ABFM DIABETES TEST QUESTIONS WITH ANSWERS

ABFM DIABETES TEST QUESTIONS WITH ANSWERS During rounds at the nursing home, you are informed that there are two residents on the unit with laboratory-confirmed influenza. According to CDC guidelines, who should receive chemoprophylaxis for influenza? - ANSWER- In long-term care facilities, an influenza outbreak is defined as two laboratory-confirmed cases of influenza within 72 hours in patients on the same unit. The CDC recommends chemoprophylaxis for all asymptomatic residents of the affected unit. Any resident exhibiting symptoms of influenza should be treated for influenza and not given chemoprophylaxis dosing. Chemoprophylaxis is not recommended for residents of other units unless there are two laboratory-confirmed cases in those units. Facility staff of the affected unit can be considered for chemoprophylaxis if they have not been vaccinated or if they had a recent vaccination, but chemoprophylaxis is not recommended for all staff in the entire facility. Long-term proton pump inhibitor use is associated with an increased risk for A) Barrett's esophagus B) gout C) hypertension D) pneumonia E) type 2 diabetes - ANSWER- ANSWER: D Acid suppression therapy is associated with an increased risk of community-acquired and health care-associated pneumonia, which is related to gastric overgrowth by gramnegative bacteria. Long-term treatment of Barrett's esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI therapy does not increase the risk of gout, hypertension, or type 2 diabetes. An 87-year-old female comes to your office for an annual health maintenance visit. She appears cachectic and tells you that for the past 6 months she has had a decreased appetite and generalized muscle weakness. The patient is alert and oriented to person and place. She has a 10% weight loss, dry mucous membranes, and tenting of the skin on the extensor surface of her hands. While inflating the blood pressure cuff on her right arm you observe carpopedal spasms. Which one of the following is the most likely electrolyte disturbance? A) Hypercalcemia B) Hypocalcemia C) Hypokalemia D) Hypernatremia E) Hyponatremia - ANSWER- ANSWER: B A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the nerves that control them, is present in up to 94% of patients with hypocalcemia. Hypercalcemia is more likely to present with hyperreflexia. Patients with hypokalemia, hypernatremia, or hyponatremia may present with weakness and confusion, but tetany is not a common sign of either sodium or potassium imbalance. A 24-year old female presents to your office with a 3-month history of difficulty sleeping. She says that she struggles to fall asleep and wakes up multiple times at night at least three times a week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of the night trying to fall back asleep. Lately she has been feeling fatigued and having difficulty concentrating at work. You conduct a full history and physical examination and tell her to return in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping an average of 51⁄2 hours per night. Which one of the following would be the most appropriate recommendation? A) Set her alarm for 5:30 a.m. B) Add a mid-afternoon nap C) Move her bedtime to 9:00 p.m. D) Move her bedtime to 12:30 a.m. E) Stay up for an hour if she wakes up at 3:00 a.m. - ANSWER- ANSWER: D This patient presents with symptoms of chronic insomnia. Cognitive-behavioral therapy for insomnia (CBT-I) and brief behavioral therapy for insomnia (BBT-I) are effective nonpharmacologic treatments for chronic insomnia. Modified CBT-I and BBT-I can be administered by a primary care physician. The basic principles include stimulus control (sleep hygiene) and sleep restriction. Reducing time in bed increases sleep efficiency. In this case, 6 hours of time in bed would improve the patient's sleep efficiency and a bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is accomplished by postponing bedtime rather than getting up earlier. Naps generally do not improve sleep efficiency. While getting out of bed is recommended after being in bed for 30 minutes without falling asleep, or being awake for 30 minutes after being asleep, staying up for a prescribed period of time is not recommended. A 16-year-old female presents with chronic acne on her nose, forehead, and chin consisting of a few comedones and a few mildly inflamed papules and pustules. She says it is minimally improved after 12 weeks of daily adapalene 0.1% gel. There are no scars or cysts. The patient would like to try to achieve better control. Which one of the following would you recommend at this time? A) Continue adapalene 0.1% gel for 12 more weeks B) Add clindamycin (Cleocin T) 1% gel for up to 12 weeks C) Add clindamycin 1% gel for maintenance D) Stop adapalene 0.1% gel and start clindamycin 1% gel for maintenance E) Stop adapalene 0.1% gel and start erythromycin 2% gel for maintenance - ANSWER- ANSWER: B Family physicians are often asked to manage mild to moderate acne vulgaris. Topical retinoids such as adapalene and benzoyl peroxide are first-line therapy and a trial of therapy is typically 8-12 weeks. Topical antibiotics may be added to topical retinoids or benzoyl peroxide to achieve better symptom control. To decrease emerging antibiotic resistance, studies support limiting antibiotic use to 12 weeks except in severe cases, not using antibiotics as monotherapy, and using clindamycin rather than erythromycin. Adding clindamycin gel rather than erythromycin gel for up to 12 weeks is recommended for this patient at this time. A 57-year-old male with a history of heart failure sees you for follow-up. He describes symptoms of mild dyspnea on exertion with ordinary activities such as shopping or yard work. An echocardiogram shows an ejection fraction of 37%. According to the New York Heart Association criteria, this patient's heart failure would be classified as which one of the following? A) Class I B) Class II C) Class III D) Class IV - ANSWER- ANSWER: B The appropriate classification of heart failure is important for monitoring the disease. The most common currently used system is the New York Heart Association (NYHA) functional classification. In this system, class I is defined as heart disease in a patient with no symptoms and no limitations of physical activity. Patients with class II heart failure have mild symptoms with normal physical activity. Class III heart failure refers to significant limitations of activity, including symptoms with less than normal activities. Patients with class IV heart failure have symptoms at rest and are unable to carry on activity without discomfort. A 24-year-old female presents with progressively worsening vulvar pain for 3 days. On examination a 3×3-cm tender, fluctuant mass is noted on the right labia minora. She had a similar episode of this problem last year. Which one of the following would be the most appropriate management? A) Expectant management B) Fine-needle aspiration C) Incision and drainage D) Marsupialization E) Excision under general anesthesia - ANSWER- ANSWER: D