ABFM HYPERSTENSION EXAM: A+ GUIDE WITH LATEST
KEY QUESTIONS AND ANSWERS
Catheterisation in acute urinary retention
The likelihood of a successful return to voiding spontaneously will increase over time. However, the risk
of catheter-associated urinary tract infection is estimated to be about 5% per day. Therefore, catheter
removal and a trial of spontaneous voiding should be attempted after 48-72 hours.
There is good evidence that starting an alpha-blocking medication such as tamsulosin during the time
the catheter is in place will nearly double the success of the trial of spontaneous voiding.
What is a benefit of the use of probiotics in children?
They prevent antibiotic-associated diarrhea
For diagnosis of malignant melanoma
The American Academy of Dermatology recommends an excision with narrow margins (1-3 mm) that
includes the entire gross lesion with clinically negative margins to a depth that ensures the lesion is not
transected.
Once the tissue diagnosis is obtained, appropriate staging and definitive surgery should be undertaken.
Which is the most important risk factor for being a victim of domestic abuse?
Gender i.e. female
Which histologic type of colonic polyps >1.0 cm in size has the highest likelihood of becoming
malignant?
Villous adenomas
- Hyperplastic polyps are the most common histologic type by far, but only rarely become cancerous.
Criteria for diagnosing diabetes
HbA1c >/= 6.5%, a fasting plasma glucose level >/= 126 mg/dL, a 2-hour plasma glucose level >/= 200
mg/dL, or, in a symptomatic patient, a random blood glucose level >/= 200 mg/dL. In the absence of
unequivocal hyperglycemia, results require confirmation by repeat testing.
Management of liver cirrhosis
Dietary counselling is key
- Patients with ascites should be limited to 2000 mg of sodium daily
- Often suffers from malnutrition and hence high-protein diet recommended (also results in improved
mental status)
, Statins can be safely used in patients with cirrhosis. Their cardiovascular benefits are well established
and the risk of associated liver failure is extremely low.
In a patient with suspected pulmonary embolism, next investigations include
- A D-dimer level is the next most appropriate test for this low-probability scenario.
- Compression ultrasonography would be the next test for a patient with an intermediate or high pretest
probability for DVT.
- CT angiography would be the next test for a clinically stable patient with an intermediate or high
pretest probability of pulmonary embolism. A VQ scan would be the next test if a CT angiogram were
indicated in a patient with a contraindication such as contrast allergy, renal disease, or pregnancy.
- Echocardiography would be the next test for a critically ill patient with a high pretest probability of
pulmonary embolism.
HbA1c goal for diabetics
In patients >/= 65 years of age treated with medication for type 2 diabetes mellitus, HbA1c of 7%-8%
have shown the greatest reduction in mortality in multiple studies.
Radiographic character of small bowel obstruction
Central abdomen, minimal or no colonic gas if mechanical, otherwise multiple gas-filled levels with
distended bowel resembling inverted U, valvulae conniventes also known as Kerckring folds/valves or
plicae circulares.
Medications shown to improve mortality in patients with heart failure with a reduced ejection
fraction
ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, and in African-American patients, direct-
acting vasodilators.
- Among the beta-blockers, carvedilol, bisoprolol, and
metoprolol succinate have this indication.
In a patient with sepsis, vasopressors are indicated when fluid resuscitation does not restore organ
perfusion and blood pressure.
Norepinephrine and dopamine are the preferred pressor agents; however, norepinephrine appears to
be more effective and has a lower mortality rate. It is a potent vasoconstrictor and inotropic stimulant
and is useful for shock. As a first-line therapy, norepinephrine is associated with fewer adverse events,
including arrhythmia, compared to dopamine.
Buckle/torus fractures revealed as a bend in the cortex of the distal radius
Will heal with almost any choice of treatment. Most clinicians opt for casting to reduce the chance of
reinjury during the first few weeks of healing, but parent preference in this regard is important.
Long-acting reversible contraception (LARC) includes the copper IUD, levonorgestrel IUDs, and
subdermal implants.
KEY QUESTIONS AND ANSWERS
Catheterisation in acute urinary retention
The likelihood of a successful return to voiding spontaneously will increase over time. However, the risk
of catheter-associated urinary tract infection is estimated to be about 5% per day. Therefore, catheter
removal and a trial of spontaneous voiding should be attempted after 48-72 hours.
There is good evidence that starting an alpha-blocking medication such as tamsulosin during the time
the catheter is in place will nearly double the success of the trial of spontaneous voiding.
What is a benefit of the use of probiotics in children?
They prevent antibiotic-associated diarrhea
For diagnosis of malignant melanoma
The American Academy of Dermatology recommends an excision with narrow margins (1-3 mm) that
includes the entire gross lesion with clinically negative margins to a depth that ensures the lesion is not
transected.
Once the tissue diagnosis is obtained, appropriate staging and definitive surgery should be undertaken.
Which is the most important risk factor for being a victim of domestic abuse?
Gender i.e. female
Which histologic type of colonic polyps >1.0 cm in size has the highest likelihood of becoming
malignant?
Villous adenomas
- Hyperplastic polyps are the most common histologic type by far, but only rarely become cancerous.
Criteria for diagnosing diabetes
HbA1c >/= 6.5%, a fasting plasma glucose level >/= 126 mg/dL, a 2-hour plasma glucose level >/= 200
mg/dL, or, in a symptomatic patient, a random blood glucose level >/= 200 mg/dL. In the absence of
unequivocal hyperglycemia, results require confirmation by repeat testing.
Management of liver cirrhosis
Dietary counselling is key
- Patients with ascites should be limited to 2000 mg of sodium daily
- Often suffers from malnutrition and hence high-protein diet recommended (also results in improved
mental status)
, Statins can be safely used in patients with cirrhosis. Their cardiovascular benefits are well established
and the risk of associated liver failure is extremely low.
In a patient with suspected pulmonary embolism, next investigations include
- A D-dimer level is the next most appropriate test for this low-probability scenario.
- Compression ultrasonography would be the next test for a patient with an intermediate or high pretest
probability for DVT.
- CT angiography would be the next test for a clinically stable patient with an intermediate or high
pretest probability of pulmonary embolism. A VQ scan would be the next test if a CT angiogram were
indicated in a patient with a contraindication such as contrast allergy, renal disease, or pregnancy.
- Echocardiography would be the next test for a critically ill patient with a high pretest probability of
pulmonary embolism.
HbA1c goal for diabetics
In patients >/= 65 years of age treated with medication for type 2 diabetes mellitus, HbA1c of 7%-8%
have shown the greatest reduction in mortality in multiple studies.
Radiographic character of small bowel obstruction
Central abdomen, minimal or no colonic gas if mechanical, otherwise multiple gas-filled levels with
distended bowel resembling inverted U, valvulae conniventes also known as Kerckring folds/valves or
plicae circulares.
Medications shown to improve mortality in patients with heart failure with a reduced ejection
fraction
ACE inhibitors, ARBs, beta-blockers, aldosterone antagonists, and in African-American patients, direct-
acting vasodilators.
- Among the beta-blockers, carvedilol, bisoprolol, and
metoprolol succinate have this indication.
In a patient with sepsis, vasopressors are indicated when fluid resuscitation does not restore organ
perfusion and blood pressure.
Norepinephrine and dopamine are the preferred pressor agents; however, norepinephrine appears to
be more effective and has a lower mortality rate. It is a potent vasoconstrictor and inotropic stimulant
and is useful for shock. As a first-line therapy, norepinephrine is associated with fewer adverse events,
including arrhythmia, compared to dopamine.
Buckle/torus fractures revealed as a bend in the cortex of the distal radius
Will heal with almost any choice of treatment. Most clinicians opt for casting to reduce the chance of
reinjury during the first few weeks of healing, but parent preference in this regard is important.
Long-acting reversible contraception (LARC) includes the copper IUD, levonorgestrel IUDs, and
subdermal implants.
