ABFM ITE EXAM 2023-
m m m
2024 ACTUAL EXAM 200 REAL EXAM QUESTIONS AND
m m m m m m m m
CORRECT DETAILED m
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
m m m m
|ALREADY GRADED A+ m m
Am42-year-oldmAsianmmale mpresentsmformfollow-
upmof melevatedmbloodmpressure.mHemhasmnomadditionalmchronicmmedicalmproblemsmandmismotherwise mas
ymptomatic.mAnmexaminationmismsignificantmformambloodmpressuremof m162/95mmmmHgmbutmismotherwisem
unremarkable.
LaboratorymworkmshowsmthatmhismBMPmismwithinmnormalmlimits.
AccordingmtomthemAmericanmCollegemofmCardiology/AmericanmHeartmAssociationm2017mguidelines,mwhic
hmone mof mthe mfollowingmwouldmbe mthe mmostmappropriate mmedicationmtominitiate matmthismtime?
A) Clonidine m(Catapres),m0.1mmgmtwice mdaily
B) Hydralazine,m25mmgmthree mtimesmdaily
C) Lisinopril/hydrochlorothiazide m(Zestoretic), m10/12.5mmgmdaily
D) Metoprololmtartrate m(Lopressor), m25mmgmtwice mdaily
E) Triamterene m(Dyrenium), m50mmgmdailym-mANSWER-ANSWER:mC
ThismpatientmhasmhypertensionmandmaccordingmtombothmJNCm8mandmAmericanmCollegemof mCardiology/Am
ericanmHeartmAssociationm2017mguidelines,mantihypertensive mtreatmentmshouldmbeminitiated.mFormthemge
neralmnon-African-
Americanmpopulation,mmonotherapymwithmanmACEminhibitor,manmangiotensinmreceptormblocker,mamcalciu
mmchannelmblocker,mormamthiazidemdiureticmwouldmbemappropriate mforminitialmmanagement.mItmismalsomap
propriate mtominitiate mcombinationmantihypertensive mtherapymasmanminitialmmanagementmstrategy,maltho
ughmpatientsmshouldmnotmtake manmACEminhibitormandmanmangiotensinmreceptormblockermsimultaneously.m
Studiesmhavemshownmthatmbloodmpressure mcontrolmismachievedmfastermwithmtheminitiationmof mcombinatio
nmtherapymcomparedmtommonotherapy, mwithoutmanmincrease minmmorbidity.
Lisinopril/hydrochlorothiazide mwouldmbemanmappropriate mchoice minmthismpatient.mAlphamblockers,mvasod
ilators,mbeta-blockers,mandmpotassium-
sparingmdiureticsmare mnotmrecommendedmasminitialmchoicesmformthe mtreatmentmof mhypertension.
Am36-year-
oldmfemale mpresentsmformevaluationmofmelevatedmbloodmpressure.mShemismasymptomaticmandmdoesmnotmt
ake manymmedications.mOnmexaminationmhermbloodmpressuremism160/96mmmmHgmandmhermBMImism26mkg/
m2.mFastingmlaboratorymstudiesminclude mthe mfollowing:
Sodiumm142.
Potassiumm3.0.
Creatinine m0.76.
,Glucose m97.
,Whichmone mofmthemfollowingmadditionalmlaboratorymevaluationsmshouldmbe mperformedmtomassessmhermbloodmp
ressure?
A) Am24-hourmurine mcollectionmform5-hydroxyindoleaceticmacidm(5-HIAA)
B) Amserummaldosterone/reninmratio
C) Amserummcortisolmlevel
D) AmserummcystatinmCmlevelm-mANSWER-ANSWER:mB
Primarymhyperaldosteronismmshouldmbemsuspectedmasmamcause mformhypertensionmif mampatientmhasmamspo
ntaneouslymlowmpotassiummlevelmormpersistentmhypertensionmdespite mthemusemofmthree mormmoremantihyp
ertensive mmedications,mincludingmamdiuretic.mThismcanmbe mevaluatedmbymcheckingmamserummreninmactivity
m levelm andmam serumm aldosteronem concentration m andmdeterminingm themaldosterone/renin mratio. mPrimarym
hyperaldosteronismmtypicallympresentsmwithmamverymlowmserummreninmactivitymlevelmandmanmelevatedmser
ummaldosterone mconcentration.
Am24-hourmurine mcollectionmform5-hydroxyindoleaceticmacidm(5-
HIAA) mwouldmbemusedmtomevaluatemformamneuroendocrinemtumor,mwhichmcanmpresentmasmchronicmflushi
ngmandmdiarrhea.mCortisolmlevelsmcanmbe mcheckedmifmCushingmsyndromemismsuspected.mHypertensionmca
nmbe mpresentminmCushingmsyndrome,mbutmitmismtypicallymassociatedmwithmothermsignsmsuchmasmobesityman
dmanmelevatedmbloodmglucosemlevelmduemtominsulinmresistance.mCystatinmCmismammarkermofmrenalmfunction
m andm measurementm would m notm be m indicated m givenm thism patient's m normalm creatinine m level.
Am26-year-
oldmmale mdiagnosedmwithmcoccidioidomycosism(valleymfever)mdevelopsmamrashmonmthe mextensormsurfacesm
ofmhismlowermlegsmconsistingmofmpainful,msubcutaneous, mnonulcerated, merythematousmnodules.mThismrash
m ism consistentm withm whichm one m of m the m following?
A) Erythemamabmigne
B) Erythemaminfectiosum
C) Erythemammigrans
D) Erythemammultiforme
E) Erythemamnodosumm-mANSWER-ANSWER:mE
Erythemamnodosum,mampanniculitismthatmtypicallymaffectsmthemsubcutaneousmfatmonmthe manteriormsurfac
e mof mthemlowermlegs,mismassociatedmwithmcoccidioidomycosism(valleymfever) mandmcanmsuggestmthemdiagno
sis.mItmismammanifestationmof mthempatient'smimmunemresponse mandmoftenmindicatesmamgoodmprognosis.mIn
m addition m tom coccidioidomycosis,m itmcanm alsom be massociated mwithmstreptococcalm infections masm wellm asm t
uberculosis.
Erythemamabmignemismamcutaneousmrashmcausedmbymprolongedmheatmexposurem(suchmasmamheatingmpad)m
presentingmasmanmotherwisemasymptomatic,mred,mreticulatedmpatternmonmthemskin.mErythemaminfectiosu
mmismassociatedmwithmparvovirusmB19minfectionmandmismusuallymseenminmyoungmchildren.mItmmanifestsmas
m an
, erythematousmrashmofmthe mface m(slappedmcheekmappearance),marms,mandmlegs.mErythemammigransmisman
m expanding, merythematous, mannularmrashmwithmorm withoutm centralmclearingmandmismoftenmassociated m wit
hmtickmexposure m(Lyme mdisease).mErythemammultiforme mconsistsmof mraised,mannular,mtarget-
like mlesionsmwithmcentralmerythemamandmismusuallymassociatedmwithmherpesmsimplex mvirusmtype m1.
Am50-year-
oldmmale mpresentsmwithmchronicmabdominalmpain.mAmworkupmleadsmyoumtomsuspectmpepticmulcermdisease
,mandmyoumrefermhimmformendoscopy,mwhichmshowsmamsmallmduodenalmulcer.mThemendoscopistmalsomnot
esmsome msmallmesophagealmvaricesmwithoutmredmwale msigns.
Furthermevaluationmconfirmsmthatmthempatientmhasmcompensatedmcirrhosisminmthemsettingmof malcoholmuse
m disorder. m He mreadily m acceptsmthismdiagnosis m andm entersmanmAlcoholics m Anonymous mprogram. m Hism ulcer
m symptoms mresolve mwithm antibioticm therapym formHelicobacterm pylori. mHe msaysmhem hasmabstained mfromm al
coholmform6mweeks,mandmhe mwouldmlike mtomfurthermreduce mhismrisksmfrommcirrhosis.
The mmostmappropriate mnextmstepminmthe mmanagementmof mhismesophagealmvaricesmwouldmbe:
A) octreotide m(Sandostatin)
B) omeprazole m(Prilosec)
C) propranolol
D) endoscopicmvaricealmligation
E) repeatmendoscopyminm1-2myearsm- mANSWER-ANSWER:mE
Primarympreventionmof mvaricealmhemorrhagemismanmimportantmconsiderationminmthemmanagementmofmpati
entsmwithmcirrhosis.mAlthoughmthismpatient'smvaricesmweremdiagnosedmincidentally,mpatientsmwithmcirrhosi
smandmclinicallymsignificantmportalmhypertensionmshouldmbe mscreenedmformvaricesmeverym2-
3myearsmwithmesophagogastroduodenoscopy m(EGD).mEGDmcanmbemdeferredminmpatientsmwithmplateletmcou
nts
<150,000/mm3mandmtransientmelastographymwithmlivermstiffnessm<20mkPa.mOncemesophagealmvaricesmare
m identified, m them criteriam forminitiatingm prophylaxis mtompreventmvaricealmhemorrhagemism basedm onmthem risk
m of m bleeding. mFindings massociated mwithm amhighmrisk mof mbleedingm includemsmallm varicesm inm patients m withm
decompensatedmcirrhosis,msmallmvaricesmwithmredmwalemsignsm(thinningmof mthemvaricealmwall),mandmmedi
umm tomlarge mvarices.mPatientsmwithmsmallmvaricesmnotmmeetingmthese mcriteriamhavemamlowmriskmofmhemor
rhage mandmdomnotmrequire mprophylaxis.mTheymshouldmbe mrescreenedmwithmEGDmeverym1-2myears.
Formpatientsmrequiringmtreatmentmdue mtomhigh-
riskmfeatures,moptionsmformprimarymprophylaxismof mhemorrhage minclude mnonselective m-
blockersmsuchmasmpropranololmormendoscopicmvaricealmligation.mTreatmentmdecisionsmare mbasedmonmpati
entmpreference,mothermpotentialmcontraindications, mandmlocalmresources.mThe mneedmformrepeatmendosco
pyminmthese mcasesmwillmdependmonmthe mclinicalmcircumstances.mIfmnonselective m-
blockersmare mused,mtheymshouldmbe mcontinuedmindefinitely.mOctreotidemismonlymgivenmintravenouslymfor
m acute m hemorrhage. mTheremism nom evidencemthatmomeprazolemslows mthe mprogression m of mesophagealmvar
ices.
m m m
2024 ACTUAL EXAM 200 REAL EXAM QUESTIONS AND
m m m m m m m m
CORRECT DETAILED m
ANSWERS WITH RATIONALES (VERIFIED ANSWERS)
m m m m
|ALREADY GRADED A+ m m
Am42-year-oldmAsianmmale mpresentsmformfollow-
upmof melevatedmbloodmpressure.mHemhasmnomadditionalmchronicmmedicalmproblemsmandmismotherwise mas
ymptomatic.mAnmexaminationmismsignificantmformambloodmpressuremof m162/95mmmmHgmbutmismotherwisem
unremarkable.
LaboratorymworkmshowsmthatmhismBMPmismwithinmnormalmlimits.
AccordingmtomthemAmericanmCollegemofmCardiology/AmericanmHeartmAssociationm2017mguidelines,mwhic
hmone mof mthe mfollowingmwouldmbe mthe mmostmappropriate mmedicationmtominitiate matmthismtime?
A) Clonidine m(Catapres),m0.1mmgmtwice mdaily
B) Hydralazine,m25mmgmthree mtimesmdaily
C) Lisinopril/hydrochlorothiazide m(Zestoretic), m10/12.5mmgmdaily
D) Metoprololmtartrate m(Lopressor), m25mmgmtwice mdaily
E) Triamterene m(Dyrenium), m50mmgmdailym-mANSWER-ANSWER:mC
ThismpatientmhasmhypertensionmandmaccordingmtombothmJNCm8mandmAmericanmCollegemof mCardiology/Am
ericanmHeartmAssociationm2017mguidelines,mantihypertensive mtreatmentmshouldmbeminitiated.mFormthemge
neralmnon-African-
Americanmpopulation,mmonotherapymwithmanmACEminhibitor,manmangiotensinmreceptormblocker,mamcalciu
mmchannelmblocker,mormamthiazidemdiureticmwouldmbemappropriate mforminitialmmanagement.mItmismalsomap
propriate mtominitiate mcombinationmantihypertensive mtherapymasmanminitialmmanagementmstrategy,maltho
ughmpatientsmshouldmnotmtake manmACEminhibitormandmanmangiotensinmreceptormblockermsimultaneously.m
Studiesmhavemshownmthatmbloodmpressure mcontrolmismachievedmfastermwithmtheminitiationmof mcombinatio
nmtherapymcomparedmtommonotherapy, mwithoutmanmincrease minmmorbidity.
Lisinopril/hydrochlorothiazide mwouldmbemanmappropriate mchoice minmthismpatient.mAlphamblockers,mvasod
ilators,mbeta-blockers,mandmpotassium-
sparingmdiureticsmare mnotmrecommendedmasminitialmchoicesmformthe mtreatmentmof mhypertension.
Am36-year-
oldmfemale mpresentsmformevaluationmofmelevatedmbloodmpressure.mShemismasymptomaticmandmdoesmnotmt
ake manymmedications.mOnmexaminationmhermbloodmpressuremism160/96mmmmHgmandmhermBMImism26mkg/
m2.mFastingmlaboratorymstudiesminclude mthe mfollowing:
Sodiumm142.
Potassiumm3.0.
Creatinine m0.76.
,Glucose m97.
,Whichmone mofmthemfollowingmadditionalmlaboratorymevaluationsmshouldmbe mperformedmtomassessmhermbloodmp
ressure?
A) Am24-hourmurine mcollectionmform5-hydroxyindoleaceticmacidm(5-HIAA)
B) Amserummaldosterone/reninmratio
C) Amserummcortisolmlevel
D) AmserummcystatinmCmlevelm-mANSWER-ANSWER:mB
Primarymhyperaldosteronismmshouldmbemsuspectedmasmamcause mformhypertensionmif mampatientmhasmamspo
ntaneouslymlowmpotassiummlevelmormpersistentmhypertensionmdespite mthemusemofmthree mormmoremantihyp
ertensive mmedications,mincludingmamdiuretic.mThismcanmbe mevaluatedmbymcheckingmamserummreninmactivity
m levelm andmam serumm aldosteronem concentration m andmdeterminingm themaldosterone/renin mratio. mPrimarym
hyperaldosteronismmtypicallympresentsmwithmamverymlowmserummreninmactivitymlevelmandmanmelevatedmser
ummaldosterone mconcentration.
Am24-hourmurine mcollectionmform5-hydroxyindoleaceticmacidm(5-
HIAA) mwouldmbemusedmtomevaluatemformamneuroendocrinemtumor,mwhichmcanmpresentmasmchronicmflushi
ngmandmdiarrhea.mCortisolmlevelsmcanmbe mcheckedmifmCushingmsyndromemismsuspected.mHypertensionmca
nmbe mpresentminmCushingmsyndrome,mbutmitmismtypicallymassociatedmwithmothermsignsmsuchmasmobesityman
dmanmelevatedmbloodmglucosemlevelmduemtominsulinmresistance.mCystatinmCmismammarkermofmrenalmfunction
m andm measurementm would m notm be m indicated m givenm thism patient's m normalm creatinine m level.
Am26-year-
oldmmale mdiagnosedmwithmcoccidioidomycosism(valleymfever)mdevelopsmamrashmonmthe mextensormsurfacesm
ofmhismlowermlegsmconsistingmofmpainful,msubcutaneous, mnonulcerated, merythematousmnodules.mThismrash
m ism consistentm withm whichm one m of m the m following?
A) Erythemamabmigne
B) Erythemaminfectiosum
C) Erythemammigrans
D) Erythemammultiforme
E) Erythemamnodosumm-mANSWER-ANSWER:mE
Erythemamnodosum,mampanniculitismthatmtypicallymaffectsmthemsubcutaneousmfatmonmthe manteriormsurfac
e mof mthemlowermlegs,mismassociatedmwithmcoccidioidomycosism(valleymfever) mandmcanmsuggestmthemdiagno
sis.mItmismammanifestationmof mthempatient'smimmunemresponse mandmoftenmindicatesmamgoodmprognosis.mIn
m addition m tom coccidioidomycosis,m itmcanm alsom be massociated mwithmstreptococcalm infections masm wellm asm t
uberculosis.
Erythemamabmignemismamcutaneousmrashmcausedmbymprolongedmheatmexposurem(suchmasmamheatingmpad)m
presentingmasmanmotherwisemasymptomatic,mred,mreticulatedmpatternmonmthemskin.mErythemaminfectiosu
mmismassociatedmwithmparvovirusmB19minfectionmandmismusuallymseenminmyoungmchildren.mItmmanifestsmas
m an
, erythematousmrashmofmthe mface m(slappedmcheekmappearance),marms,mandmlegs.mErythemammigransmisman
m expanding, merythematous, mannularmrashmwithmorm withoutm centralmclearingmandmismoftenmassociated m wit
hmtickmexposure m(Lyme mdisease).mErythemammultiforme mconsistsmof mraised,mannular,mtarget-
like mlesionsmwithmcentralmerythemamandmismusuallymassociatedmwithmherpesmsimplex mvirusmtype m1.
Am50-year-
oldmmale mpresentsmwithmchronicmabdominalmpain.mAmworkupmleadsmyoumtomsuspectmpepticmulcermdisease
,mandmyoumrefermhimmformendoscopy,mwhichmshowsmamsmallmduodenalmulcer.mThemendoscopistmalsomnot
esmsome msmallmesophagealmvaricesmwithoutmredmwale msigns.
Furthermevaluationmconfirmsmthatmthempatientmhasmcompensatedmcirrhosisminmthemsettingmof malcoholmuse
m disorder. m He mreadily m acceptsmthismdiagnosis m andm entersmanmAlcoholics m Anonymous mprogram. m Hism ulcer
m symptoms mresolve mwithm antibioticm therapym formHelicobacterm pylori. mHe msaysmhem hasmabstained mfromm al
coholmform6mweeks,mandmhe mwouldmlike mtomfurthermreduce mhismrisksmfrommcirrhosis.
The mmostmappropriate mnextmstepminmthe mmanagementmof mhismesophagealmvaricesmwouldmbe:
A) octreotide m(Sandostatin)
B) omeprazole m(Prilosec)
C) propranolol
D) endoscopicmvaricealmligation
E) repeatmendoscopyminm1-2myearsm- mANSWER-ANSWER:mE
Primarympreventionmof mvaricealmhemorrhagemismanmimportantmconsiderationminmthemmanagementmofmpati
entsmwithmcirrhosis.mAlthoughmthismpatient'smvaricesmweremdiagnosedmincidentally,mpatientsmwithmcirrhosi
smandmclinicallymsignificantmportalmhypertensionmshouldmbe mscreenedmformvaricesmeverym2-
3myearsmwithmesophagogastroduodenoscopy m(EGD).mEGDmcanmbemdeferredminmpatientsmwithmplateletmcou
nts
<150,000/mm3mandmtransientmelastographymwithmlivermstiffnessm<20mkPa.mOncemesophagealmvaricesmare
m identified, m them criteriam forminitiatingm prophylaxis mtompreventmvaricealmhemorrhagemism basedm onmthem risk
m of m bleeding. mFindings massociated mwithm amhighmrisk mof mbleedingm includemsmallm varicesm inm patients m withm
decompensatedmcirrhosis,msmallmvaricesmwithmredmwalemsignsm(thinningmof mthemvaricealmwall),mandmmedi
umm tomlarge mvarices.mPatientsmwithmsmallmvaricesmnotmmeetingmthese mcriteriamhavemamlowmriskmofmhemor
rhage mandmdomnotmrequire mprophylaxis.mTheymshouldmbe mrescreenedmwithmEGDmeverym1-2myears.
Formpatientsmrequiringmtreatmentmdue mtomhigh-
riskmfeatures,moptionsmformprimarymprophylaxismof mhemorrhage minclude mnonselective m-
blockersmsuchmasmpropranololmormendoscopicmvaricealmligation.mTreatmentmdecisionsmare mbasedmonmpati
entmpreference,mothermpotentialmcontraindications, mandmlocalmresources.mThe mneedmformrepeatmendosco
pyminmthese mcasesmwillmdependmonmthe mclinicalmcircumstances.mIfmnonselective m-
blockersmare mused,mtheymshouldmbe mcontinuedmindefinitely.mOctreotidemismonlymgivenmintravenouslymfor
m acute m hemorrhage. mTheremism nom evidencemthatmomeprazolemslows mthe mprogression m of mesophagealmvar
ices.
