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ABFM 2021
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ABFM 2021 ABFM 2021 ABFM 2021
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ABFM 2021-year-old female is brought to your office by her mother because of a cough and fever. The mother
also tells you that the child has had a reduced appetite but she is drinking fluids normally. The child
was born at term and has previously been healthy. On examination the child appears alert and
happy. She has a temperature of 37.2°C (99.0°F), a pulse rate of 100 beats/min, a respiratory rate of
30/min, and an oxygen saturation of 98% on room air. An HEENT examination reveals clear
rhinorrhea. Auscultation of the lungs reveals mild expiratory wheezing throughout with no crackles,
and you note no signs of respiratory distress such as retractions or use of accessory muscles of
respiration. Which one of the following would be the most appropriate next step? - verified answer
reassurance only
RSV bronchiolitis; appears well hydrated and no signs of distress;
albuterol not helpful since mechanism of wheezing is not due to bronchospasm
. You are providing end-of-life care for a 53-year-old female with end-stage colon cancer. Her family
reports that she is having significant abdominal pain, nausea, and vomiting, and she is not able to
tolerate oral intake. You suspect a malignant bowel obstruction. Which one of the following
interventions would be most likely to significantly improve her symptoms?
A) Medical cannabis
B) Dexamethasone
C) Morphine
D) Octreotide (Sandostatin)
E) Polyethylene glycol (MiraLAX) - verified answer STEROIDS!!!!
this lady has malignant bowel obstruction and steroids act as a central antiemetic (for the nausea)
antiinflammatory, antisecretory and analgesic (so will help with pain); Recommend IV Dexa 4mg 3-4x
a day
Miralax can worsen the symptoms (will draw water in and cause more pressure, and still can't go
anywhere);
1-month-old infant is brought to your office by her parents for routine follow-up. The infant was
born at 35 weeks and 5 days gestation by normal vaginal delivery after induction of labor for
maternal preeclampsia with severe features. The infant was discharged with the mother on the third
day of life. There were no additional complications noted. Today the parents report exclusive
breastfeeding and tell you the infant spits up after longer feedings. Voiding and stooling are as
expected and the infant's development is normal. The weight at birth was at the 20th percentile, and
,today's weight is at the 25th percentile. Which one of the following would be the most appropriate
intervention at this time? A) Caloric supplementation in addition to breastfeeding
B) Iron supplementation
C) Vitamin E supplementation
D) Referral for early intervention - verified answer IRON SUPPL
Breastfed infants born before 37 weeks gestation should receive iron supplementation at 2
mg/kg/day after 1 month of life. This infant does have some physiologic reflux but since this infant
appears asymptomatic, the parents should be counseled on behavioral techniques to reduce spitting
up, as there is no clear long-term benefit to antireflux medication. This infant's growth and
development are normal so there is no indication for caloric fortification of breast milk, which is
more appropriate for small-for-gestational-age infants or those born below the 10th percentile
11-year-old female is brought to your office for a well child visit. The mother is concerned because
the patient's back seems to have a curve. The patient is not aware of this although she has frequent
back pain.An examination is notable for a BMI above the 95th percentile for her age, and breast bud
development. Menarche has not occurred. When she leans forward with her arms outstretched
there is a 12° curve in her spine with a rib hump. Radiography reveals a measured Cobb angle of
20°.Which one of the following indicates a need for referral to a specialist? (check one)
a) Back pain
b) A Cobb angle of 20°
c) Female sex
d) Obesity
e) Premenarchal status - verified answer cobb angle of 20
if the cobb angle is 20, then there is a high risk that the curve will progress and that the patient may
need treatment
12-year-old male with type 1 diabetes is brought to your office for routine follow-up. Laboratory
work performed prior to the appointment shows an LDL-cholesterol level of 120 mg/dL. In addition
to counseling the patient on a heart-healthy diet and daily physical activity, which one of the
following would you recommend? A) No additional measures B) Fish oil supplements C) Atorvastatin
(Lipitor) D) Ezetimibe (Zetia) E) Gemfibrozil (Lopid) - verified answer u r gonna give this 12 yo with
T1DM Lipitor
T1DM is a high risk condition for development of CV dz
guidelines recommend initiating a statin in addition to healthy diet for peds patient in this category
with an LDL >100
,13-year-old male is brought to your office for evaluation of back pain. Plain radiography would be
indicated at this time if the patient has... - verified answer pain that awakens him at night
American College of Radiology says that imaging in kids and adolescents with back pain can be
delayed unless there are a
> abnormal neuro findings
> pain that awakens the patient at night.
> pain that radiates or persist for more than 4 weeks
14 M caught shoplifting, smoking cigarettes at 10, truant for the also 2 years,,,injuring pet Dog,
starting fires outside their home - verified answer Conduct disorder most commonly occurs during
adolescence and childhood. There are multiple criteria, including aggression toward people and
animals, theft, starting fires, and truancy. It may be associated with other disorders. Antisocial
personality disorder, which is usually diagnosed after age 18
18-month-old female develops immune thrombocytopenic purpura following MMR administration in
your clinic. She requires hospitalization and extensive treatment. The child does not have any health
insurance coverage. The child's family could be eligible for compensation by the
A) clinic's malpractice insurance
B) vaccine manufacturer's liability coverage
C) Countermeasures Injury Compensation Program
D) National Vaccine Injury Compensation Program - verified answer common reactions to vaccines
are typically mild and include pain or swelling at the injection site, fever, drowsiness and rash
serious adverse reactions are rare but can include febrile seizures, immune thrombocytopenia
purpura and intussusception
19-year-old female presents with a 4-year history of intermittent facial acne. She tells you that her
acne has never completely resolved, and it worsens during her menstrual period. She has tried
various over-the-counter facial cleansers although she does not recall what they contained. On
examination she has scattered open and closed comedones, and pustules on her forehead and
around her mouth. Which one of the following treatments would you recommend? A) Topical
adapalene (Differin)
B) Topical clindamycin (Cleocin T)
C) Oral doxycycline
D) Oral isotretinoin (Absorica) - verified answer Scattered open and closed comedone w/ pustules;
but not sever, not nodular, so likely characyterized as mild inflammatory that can be treated with
Topical agent
, Of note, topical abx can lead to bacterial resistance so should not be used as monotherapy
oral abx= moderate to severe acne
severe nodular, then u go the PO tretinoin route
22-year-old gravida 1 para 0 was recently diagnosed with gestational diabetes. Her fasting blood
glucose levels have consistently been 120-130 mg/dL since she began following nutrition and
exercise recommendations. Based on guidelines from the American Diabetes Association and the
American College of Obstetricians and Gynecologists, which one of the following would be preferred
at this point?
A) No change in management
B) Loosening the calorie restrictions C) Adding glyburide
D) Adding insulin
E) Adding metformin (Glucophage) - verified answer Accepted goals are fasting blood glucose levels
<95 mg/dL, 1-hour postprandial glucose levels <140 mg/dL, and 2-hour glucose levels <120 mg/dL.
Although oral antidiabetic medications are being used more frequently in GDM, insulin is the
preferred treatment recommended by the American Diabetes Association and the American College
of Obstetricians and Gynecologists. Oral medication may be initiated in patients who refuse insulin
or are unable to comply with insulin management. This recommendation is made predominantly
because metformin has not shown superiority and there is a lack of long-term outcome studies in
the offspring exposed to metformin.
23-year-old gravida 1 para 1 who is a single mother of a 3-day-old infant comes to your office for a
newborn follow-up. She reports some sleep disturbance, mild depression without suicidal ideation,
and financial concerns. Her past medical history is significant for persistent depressive disorder. The
U.S. Preventive Services Task Force recommends which one of the following to help prevent
perinatal depression in patients such as this?
A) Exercise
B) Amitriptyline
C) Sertraline (Zoloft)
D) Referral for cognitive-behavioral therapy - verified answer cognitive behavioral therapy....
if you were to go the ssri route, paroxetine and sertraline are safe for breastfeeding
23-year-old primigravida comes to your office for her initial obstetric visit. She is at 13 weeks
gestation based on the dates of her last menstrual period. She is a nonsmoker and does not drink
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