ABFM ITE 2021 Exam Updated completely 100% solved
correctly Grade A+ (with Explanation) 200Q.
-A 67-year old male sees you for a Medicare annual wellness visit. He tell s you that his best friend had a
stroke and he asks about his risk for stroke. He has a family history of cardiovascular disease in his
father, who had a myocardial infarction at age 65 and died from a thrombotic stroke at age 71. The
patient exercises regularly and has a BMI of 27 kg/m2. His only current medical condition is
hyperlipidemia, and his cholesterol level is at goal on rosuvastatin (Crestor), 10 mg daily. He also takes
aspirin, 81 mg daily. His blood pressure 125/78 mmHg.
Based on US Preventive Services Task Force guidelines, which one of the following would be most
appropriate at this time?
A. No additional testing for stroke risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonography
D. Magnetic resonance angiography
E. CT angiography of the carotid arteries {{Correct Ans- ANSWER: A
No additional testing for stroke risk Carotid artery disease affects extra cranial carotid arteries and is
caused by atherosclerosis.
Explanation
This patient is asymptomatic and has no history of an ischemic stroke, neurology symptoms referable to
the carotid arteries such as amaurosis fugal, or TIA. He has risk factors for cardiovascular disease (age,
male sex, hyperlipidemia_, but the USPSTF recommends against specific screening asymptomatic carotid
artery stenosis (D recommendation) which a low prevalence in the general adult population. Stroke is a
leading cause of disability and death in the US, but asymptomatic carotid artery stenosis causes a
relatively small portion of strokes. Auscultation of the carotid arteries for bruits has been found to have
poor accuracy for detecting carotid stenosis and is not a reasonable screening approach. Appropriate
modalities for detecting carotid stenosis include carotid duplex ultrasonography, magnetic resonance
angiography, and computed tomography, but there are not recommended for screening asymptomatic
patients.
,-A 28 year old female presents for evaluation of nasal congestion, sneezing, watery eyes, and postnasal
drip. This has been an intermittent issue for her every spring and she would like to manage it more
effectively.
Which one of the following treatments has been shown to be the most effective and best tolerated first-
line therapy for this patient's condition?
A. A leukotriene receptor agonist
B. Intranasal corticosteroid monotherapy
C. Intranasal corticosteroids plus an oral antihistamine
D. Inhaled corticosteroids
E. Annual triamcinolone injections {{Correct Ans- ANSWER: B
Intranasal corticosteroid monotherapy
Explanation
This patient has seasonal allergic rhinitis. A joint guideline statement from the American Academy of
Allergy, Asthma, and Immunology/American College of Allergy, Asthma and Immunology Joint Task
Force on Practice Parameters recommends that mono therapy with intranasal corticosteroids would be
prescribed initially in patients equal to or more than 12 years of age rather than combined treatment
with oral antihistamines because data has not shown an additional benefit to adding the antihistamine.
Higher patient adherence and tolerance and fewer side effects were seen with the mono therapy
regimen. High quality evidence indicates that intranasal corticosteroids were more effective than
leukotriene receptor antagonists. Inhaled corticosteroids and triamcinolone injections are not
appropriate first line options for the treatment of seasonal allergic rhinitis
-A 68 year old female presents with a 2 month history of watery diarrhea. She has not had any blood or
pus in her stools, and the stools are not oily. She has not had any history of fever, chills, or weight loss,
and has not traveled recently. She smokes one pack of cigarettes per day. Her medications include
ibuprofen, sertraline and pantoprazole. A CBC, metabolic panel, CRP, IgA anti tissue transglutaminase
level, total IgA level, and stool guaiac test are all normal.
Which one of the following tests would be mostly likely to yield a diagnosis?
A. C difficile toxin
,B. Colonoscopy
C. Fecal calprotectin
D. A stool culture
E. Stool exam for ova and parasites {{Correct Ans- ANSWER: B
Colonoscopy
Explanation
In patients with chronic nonbloody diarrhea, the differential diagnosis includes microscopic (lymphocytic
or collagenous) colitis. The mucosa appears normal on colonoscopy but a biopsy will show lymphocytic
infiltration of the epithelium. The etiology is unknown but there are several risk factors to consider,
including older age, female sex, and smoking status. Drugs with a high level of evidence causing
microscopic colitis include NSAIDs, PPIs, sertraline, acarbose, aspirin, and ticlopidine. C. diff should be
suspected in individuals who have taken antibiotics in the past 3 months. Fecal calprotectin is elevated
in inflammatory diarrhea such as Crohn's disease or ulcerative colitis. A stool culture would be indicated
if there is a suspicion of an infectious bacterial diarrhea such as Shigella or Salmonella, but these
bacteria tend to cause bloody diarrhea. Checking for a parasitic infection should be considered for
patients with a history of recent travel or exposure to unpurified water.
-A 23 year old male with opioid use disorder requests buprenorphine therapy. He is still actively using
immediate release oxycodone and he took a dose 2 hours ago.
This patient should begin buprenorphine induction
A. Now
B. In 2 hours
C. 8-12 hours after his last opioid use
D. 24 hours after his last opioid use
E. 1 week after his last opioid use {{Correct Ans- ANSWER: C
8-12 hours after his last opioid use
Explanation
Buprenorphine is a partial opioid agonist. In order to reduce the risk of precipitated withdrawal,
buprenorphine induction should begin once the patient is exhibiting signs of mild to moderate
, withdrawal, usually 8-12 hours after the last opioid use. Waiting until a patient goes through a full
withdrawal increases the chances that the patient will revert back to using opi oids.
-A 45 year old left hand dominant female presents to your office with a lump on her hand. She first
noticed the lump 2 weeks ago and thinks it has gotten bigger. She does not recall any injury. She has not
had any numbness, weakness, or tingling. She has minimal discomfort when she presses on the lump,
and it does not affect her activity. On examination her left wrist is neurovascularly intact.
Which one of the following management options would you recommend?
A. Re-examination if she develops numbness, weakness, or increased pain
B. Immobilization of the wrist for 6 weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the lesion with a corticosteroid
E. Referral for excision of the lesion {{Correct Ans- ANSWER: A. Re-examination if she develops
numbness, weakness or increased pain
Explanation
This patient has a ganglion cyst, which is common and resolves spontaneously in 50% of cases, and
watchful waiting would be most appropriate at this time. Treatment is indicated if the cyst is causing
significant symptoms such as pain, numbness, or weakness, or for cosmetic symptoms. Aspiration of the
lesion is the initial treatment, although recurrence may occur in 85% of cases. Immobilizing the wrist
with a splint or brace is sometimes helpful in the short term if the patient is bothered by the symptoms,
but immobilization does not provide lasting relief and could cause muscle atrophy. Corticosteroid
injections have not shown any benefit. Referral for excision is appropriate if there has been no
improvement. Patients should be advised that there is a 10%-15% recurrence rate even after excision.
-A 57 year old female with diabetes mellitus comes to your office for a routine follow up. Her current
medications include metformin 1000 mg twice daily. She tells you that she does not exercise regularly
and finds it difficult to follow a healthy diet. HbA1c today is 7.5%. She does not want to add medications
at this time, but she does want to het her HbA1c below 7%, which is the goal that was previously
discussed.
Which one of the following would be the most effective way to improve glucose control for this patient.
