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ABIM Core Scripts Questions And Answers Latest Solution
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ABIM Core Scripts Questions And Answers LatestSolution
Young adult, no meds, presents with non-pitting lip edema that:
Began in adolescence
Triggered by strong emotions, crying
Preceded by tingling lips and swelling over 24 hrs
Resolves in 1-2 days
2-4 attacks/ year
Unresponsive to antihistamines
low C4 during episodes Correct Answer: Hereditary angioedema
Young female with 6 month H/O
Fever, wt loss, arthralgias
Recurrent sinus infections
Intermittent hematuria
Papulosquamous rash on cheeks, extends to nose, spares nasolabial folds
Violaceous mottled rash on forearms, thighs
Bilateral active synovitis of MCPs
Low WBC, Hgb, plts, + Coombs, hematuria, proteinuria, + anti-dsDNA and anti-Sm
H/O childhood pneumonia with one episode of pneumococcal bacteremia Correct Answer: SLE
presenting with early complement deficiency
See complement deficiency, esp C1q
Young adult, H/O N. meningitidis bacteremia at age 15, presents with:
Fever
HA
Stable BP
Diffuse erythematous maculopapular rash on extremities and thorax. Petechiae on oral mucosa and
conjunctiva
Absent Kernig, Brudzinski
BCx- Gram neg cocci Correct Answer: N. men meningitis with terminal complement deficiency
Usually have a less fulminant disease course
Healthy patient with acute onset of:
Generalized hives
Dyspnea, wheezing after using latex gloves for the first time
Tachycardia
hypoxia
Decreased air movement in lungs with audible wheezing Correct Answer: Anaphylaxis
Do NOT require HoTN
Common triggers: drugs (B-lactams), insect stings, foods (shellfish, peanuts), food additives
Healthy pt with:
Itchy hives on thighs, chest after exercise and hot showers
No wheezing, dyspnea Correct Answer: Cholinergic urticaria
,Healthy pt with:
Chronic rhinorrhea and nasal congestion in the spring and fall
Bilateral conjunctival injection, dark circles around the eyes, Dennie-Morgan lines (accentuated lines
under the eyes)
Pale blue nasal mucose with edema of the turbinates Correct Answer: Allergic rhinitis
Pt presents with:
Chronic nasal congestion, worse in spring and fall
Swollen and "beefy red" or "boggy, erythematous" nasal mucosa Correct Answer: Rhinitis
medicamentosa
Note nasal exam is different from AR
Young patient with:
Diarrhea
Foul smelling stools
PMH: frequent ear, sinus infections as a child, allergies to several foods
+ Giardia stool antigen Correct Answer: Selective IgA deficiency
85% have no symptoms
Can see false positive pregnancy test, anaphylaxis with blood transfusion
Previously healthy person presents with 1 week of:
Exertional dyspnea and fatigue
Chest discomfort and fullness
Leg edema with clear lungs
Low BP, SBP drops >10 with ispiration
JVD with rapid x descent (nl/ absent y descent)
EKG: sinus tach, low voltage, diffuse ST elevation with some T wave inversions
CXR- enlarged cardiac silhouette Correct Answer: Acute pericarditis with tamponade
Subacute onset, usually idiopathic
Pulsus paradoxus (also in asthma, COPD, PE)
Could see PA cath with equalization of diastolic pressures
DDx - constrictive pericarditis (both x+y descent), MI (different EKG), Ao dissection (no JVD, edema)
Pt with HO HTN, presents with acute CP and:
HoTN
JVD, increased a+v waves
EKG: sinus brady, ST elevation in II, III, aVF, and V4R-V6R
PA cath: low CO, PCWP, increased RAP Correct Answer: IWMI with RV infarct
Pt with confusion and hypotension:
low CO
High PCWP
High RAP Correct Answer: Cardiogenic shock
Pt with history of exertional syncope presents with:
Nl PCWP
high RAP Correct Answer: Pulmonary HTN
Pt admitted to the CCU for MI, has CV cath placed in R IJ position, develops:
Recurrent CP
,Dyspnea and confusion
Tachypnea, hypotension with decrease in SBP>10 with inspiration
Distended neck veins
Diminished breath sounds on the right Correct Answer: Tension penumothorax
In DDX of post MI decompensation (papillary muscle rupture, free wall rupture, septal rupture), none
have pulsus paradoxus, distended neck veins, reduced breath sounds
Can also see in pt on vent with high levels of PEEP
Young patient with long history of fatigue, exercise intolerance, episodic palps presents with acute
onset of:
R had weakness and dysarthria
Nl JVP but irregular pulse
No edema
Wide, fixed split S2 when standing
Midsystolic ejection murmur at 2nd ICS on L
EKG- tachycardic, sawtootth morphology
CXR- RA enlargement Correct Answer: Atrial septal defect, now with atrial flutter and embolic CVA
ASD->RAE->A. flutt-> CVA
Can also see 1st degr AV block, R axis deviation, incomplete RBBB
If severe RV overload, development of pulm HTN, can see fixed split S2. S2 gets louder with pulm
HTN
Pt with ischemic HD presents with:
Recent onset of lightheadedness and feeling like going to pass out
Decreased exercise capacity
Increased SL NTG use
HR<40
No JVD
Cannon a waves
EKG: wide QRS escape rhythm Correct Answer: Complete HB
Slow HR with wide QRS makes it an escape rhythm, unlike wide complex tachycardia
Female patient, smoker, on OCPs, presents with acute onset of:
Dyspnea, pleuritic CP
Hypotention, increased HR
Increased P2 component of S2
low pO2
High D-dimer
High troponin Correct Answer: Pulmonary embolism
Young patient with history of primary Raynaud syndrome presents with:
Acute chest discomfort
HTN
Positive UDS for cocaine
EKG: ST elevation >1mm in II, III, aVF, returns to nl as soon as chest discomfort subsides
Cath- nl coronaries Correct Answer: Variant angina (Prinzmetal;s)
Vasospasm is usually inferion
MI- EKG doesn't return to nl that quick
See it more often in pts with H/O raynauds
, Pt with hyperlipidemia, HTN now with MI, 3 days ago:
Acute dyspnea
Hypotension
Bilateral rales +/- JVD
Hyperdynamic precordium with new systolic murmur at the apex with wide radiation Correct Answer:
Papillary muscle rupture
See acute onset new MR murmur
Patient post-MI 3 days with:
Hypotension
JVD, bilateral rales, edema
Hyperdynamic precordium with a thrill, new loud, harsh, holosystolic murmur at the LLSB with wide
radiation Correct Answer: Ventricular septal rupture
See biventricular failure, murmur in different location
Pt with MI, now 3-5 days out, presents with:
Acute recurrent CP
Nausea
Restlessness
Hypotension
PR prolongation and ST elevation consistent with pericarditis Correct Answer: Ventricular free wall
rupture
Leads to tamponade, then death
This was an incomplete rupture that clotted over
40-50 y/o smoker presents with:
Claudication in feet and calves +/- hands, which progresses to rest pain
Ulceration on the toes and fingers
Negative ANA, RF, anti-centromere, anti-Scl-70, APLA
Nl complement
TEE: no intracardiac thrombus, valve lesions Correct Answer: Thromboangiitis obliterans
Smoking activates it
Think about with smoker and PVD symptoms
Exclude autoimmune vasculitis, endocarditis
60 y/o male presents with
Acute, severe, sharp CP, radiating to back and abdomen
Hypotension, >20 SBP between the upper extremities
Nl JVP
Diastolic, decrescendo murmur loudest at R 2nd ICS
EKG: non-specific ST, T wave changes
CXR- widened mediastinuim Correct Answer: Aortic dissection
With dissection near the AoV, can see it affect coronaries, give MI like EKG changes, but the pain
here is like dissection
Tearing, ripping, sharp pain
Male pt with know bicuspid AoV presents with:
Hypertension in the arms
Diminished femoral pulses
Low BP in the legs Correct Answer: Coarctation of the aorta
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