ABFM HYPERSTENSION EXAM: A+ GUIDE WITH LATEST
KEY QUESTIONS AND ANSWERS
Difference between posterior vitreous detachment and retinal detachment
Former may precede latter, patient experience increase in floaters but no light flashes or loss of vision
Which laboratory findings would be most consistent with von Willebrand disease?
Isolated prolonged partial thromboplastin time.
- Low levels of FVIII because one of the normal functions of vWF is to protect FVIII from degradation.
Vitamin D deficiency
Supplementation with activated vitamin D (calcitriol) is generally only necessary in patients with renal
failure or other conditions associated with inadequate activation of the storage forms of vitamin D.
U.S. federal labor law requires companies with >50 employees to provide which benefits for
employees who are nursing mothers?
- Reasonable unpaid break time to express milk
for up to 1 year following the birth of their children.
- Not required to provide refrigerated storage for the expressed milk.
- Provide a place to express milk, other than a bathroom, that is shielded from view and free from
intrusion from coworkers and the public.
C diff infection
Lab testing only on symptomatic patients
- Requires the presence of diarrhoea (>/= 3 unformed stools in a 24-hour period) or radiographic
evidence of ileus and toxic megacolon
Test of cure is not recommended after C. difficile treatment (PO Metronidazole or PO Vancomycin if
severe)
Proctalgia fugax
Episodic, sudden, sharp pains in the anorectal area lasting several seconds to minutes. The diagnosis is
based on a history that fits the classic picture in a patient with a normal examination.
Keratoacanthoma
Occurs most commonly on the face, grows very rapidly, and often is more nodular with a central pit.
Fragility fractures due to osteoporosis
Hip, spine, wrist
Urinary retention is the most frequent finding in cauda equina syndrome
Usually due to a massive, centrally herniated disc
,Falsely elevated HbA1c
Hypertriglyceridemia, hyperbilirubinemia, iron deficiency anaemia, splenectomy, renal failure, and
aplastic anaemia.
Osteoporosis screening in men
Men older than 50 with a minimal-trauma fracture and men with conditions associated with bone loss
could be considered for screening.
The National Osteoporosis Foundation recommends screening all men age 70 and above for
osteoporosis.
Hypotestosteronism is not an infrequent cause of osteoporosis in men.
Acute salpingitis
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.
Advantage of interferon-gamma release assay (IGRA, QuantiFERON-TB Gold) over tuberculin test for
TB screening
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.
Most likely to improve outcomes in schizophrenia
The combination of antipsychotic medication and psychosocial treatments, including CBT, family
therapy, and social skills training.
Preferred method for diagnosing psychogenic nonepileptic seizures (pseudoseizures) is
Video-electroencephalography (vEEG) monitoring
Treatment of choice for Kawasaki
IVIG and high-dose aspirin to reduce the risk of coronary abnormalities
Acute migraine not responding to NSAIDs
, 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.
Hyperandrogenism
The rapid onset and high testosterone level suggest an ovarian or adrenal tumour that should be
evaluated by CT Abdo-Pelvis.
Most prevalent form of elder abuse
Financial exploitation
If present, would indicate a diagnosis other than chronic fatigue
syndrome (myalgic encephalomyelitis)?
Joint erythema
The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics
support the advance provision of emergency contraception to sexually active women.
Decreases the time from unprotected sex to use of emergency contraception.
Expected physiologic change in elderly patients?
Wider pulse pressure
Asymptomatic microscopic hematuria definition
>/= 3 RBCs/hpf in the absence of an obvious cause such as menstruation, infection, vigorous exercise,
renal disease, trauma, a recent urologic procedure, or a viral illness. Urine microscopy is required to
confirm.
The recommended initial workup (esp. if suspecting malignancy) includes renal function testing, CT
urography, and cystoscopy.
Herbal supplement with most benefit in joint pain relief
S-adenosyl-L-methionine is found in all human cells and assists in producing a wide range of compounds
such as cartilage and neurotransmitters
Inpatient treatment of CAP in the elderly
Azithromycin + beta-lactam e.g. Ceftriaxone
- Decreased mortality, greater clinical stability
Pertussis cough (can induce vomiting)
PCR for definite diagnosis
Rx: Macrolides e.g. Azithromycin, or Co-trimoxazole
KEY QUESTIONS AND ANSWERS
Difference between posterior vitreous detachment and retinal detachment
Former may precede latter, patient experience increase in floaters but no light flashes or loss of vision
Which laboratory findings would be most consistent with von Willebrand disease?
Isolated prolonged partial thromboplastin time.
- Low levels of FVIII because one of the normal functions of vWF is to protect FVIII from degradation.
Vitamin D deficiency
Supplementation with activated vitamin D (calcitriol) is generally only necessary in patients with renal
failure or other conditions associated with inadequate activation of the storage forms of vitamin D.
U.S. federal labor law requires companies with >50 employees to provide which benefits for
employees who are nursing mothers?
- Reasonable unpaid break time to express milk
for up to 1 year following the birth of their children.
- Not required to provide refrigerated storage for the expressed milk.
- Provide a place to express milk, other than a bathroom, that is shielded from view and free from
intrusion from coworkers and the public.
C diff infection
Lab testing only on symptomatic patients
- Requires the presence of diarrhoea (>/= 3 unformed stools in a 24-hour period) or radiographic
evidence of ileus and toxic megacolon
Test of cure is not recommended after C. difficile treatment (PO Metronidazole or PO Vancomycin if
severe)
Proctalgia fugax
Episodic, sudden, sharp pains in the anorectal area lasting several seconds to minutes. The diagnosis is
based on a history that fits the classic picture in a patient with a normal examination.
Keratoacanthoma
Occurs most commonly on the face, grows very rapidly, and often is more nodular with a central pit.
Fragility fractures due to osteoporosis
Hip, spine, wrist
Urinary retention is the most frequent finding in cauda equina syndrome
Usually due to a massive, centrally herniated disc
,Falsely elevated HbA1c
Hypertriglyceridemia, hyperbilirubinemia, iron deficiency anaemia, splenectomy, renal failure, and
aplastic anaemia.
Osteoporosis screening in men
Men older than 50 with a minimal-trauma fracture and men with conditions associated with bone loss
could be considered for screening.
The National Osteoporosis Foundation recommends screening all men age 70 and above for
osteoporosis.
Hypotestosteronism is not an infrequent cause of osteoporosis in men.
Acute salpingitis
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.
Advantage of interferon-gamma release assay (IGRA, QuantiFERON-TB Gold) over tuberculin test for
TB screening
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.
Most likely to improve outcomes in schizophrenia
The combination of antipsychotic medication and psychosocial treatments, including CBT, family
therapy, and social skills training.
Preferred method for diagnosing psychogenic nonepileptic seizures (pseudoseizures) is
Video-electroencephalography (vEEG) monitoring
Treatment of choice for Kawasaki
IVIG and high-dose aspirin to reduce the risk of coronary abnormalities
Acute migraine not responding to NSAIDs
, 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.
Hyperandrogenism
The rapid onset and high testosterone level suggest an ovarian or adrenal tumour that should be
evaluated by CT Abdo-Pelvis.
Most prevalent form of elder abuse
Financial exploitation
If present, would indicate a diagnosis other than chronic fatigue
syndrome (myalgic encephalomyelitis)?
Joint erythema
The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics
support the advance provision of emergency contraception to sexually active women.
Decreases the time from unprotected sex to use of emergency contraception.
Expected physiologic change in elderly patients?
Wider pulse pressure
Asymptomatic microscopic hematuria definition
>/= 3 RBCs/hpf in the absence of an obvious cause such as menstruation, infection, vigorous exercise,
renal disease, trauma, a recent urologic procedure, or a viral illness. Urine microscopy is required to
confirm.
The recommended initial workup (esp. if suspecting malignancy) includes renal function testing, CT
urography, and cystoscopy.
Herbal supplement with most benefit in joint pain relief
S-adenosyl-L-methionine is found in all human cells and assists in producing a wide range of compounds
such as cartilage and neurotransmitters
Inpatient treatment of CAP in the elderly
Azithromycin + beta-lactam e.g. Ceftriaxone
- Decreased mortality, greater clinical stability
Pertussis cough (can induce vomiting)
PCR for definite diagnosis
Rx: Macrolides e.g. Azithromycin, or Co-trimoxazole
