic
tatin (Crestor), 10 mg daily. He carotid artery stenosis causes a relatively small portion of
also takes aspirin, 81 mg daily. Hisstrokes. Auscultation of the carotid arteries for bruits has
blood pressure 125/78 mmHg. been found to have poor accuracy for detecting carotid
stenosis and is not a reasonable screening approach.
Based on US Preventive Services Appropriate modalities for detecting carotid stenosis
Task Force guidelines, which one include carotid duplex ultrasonography, magnetic res-
of the following would be most ap- onance angiography, and computed tomography, but
propriate at this time? there are not recommended for screening asympto-
A. No additional testing for stroke matic patients.
risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonogra-
phy
D. Magnetic resonance angiogra-
phy
E. CT angiography of the carotid
arteries
, ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
2. A 28 year old female presents ANSWER: B
for evaluation of nasal congestion, Intranasal corticosteroid monotherapy
sneezing, watery eyes, and post-
nasal drip. This has been an inter- This patient has seasonal allergic rhinitis. A joint guide-
mittent issue for her every spring line statement from the American Academy of Allergy,
and she would like to manage it Asthma, and Immunology/American College of Aller-
more effectively. gy, Asthma and Immunology Joint Task Force on Prac-
tice Parameters recommends that mono therapy with
Which one of the following treat- intranasal corticosteroids would be prescribed initial-
ments has been shown to be the ly in patients equal to or more than 12 years of age
most effective and best tolerated rather than combined treatment with oral antihistamines
first-line therapy for this patient's because data has not shown an additional benefit to
condition? adding the antihistamine. Higher patient adherence
A. A leukotriene receptor agonist and tolerance and fewer side effects were seen with
B. Intranasal corticosteroid the mono therapy regimen. High quality evidence indi-
monotherapy cates that intranasal corticosteroids were more effective
C. Intranasal corticosteroids plus than leukotriene receptor antagonists. Inhaled corticos-
an oral antihistamine teroids and triamcinolone injections are not appropriate
D. Inhaled corticosteroids first line options for the treatment of seasonal allergic
E. Annual triamcinolone injections rhinitis
3. A 68 year old female presents with ANSWER: B
a 2 month history of watery diar- Colonoscopy
rhea. She has not had any blood
or pus in her stools, and the stools In patients with chronic nonbloody diarrhea, the dif-
are not oily. She has not had any ferential diagnosis includes microscopic (lymphocytic
history of fever, chills, or weight or collagenous) colitis. The mucosa appears normal on
loss, and has not traveled recently. colonoscopy but a biopsy will show lymphocytic infiltra-
She smokes one pack of cigarettes tion of the epithelium. The etiology is unknown but there
per day. Her medications include are several risk factors to consider, including older age,
ibuprofen, sertraline and panto- female sex, and smoking status. Drugs with a high level
prazole. A CBC, metabolic panel, of evidence causing microscopic colitis include NSAIDs,
, ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
CRP, IgA anti tissue transglutam- PPIs, sertraline, acarbose, aspirin, and ticlopidine. C.
inase level, total IgA level, and diff should be suspected in individuals who have taken
stool guaiac test are all normal. antibiotics in the past 3 months. Fecal calprotectin is ele-
vated in inflammatory diarrhea such as Crohn's disease
Which one of the following tests or ulcerative colitis. A stool culture would be indicated
would be mostly likely to yield a if there is a suspicion of an infectious bacterial diarrhea
diagnosis? such as Shigella or Salmonella, but these bacteria tend
A. C difficile toxin to cause bloody diarrhea. Checking for a parasitic infec-
B. Colonoscopy tion should be considered for patients with a history of
C. Fecal calprotectin recent travel or exposure to unpurified water.
D. A stool culture
E. Stool exam for ova and para-
sites
4. A 23 year old male with opioid ANSWER: C
use disorder requests buprenor- 8-12 hours after his last opioid use
phine therapy. He is still active-
ly using immediate release oxy- Buprenorphine is a partial opioid agonist. In order to
codone and he took a dose 2 reduce the risk of precipitated withdrawal, buprenor-
hours ago. phine induction should begin once the patient is ex-
hibiting signs of mild to moderate withdrawal, usually
This patient should begin 8-12 hours after the last opioid use. Waiting until a
buprenorphine induction patient goes through a full withdrawal increases the
A. Now chances that the patient will revert back to using opioids.
B. In 2 hours
C. 8-12 hours after his last opioid
use
D. 24 hours after his last opioid
use
E. 1 week after his last opioid use
5.
, ABFM ITE 2021
Study online at https://quizlet.com/_atzan2
A 45 year old left hand domi- ANSWER: A. Re-examination if she develops numbness,
nant female presents to your of- weakness or increased pain
fice with a lump on her hand. She
first noticed the lump 2 weeks ago This patient has a ganglion cyst, which is common and
and thinks it has gotten bigger. resolves spontaneously in 50% of cases, and watchful
She does not recall any injury. She waiting would be most appropriate at this time. Treat-
has not had any numbness, weak- ment is indicated if the cyst is causing significant symp-
ness, or tingling. She has minimal toms such as pain, numbness, or weakness, or for cos-
discomfort when she presses on metic symptoms. Aspiration of the lesion is the initial
the lump, and it does not affect treatment, although recurrence may occur in 85% of
her activity. On examination her cases. Immobilizing the wrist with a splint or brace is
left wrist is neurovascularly intact.sometimes helpful in the short term if the patient is
bothered by the symptoms, but immobilization does not
Which one of the following man- provide lasting relief and could cause muscle atrophy.
agement options would you rec- Corticosteroid injections have not shown any benefit.
ommend? Referral for excision is appropriate if there has been no
A. Re-examination if she devel- improvement. Patients should be advised that there is a
ops numbness, weakness, or in- 10%-15% recurrence rate even after excision.
creased pain
B. Immobilization of the wrist for 6
weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the
lesion with a corticosteroid
E. Referral for excision of the le-
sion
6. A 57 year old female with dia- ANSWER: E. Refer her to a diabetes educator for medical
betes mellitus comes to your of- nutrition therapy
fice for a routine follow up. Her
current medications include met- Counseling by a diabetic educator or a team of edu-
formin 1000 mg twice daily. She cators for medical nutrition therapy lowers HbA1c by
