ABFM HYPERSTENSION EXAM: A+ GUIDE WITH LATEST
KEY QUESTIONS AND ANSWERS
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.
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.
Precocious puberty in boys
Penile enlargement before 9yo
Isolated sparse pubic and axillary hair growth and axillary odour is referred to as premature adrenarche,
and represents high levels of dehydroepiandrosterone rather than activation of the hypothalamic-
pituitary-gonadal axis that leads to puberty.
Incidental isolated leukocytosis
For most cases without a clear cause, a repeat CBC with differential and a peripheral smear review are
indicated to confirm leukocytosis, determine subtypes, and look for concerning abnormalities on the
smear.
The drug class of choice for the management of breathlessness in end-of-life care is
Opiates
When administered at appropriate doses, opiates do not reduce or compromise respiratory status and
do not hasten dying. Opiates help to reduce the sense of air hunger in patients with dyspnea.
Avoid Donepezil (used in Alzheimer's, cholinesterase inhibitor) in those with syncope
Due to increased risk of bradycardia (+ prolonged PR)
Hypertension in paediatric population
All paediatric patients with confirmed hypertension should have further evaluation to check for renal
dysfunction as well as other cardiac risk factors.
Additionally, renal ultrasonography is recommended to evaluate for renal disease and echocardiography
, to evaluate for end-organ damage that would affect treatment goals. Additional studies, such as plasma
renin and catecholamine levels or renovascular imaging, may be indicated in children with abnormalities
on initial evaluation that suggest secondary causes of hypertension.
Patients on valproate who present with altered mental status or encephalopathy
Hyperammonaemia
Somatic symptom disorder
Characterized by multiple unexplained physical symptoms, insistence on surgical procedures, and an
imprecise or inaccurate medical history.
SSRIs and tricyclic antidepressants (esp. Amitriptyline) have been found to be the most effective
pharmacotherapy.
What is the most accurate and appropriate manoeuvre to detect an
anterior cruciate ligament tear?
Lachman test
De Quervain's tenosynovitis usually occurs with repeated use of the thumb and is characterized by
pain in the radial wrist. The course is typically self-limited but can last for up to a year, so waiting
would not be a good option.
Immobilization in a thumb spica splint and an NSAID for 1-4 weeks.
Parvovirus 19 (erythema infectiosum)
The rash is a faint, maculopapular, irregular, reticulate exanthem that covers thighs and the inner
aspects of upper arms.
Symmetric synovitis is present in several distal and proximal interphalangeal joints and in the
metacarpophalangeal joints. Small effusions, warmth, and tenderness are noted in her left wrist and
right elbow.
Cervical lymphadenopathy with signs of infection i.e. fever, inflammation
Treat empirically with antibiotics and evaluate for improvement in 2-3 days
H pylori treat and test strategy
Appropriate for patients with dyspepsia who are younger than 55 years of age and have no alarm
symptoms for gastric cancer.
What additional test results must be documented before offering preexposure prophylaxis for HIV
with emtricitabine/tenofovir (Truvada)?
Antibody testing for HIV (as Truvada is inadequate in treating HIV), Hepatitis B surface antibody and
antigen, renal panel, STI screening, UPT
KEY QUESTIONS AND ANSWERS
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.
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.
Precocious puberty in boys
Penile enlargement before 9yo
Isolated sparse pubic and axillary hair growth and axillary odour is referred to as premature adrenarche,
and represents high levels of dehydroepiandrosterone rather than activation of the hypothalamic-
pituitary-gonadal axis that leads to puberty.
Incidental isolated leukocytosis
For most cases without a clear cause, a repeat CBC with differential and a peripheral smear review are
indicated to confirm leukocytosis, determine subtypes, and look for concerning abnormalities on the
smear.
The drug class of choice for the management of breathlessness in end-of-life care is
Opiates
When administered at appropriate doses, opiates do not reduce or compromise respiratory status and
do not hasten dying. Opiates help to reduce the sense of air hunger in patients with dyspnea.
Avoid Donepezil (used in Alzheimer's, cholinesterase inhibitor) in those with syncope
Due to increased risk of bradycardia (+ prolonged PR)
Hypertension in paediatric population
All paediatric patients with confirmed hypertension should have further evaluation to check for renal
dysfunction as well as other cardiac risk factors.
Additionally, renal ultrasonography is recommended to evaluate for renal disease and echocardiography
, to evaluate for end-organ damage that would affect treatment goals. Additional studies, such as plasma
renin and catecholamine levels or renovascular imaging, may be indicated in children with abnormalities
on initial evaluation that suggest secondary causes of hypertension.
Patients on valproate who present with altered mental status or encephalopathy
Hyperammonaemia
Somatic symptom disorder
Characterized by multiple unexplained physical symptoms, insistence on surgical procedures, and an
imprecise or inaccurate medical history.
SSRIs and tricyclic antidepressants (esp. Amitriptyline) have been found to be the most effective
pharmacotherapy.
What is the most accurate and appropriate manoeuvre to detect an
anterior cruciate ligament tear?
Lachman test
De Quervain's tenosynovitis usually occurs with repeated use of the thumb and is characterized by
pain in the radial wrist. The course is typically self-limited but can last for up to a year, so waiting
would not be a good option.
Immobilization in a thumb spica splint and an NSAID for 1-4 weeks.
Parvovirus 19 (erythema infectiosum)
The rash is a faint, maculopapular, irregular, reticulate exanthem that covers thighs and the inner
aspects of upper arms.
Symmetric synovitis is present in several distal and proximal interphalangeal joints and in the
metacarpophalangeal joints. Small effusions, warmth, and tenderness are noted in her left wrist and
right elbow.
Cervical lymphadenopathy with signs of infection i.e. fever, inflammation
Treat empirically with antibiotics and evaluate for improvement in 2-3 days
H pylori treat and test strategy
Appropriate for patients with dyspepsia who are younger than 55 years of age and have no alarm
symptoms for gastric cancer.
What additional test results must be documented before offering preexposure prophylaxis for HIV
with emtricitabine/tenofovir (Truvada)?
Antibody testing for HIV (as Truvada is inadequate in treating HIV), Hepatitis B surface antibody and
antigen, renal panel, STI screening, UPT
