ABFM ITE
"Sundowning" behaviour that includes nighttime disorientation and some mild agitation
is characteristic of - Answer Delirium
2-day-old infant with flesh-colored papules over an erythematous base located on the
face and trunk, containing eosinophils. - Answer Erythema toxicum neonatorum, which
usually resolves in the first week or two of life. Unknown cause.
A 5-year-old male is brought to your office after passing an intestinal worm. He lives on
a farm with cattle, pigs, and dogs. He has never travelled very far from home. He does
not have any respiratory symptoms or diarrhoea, but has experienced some abdominal
bloating. - Answer Ascaris lumbricoides is a large roundworm that typically infects the
ileum. Symptoms are variable but large infections can lead to intestinal obstruction.
Pinworms are much smaller and typically present with anal pruritus.
Tapeworms can be large, but are flat and segmental in appearance, and are typically
found in the stool as segments called proglottids.
Hookworms are also round, but are typically 6-12 mm in length. They are a significant
cause of anemia in children globally.
A 30-year-old male is treated with topical medications for his papulopustular rosacea
with only partial improvement. The preferred antibiotic is - Answer Doxycycline
A 35-year-old white male who has had T1DM for 20 years begins having episodes of
hypoglycaemia. His glucose levels had previously been stable and well controlled, and
he has not recently changed his diet or insulin regimen. What is the most likely cause of
the hypoglycaemia? - Answer Diabetic nephropathy
A 48-year-old female is treated appropriately for MRSA bacteremia. An echocardiogram
is negative for endocarditis. There are no indwelling devices such as prosthetic heart
valves or vascular grafts. - Answer Repeat blood cultures 2-4 days after the initial set
and as needed thereafter.
A copper T 380A intrauterine device (ParaGard) would be preferred over a
levonorgestrel-releasing intrauterine device (Mirena) in a patient with a history of -
Answer Severe cirrhosis or liver cancer
- Known association between oral contraceptive use and the growth of hepatocellular
adenoma, and this risk is thought to extend to other types of hormonal contraceptives
Breast cancer
,A doctor and patient are discussing using a particular drug to treat the patient's
uncontrolled hypertension. Which potential effects of the drug is a patient-oriented
outcome that should be discussed during shared decision-making? - Answer A
decrease in all-cause mortality
A healthy 2-month-old female is brought to your office for a routine well baby
examination by both of her parents, who have no concerns. The parents refuse routine
recommended vaccines for their daughter because of their personal beliefs. You want to
incorporate patient-centeredness and are also concerned about improving the health of
the population. You decide to follow the CDC recommendations by? - Answer Having
the parents sign a refusal to vaccinate form.
A pathogen for community-acquired pneumonia in a patient who has
a history of a hotel stay or cruise ship travel within the past couple of weeks. - Answer
Legionella
A risk factor for uncomplicated cystitis - Answer Frequent sexual intercourse
A U.S. hospital or birthing center seeking to be certified as "Baby Friendly" by the Baby-
Friendly Hospital Initiative - Answer Providing no other food or fluids to breastfeeding
infants without a medical indication
A U.S. Preventive Services Task Force "D" recommendation indicates - Answer
Moderate or high certainty that the service has no net benefit or that the harms
outweigh the benefits
A useful adjunct to Buprenorphine in the treatment of opioid use disorder to help
increase the rates of abstinence and decrease stress-related opioid cravings - Answer
Clonidine (0.1-0.3 mg every 6-8 hours)
Absolute contraindication to fibrinolytic therapy - Answer A history of an ischemic stroke
within the past 3 months unless the stroke is diagnosed within 4½ hours.
Absorption of levothyroxine is impaired by several gastrointestinal conditions - Answer
Includes atrophic gastritis, chronic PPI use, and Helicobacter pylori infection.
According to DSM-5, what is the severity of anorexia nervosa based on? - Answer BMI
According to the Centers for Disease Control and Prevention, which vaccination would
be recommended for grandparents to protect their infant grandchild from illness? -
Answer Tdap
According to U.S. Preventive Services Task Force guidelines, patients who are
overweight or obese should be screened for diabetes mellitus beginning at age -
Answer 40
,ACEi and ARB as anti-hypertensives with renoprotective effects - Answer May tolerate
a rise of <30% in serum creatinine after initiation. Rises in serum creatinine of >30%
from baseline increase the risk of renal failure, adverse cardiac outcomes, and death.
ACEi causes angioedema due to increased bradykinin - Answer Rx: Icatibant is a
bradykinin receptor type 2 blocker
Acne appearing at which one of the following ages should prompt detailed endocrine
laboratory testing for possible underlying systemic disease? - Answer Mid-childhood i.e.
5yo
Activity order in a patient is admitted to the hospital for acute DVT of the lower extremity
and started on anticoagulation therapy - Answer Early ambulation as tolerated
Acute bronchitis in adults is usually viral - Answer Indications for a chest radiograph
include: bloody sputum, rusty-colored sputum, or dyspnoea; a pulse rate >100
beats/min; a respiratory rate >24/min; or a temperature >37.8°C (100.0°F). A chest
radiograph is also indicated if there are abnormal findings on a chest examination such
as fremitus, egophony, or focal consolidation.
Acute chest syndrome in Sickle Cell Disease - Answer Atypical pathogens
predominates (Mycoplasma and Chlamydophila).
Viral infections are also common, especially in children with ACS.
Other possible pathogens include Staphylococcus aureus, Streptococcus pneumoniae,
and Haemophilus influenzae.
Therefore, the use of a third-generation cephalosporin along with azithromycin is the
recommended antibiotic coverage.
Also include supportive care with supplemental oxygen, intravenous fluids, pain control,
and incentive spirometry.
Acute laryngitis most often has a viral etiology - Answer Symptomatic treatment is
therefore most appropriate
- PPIs such as omeprazole can be of benefit in treating chronic laryngitis caused by acid
reflux
Acute migraine not responding to NSAIDs - Answer Metoclopramide is an effective
treatment for migraine beyond its antiemetic benefit and IV administration may be
helpful for the patient unable to tolerate oral medications.
Triptan medications would be another evidence-based choice for abortive therapy of
migraine.
, Acute parotitis, which is commonly caused by dehydration and can be diagnosed from
the history and examination - Answer Empiric treatment with beta-lactams.
Administration of sialagogues such as lemon drops may be helpful, as well as parotid
gland massage.
Acute salpingitis - Answer Mucopurulent cervical discharge, tenderness with cervical
motion, a normal-size uterus, and left adnexal fullness.
- Acute, adnexal fullness = Gonorrhoea
IV Abx usually consists of a beta-lactam antibiotic (cefoxitin or ceftriaxone) plus
doxycycline, or gentamicin and clindamycin.
Ceftriaxone, 250 mg intramuscularly, is appropriate for
uncomplicated gonococcal infection.
Acute uncomplicated cystitis antibiotic choice - Answer Bactrim/Co-trimoxazole,
Nitrofurantoin, Fosfomycin
- Increasing resistance to fluoroquinolones has been seen and they are therefore less
likely to be
successful. Because of the association with tendon rupture they are also not considered
first-line treatment.
Adolescent physiologic gynaecomastia - Answer One half of all adolescent males,
usually bilateral but left sided more common if unilateral, typically resolves 6-24m after
onset.
Advantage of interferon-gamma release assay (IGRA, QuantiFERON-TB Gold) over
tuberculin test for TB screening - Answer Ability to get results without follow-up and the
fact that prior bacille Calmette-Guérin (BCG) vaccination does not cause a false-positive
test.
Neither can distinguish between latent and active TB.
Age for opt-out HIV screening - Answer USPTF 15-65yo, CDC 13-64yo
Age group between which American Academy of Pediatrics recommends administration
of an autism-specific screening tool - Answer 18-24 months old
Age-related macular degeneration (Amsler grid testing notes
distorted grid lines) - Answer Smoking is a modifiable risk factor and smokers should be
counselled to quit.
Not reversible but treatment can delay progression or stabilize the changes.
"Sundowning" behaviour that includes nighttime disorientation and some mild agitation
is characteristic of - Answer Delirium
2-day-old infant with flesh-colored papules over an erythematous base located on the
face and trunk, containing eosinophils. - Answer Erythema toxicum neonatorum, which
usually resolves in the first week or two of life. Unknown cause.
A 5-year-old male is brought to your office after passing an intestinal worm. He lives on
a farm with cattle, pigs, and dogs. He has never travelled very far from home. He does
not have any respiratory symptoms or diarrhoea, but has experienced some abdominal
bloating. - Answer Ascaris lumbricoides is a large roundworm that typically infects the
ileum. Symptoms are variable but large infections can lead to intestinal obstruction.
Pinworms are much smaller and typically present with anal pruritus.
Tapeworms can be large, but are flat and segmental in appearance, and are typically
found in the stool as segments called proglottids.
Hookworms are also round, but are typically 6-12 mm in length. They are a significant
cause of anemia in children globally.
A 30-year-old male is treated with topical medications for his papulopustular rosacea
with only partial improvement. The preferred antibiotic is - Answer Doxycycline
A 35-year-old white male who has had T1DM for 20 years begins having episodes of
hypoglycaemia. His glucose levels had previously been stable and well controlled, and
he has not recently changed his diet or insulin regimen. What is the most likely cause of
the hypoglycaemia? - Answer Diabetic nephropathy
A 48-year-old female is treated appropriately for MRSA bacteremia. An echocardiogram
is negative for endocarditis. There are no indwelling devices such as prosthetic heart
valves or vascular grafts. - Answer Repeat blood cultures 2-4 days after the initial set
and as needed thereafter.
A copper T 380A intrauterine device (ParaGard) would be preferred over a
levonorgestrel-releasing intrauterine device (Mirena) in a patient with a history of -
Answer Severe cirrhosis or liver cancer
- Known association between oral contraceptive use and the growth of hepatocellular
adenoma, and this risk is thought to extend to other types of hormonal contraceptives
Breast cancer
,A doctor and patient are discussing using a particular drug to treat the patient's
uncontrolled hypertension. Which potential effects of the drug is a patient-oriented
outcome that should be discussed during shared decision-making? - Answer A
decrease in all-cause mortality
A healthy 2-month-old female is brought to your office for a routine well baby
examination by both of her parents, who have no concerns. The parents refuse routine
recommended vaccines for their daughter because of their personal beliefs. You want to
incorporate patient-centeredness and are also concerned about improving the health of
the population. You decide to follow the CDC recommendations by? - Answer Having
the parents sign a refusal to vaccinate form.
A pathogen for community-acquired pneumonia in a patient who has
a history of a hotel stay or cruise ship travel within the past couple of weeks. - Answer
Legionella
A risk factor for uncomplicated cystitis - Answer Frequent sexual intercourse
A U.S. hospital or birthing center seeking to be certified as "Baby Friendly" by the Baby-
Friendly Hospital Initiative - Answer Providing no other food or fluids to breastfeeding
infants without a medical indication
A U.S. Preventive Services Task Force "D" recommendation indicates - Answer
Moderate or high certainty that the service has no net benefit or that the harms
outweigh the benefits
A useful adjunct to Buprenorphine in the treatment of opioid use disorder to help
increase the rates of abstinence and decrease stress-related opioid cravings - Answer
Clonidine (0.1-0.3 mg every 6-8 hours)
Absolute contraindication to fibrinolytic therapy - Answer A history of an ischemic stroke
within the past 3 months unless the stroke is diagnosed within 4½ hours.
Absorption of levothyroxine is impaired by several gastrointestinal conditions - Answer
Includes atrophic gastritis, chronic PPI use, and Helicobacter pylori infection.
According to DSM-5, what is the severity of anorexia nervosa based on? - Answer BMI
According to the Centers for Disease Control and Prevention, which vaccination would
be recommended for grandparents to protect their infant grandchild from illness? -
Answer Tdap
According to U.S. Preventive Services Task Force guidelines, patients who are
overweight or obese should be screened for diabetes mellitus beginning at age -
Answer 40
,ACEi and ARB as anti-hypertensives with renoprotective effects - Answer May tolerate
a rise of <30% in serum creatinine after initiation. Rises in serum creatinine of >30%
from baseline increase the risk of renal failure, adverse cardiac outcomes, and death.
ACEi causes angioedema due to increased bradykinin - Answer Rx: Icatibant is a
bradykinin receptor type 2 blocker
Acne appearing at which one of the following ages should prompt detailed endocrine
laboratory testing for possible underlying systemic disease? - Answer Mid-childhood i.e.
5yo
Activity order in a patient is admitted to the hospital for acute DVT of the lower extremity
and started on anticoagulation therapy - Answer Early ambulation as tolerated
Acute bronchitis in adults is usually viral - Answer Indications for a chest radiograph
include: bloody sputum, rusty-colored sputum, or dyspnoea; a pulse rate >100
beats/min; a respiratory rate >24/min; or a temperature >37.8°C (100.0°F). A chest
radiograph is also indicated if there are abnormal findings on a chest examination such
as fremitus, egophony, or focal consolidation.
Acute chest syndrome in Sickle Cell Disease - Answer Atypical pathogens
predominates (Mycoplasma and Chlamydophila).
Viral infections are also common, especially in children with ACS.
Other possible pathogens include Staphylococcus aureus, Streptococcus pneumoniae,
and Haemophilus influenzae.
Therefore, the use of a third-generation cephalosporin along with azithromycin is the
recommended antibiotic coverage.
Also include supportive care with supplemental oxygen, intravenous fluids, pain control,
and incentive spirometry.
Acute laryngitis most often has a viral etiology - Answer Symptomatic treatment is
therefore most appropriate
- PPIs such as omeprazole can be of benefit in treating chronic laryngitis caused by acid
reflux
Acute migraine not responding to NSAIDs - Answer Metoclopramide is an effective
treatment for migraine beyond its antiemetic benefit and IV administration may be
helpful for the patient unable to tolerate oral medications.
Triptan medications would be another evidence-based choice for abortive therapy of
migraine.
, Acute parotitis, which is commonly caused by dehydration and can be diagnosed from
the history and examination - Answer Empiric treatment with beta-lactams.
Administration of sialagogues such as lemon drops may be helpful, as well as parotid
gland massage.
Acute salpingitis - Answer Mucopurulent cervical discharge, tenderness with cervical
motion, a normal-size uterus, and left adnexal fullness.
- Acute, adnexal fullness = Gonorrhoea
IV Abx usually consists of a beta-lactam antibiotic (cefoxitin or ceftriaxone) plus
doxycycline, or gentamicin and clindamycin.
Ceftriaxone, 250 mg intramuscularly, is appropriate for
uncomplicated gonococcal infection.
Acute uncomplicated cystitis antibiotic choice - Answer Bactrim/Co-trimoxazole,
Nitrofurantoin, Fosfomycin
- Increasing resistance to fluoroquinolones has been seen and they are therefore less
likely to be
successful. Because of the association with tendon rupture they are also not considered
first-line treatment.
Adolescent physiologic gynaecomastia - Answer One half of all adolescent males,
usually bilateral but left sided more common if unilateral, typically resolves 6-24m after
onset.
Advantage of interferon-gamma release assay (IGRA, QuantiFERON-TB Gold) over
tuberculin test for TB screening - Answer Ability to get results without follow-up and the
fact that prior bacille Calmette-Guérin (BCG) vaccination does not cause a false-positive
test.
Neither can distinguish between latent and active TB.
Age for opt-out HIV screening - Answer USPTF 15-65yo, CDC 13-64yo
Age group between which American Academy of Pediatrics recommends administration
of an autism-specific screening tool - Answer 18-24 months old
Age-related macular degeneration (Amsler grid testing notes
distorted grid lines) - Answer Smoking is a modifiable risk factor and smokers should be
counselled to quit.
Not reversible but treatment can delay progression or stabilize the changes.
