2023 ABFM Epidemiology review
Questions and Answers
Correctly verified.
Side effect of denosumab and bisphosphonates - Answer Jaw
osteonecrosis
Most likely to induce remission in Crohn dz - Answer corticosteroids >
5-ASA > infliximab
Bisphosphonates shouldn't be used in pts w/CLCr less than - Answer
35 mL/min/1.73m2
Bisphosphonates use for 5+ years risks... - Answer atypical femoral
shaft fractures, recommend drug holiday
Denosumab is safe in CKD because - Answer not cleared by kidneys
IBD diagnosis made via - Answer endoscopy with biopsies
First line for treating DM neuropathy - Answer TCAs (amitriptyline) >
SNRI, pregabalin > antiSz
Best management for acute urticaria - Answer second generation X-H1
(longer acting, less drowsy vs 1st gen)
Type of symptoms of depression seen most in elderly - Answer somatic
symptoms (also in preg women, children, low income)
Best abx treatment for diabetic foot ulcer - Answer Vanc/Zosyn
(Piperacillin/tazobactam) -> covers MRSA, pseudomonas
,Percent of wt loss leading to stat-significant improvement of lipid
ratios, blood glucose, CAD risk reduction - Answer at least 10%
Most effective weight reduction and long-term maintenance treatment
for morbidly obese - Answer bariatric surgery (gastric bypass had
mean wt loss 71.2% at 3 year, 20% at 6 years); reduce blood glucose,
resolve DMII
Which are some severe CAP symptoms requiring inpatient - Answer
confusion, tachypnea, hypotension, multilobar infiltrates (IV
ceftriaxone and oral azithromycin)
Outpatient treatment for mild/mod CAP w/out many comorbidities -
Answer oral macrolide (azithromycin, clarithromycin, erythromycin) or
doxycycline -> add fluoroquins, beta-lactams if comorbidities
Next drug to step up to after albuterol fails to control mild asthma -
Answer fluticasone inhaler
Shown to shorten course of Bell's palsy - Answer corticosteroids
(antivirals don't do a thing)
Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine -
Answer Interferon gamma release assay (QuantiFERON-TB Gold)
... - Answer
If blood sugar of DM pt who takes long acting insulin at night is high
during breakfast/lunch/dinner, how do you switch up their insulin
regimen? - Answer add short acting insulin before the last meal (if high
during bedtime, add insulin during dinner; if high b4 dinner, add insulin
at lunch time; if high b4 lunch, add at breakfast)
Post-op delirium in elderly -> tx? - Answer adequate pain control and
reorientation, don't sedate
,Hoarseness that doesn't resolve in 3 months, next best step - Answer
laryngoscopy (sooner than 3 mo if more serious condition suspected);
voice rest for 2 weeks if Hx of URI/vocal abuse
Effect of long term tx for narcotic addiction w/methadone and
buprenorphine - Answer greater success at producing opiate
abstinence than detox programs
How often to monitor serum Ca and Phos level in CKD? - Answer 3-6
mo for Ca2+ and 6-12 mo for Phos w/goal to normalize
Tramadol should be avoided in pts w/which kind of dz - Answer
seizures, lower sz threshold
Linear excoriation, thickened skin on forearms/legs/neck due to
excessive scratching -> dx? tx? - Answer Lichen simplex chronicus
presentation -> topical steroids w/occlusive bandage
Best initial approach to wt loss per USPSTF - Answer behavioral
counseling (high intensity)
Medical conditions that reduce response to warfarin (reduce INR) -
Answer hypothyroidism, visceral carcinoma, high vitK intake, DM,
hyperlipidemia
Medical conditions that increase response to warfarin (increase INR
more) - Answer vitK def (low dietary intake), malabsorption, scurvy,
malnutrition, cachexia, small body size, liver dz, renal dz, fever,
hyperthyroidism, infectious dz, HF, biliary obstruction
MC etiology for acute laryngitis - Answer viral, tx symptoms (red
oropharynx w/out exudate, mucosal congestion, can't talk)
Although helpful by themselves in protecting kidneys in DM, which two
drugs should not be used together - Answer ACE inhibitors and ARBs;
higher Cr levels, increased likelihood that dialysis will become
necessary
, Dermatologic disease assoc with Hep C - Answer lichen planus
(pruritic polygonal papules) and porphyria cutanea tarda
Has the legal authority to revoke/restrict a patient's driver's license -
Answer representative of state DMV (physicians can make
recommendations but can't legally restrict)
MC causes of CAP in healthy adolescents - Answer Mycoplasma,
Chlamydophilia, group A Strep (outpatient -> azithromycin; inpatient ->
ceftriax + erythromycin/azithromycn
Still suspecting subarachnoid bleed (continued worse HA) after
neg/equivocal head CT, next step? - Answer lumbar puncture (look for
xanthochromia, its absence rules out subarachnoid bleed)
Morphine should be avoided in patients with this kind of organ disease
- Answer renal disease; toxic metabolites of morphine are not
eliminated by kidneys in this case -> resp depression, myoclonus,
confusion (use fentanyl, methadone in CKD)
Do this if you find trace valvular regurgitation on initial
echocardiogram - Answer nothing, normal finding (70-90% of norm
individuals)
Risk factor for esophageal adenocarcinoma - Answer obesity -> GERD
Rx: Increase risk of bruising, oral candidiasis, decrease COPD
exacerbations, but no effect on mortality/FEV1 - Answer inhaled
corticosteroids
Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating
syphilis - Answer Jarisch-Herxheimer reaction -> reassurance, pyretics
Other receptors besides aldosterone that are bound by spironolactone
- Answer androgen and progesterone -> breast tenderness/
gynecomastia (eplerenone, ++specific to aldost-R, less ADEs)
Questions and Answers
Correctly verified.
Side effect of denosumab and bisphosphonates - Answer Jaw
osteonecrosis
Most likely to induce remission in Crohn dz - Answer corticosteroids >
5-ASA > infliximab
Bisphosphonates shouldn't be used in pts w/CLCr less than - Answer
35 mL/min/1.73m2
Bisphosphonates use for 5+ years risks... - Answer atypical femoral
shaft fractures, recommend drug holiday
Denosumab is safe in CKD because - Answer not cleared by kidneys
IBD diagnosis made via - Answer endoscopy with biopsies
First line for treating DM neuropathy - Answer TCAs (amitriptyline) >
SNRI, pregabalin > antiSz
Best management for acute urticaria - Answer second generation X-H1
(longer acting, less drowsy vs 1st gen)
Type of symptoms of depression seen most in elderly - Answer somatic
symptoms (also in preg women, children, low income)
Best abx treatment for diabetic foot ulcer - Answer Vanc/Zosyn
(Piperacillin/tazobactam) -> covers MRSA, pseudomonas
,Percent of wt loss leading to stat-significant improvement of lipid
ratios, blood glucose, CAD risk reduction - Answer at least 10%
Most effective weight reduction and long-term maintenance treatment
for morbidly obese - Answer bariatric surgery (gastric bypass had
mean wt loss 71.2% at 3 year, 20% at 6 years); reduce blood glucose,
resolve DMII
Which are some severe CAP symptoms requiring inpatient - Answer
confusion, tachypnea, hypotension, multilobar infiltrates (IV
ceftriaxone and oral azithromycin)
Outpatient treatment for mild/mod CAP w/out many comorbidities -
Answer oral macrolide (azithromycin, clarithromycin, erythromycin) or
doxycycline -> add fluoroquins, beta-lactams if comorbidities
Next drug to step up to after albuterol fails to control mild asthma -
Answer fluticasone inhaler
Shown to shorten course of Bell's palsy - Answer corticosteroids
(antivirals don't do a thing)
Best TB test for immigrants w/bacille Calmette-Guerin (BCG) vaccine -
Answer Interferon gamma release assay (QuantiFERON-TB Gold)
... - Answer
If blood sugar of DM pt who takes long acting insulin at night is high
during breakfast/lunch/dinner, how do you switch up their insulin
regimen? - Answer add short acting insulin before the last meal (if high
during bedtime, add insulin during dinner; if high b4 dinner, add insulin
at lunch time; if high b4 lunch, add at breakfast)
Post-op delirium in elderly -> tx? - Answer adequate pain control and
reorientation, don't sedate
,Hoarseness that doesn't resolve in 3 months, next best step - Answer
laryngoscopy (sooner than 3 mo if more serious condition suspected);
voice rest for 2 weeks if Hx of URI/vocal abuse
Effect of long term tx for narcotic addiction w/methadone and
buprenorphine - Answer greater success at producing opiate
abstinence than detox programs
How often to monitor serum Ca and Phos level in CKD? - Answer 3-6
mo for Ca2+ and 6-12 mo for Phos w/goal to normalize
Tramadol should be avoided in pts w/which kind of dz - Answer
seizures, lower sz threshold
Linear excoriation, thickened skin on forearms/legs/neck due to
excessive scratching -> dx? tx? - Answer Lichen simplex chronicus
presentation -> topical steroids w/occlusive bandage
Best initial approach to wt loss per USPSTF - Answer behavioral
counseling (high intensity)
Medical conditions that reduce response to warfarin (reduce INR) -
Answer hypothyroidism, visceral carcinoma, high vitK intake, DM,
hyperlipidemia
Medical conditions that increase response to warfarin (increase INR
more) - Answer vitK def (low dietary intake), malabsorption, scurvy,
malnutrition, cachexia, small body size, liver dz, renal dz, fever,
hyperthyroidism, infectious dz, HF, biliary obstruction
MC etiology for acute laryngitis - Answer viral, tx symptoms (red
oropharynx w/out exudate, mucosal congestion, can't talk)
Although helpful by themselves in protecting kidneys in DM, which two
drugs should not be used together - Answer ACE inhibitors and ARBs;
higher Cr levels, increased likelihood that dialysis will become
necessary
, Dermatologic disease assoc with Hep C - Answer lichen planus
(pruritic polygonal papules) and porphyria cutanea tarda
Has the legal authority to revoke/restrict a patient's driver's license -
Answer representative of state DMV (physicians can make
recommendations but can't legally restrict)
MC causes of CAP in healthy adolescents - Answer Mycoplasma,
Chlamydophilia, group A Strep (outpatient -> azithromycin; inpatient ->
ceftriax + erythromycin/azithromycn
Still suspecting subarachnoid bleed (continued worse HA) after
neg/equivocal head CT, next step? - Answer lumbar puncture (look for
xanthochromia, its absence rules out subarachnoid bleed)
Morphine should be avoided in patients with this kind of organ disease
- Answer renal disease; toxic metabolites of morphine are not
eliminated by kidneys in this case -> resp depression, myoclonus,
confusion (use fentanyl, methadone in CKD)
Do this if you find trace valvular regurgitation on initial
echocardiogram - Answer nothing, normal finding (70-90% of norm
individuals)
Risk factor for esophageal adenocarcinoma - Answer obesity -> GERD
Rx: Increase risk of bruising, oral candidiasis, decrease COPD
exacerbations, but no effect on mortality/FEV1 - Answer inhaled
corticosteroids
Post-tx febrile reaction w/malaise and HA within a 6-8 hours of treating
syphilis - Answer Jarisch-Herxheimer reaction -> reassurance, pyretics
Other receptors besides aldosterone that are bound by spironolactone
- Answer androgen and progesterone -> breast tenderness/
gynecomastia (eplerenone, ++specific to aldost-R, less ADEs)
