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ABFM EXAM 2024 QUESTIONS AND ANSWERS
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ABFM EXAM 2024 QUESTIONS AND ANSWERS
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ABFM EXAM2024 QUESTIONS
AND ANSWERS
25-year-old male presents for a pretravel consultation prior to embarking on a 10-day
mission trip to Central America with his church. His past medical history includes GERD,
irritable bowel syndrome, and generalized anxiety disorder. The last time he traveled
internationally he experienced a prolonged bout of traveler's diarrhea, despite his best
efforts at practicing good hand hygiene and careful food and drink selection. He asks if
there are any medications that he can take to prevent a similar experience this time.
Which one of the following is most appropriate for prophylactic use in this situation? -
Answers-Bismuth subsalicylate has been shown to decrease the risk of contracting
traveler's diarrhea by 50%-65% and may be considered for patients who are at
increased risk. Drawbacks include the frequent dosing of four times daily and the risk of
developing a black tongue and black stool. Bismuth subsalicylate is contraindicated in
the setting of aspirin allergy, kidney disease, breastfeeding, or concurrent anticoagulant
use. Medications that decrease gastric acidity, such as proton pump inhibitors, H2-
blockers, and antacids, substantially increase one's risk of contracting traveler's
diarrhea. Therefore, avoiding calcium carbonate and omeprazole would be preferable
for this patient. Prophylactic antibiotics typically are not recommended in this situation
although may be considered for those who are at particularly high risk of health
complications from a gastrointestinal illness. If a prophylactic antibiotic is desired,
rifaximin should be considered. Fluoroquinolones such as ciprofloxacin, however,
should be avoided for prophylactic use due to risks of inducing antibiotic resistance and
causing central nervous system side effects, QTc prolongation, medication interactions,
and tendon injuries. Probiotics have insufficient evidence of benefit for preventing
traveler's diarrhea
facial swelling + dyspnea in a patient with non Hodgkin lymphoma, with Chest Xray
notable for large hilar mass; In addition to hospitalization what would be the most
,appropriate urgent next step? - Answers-Radiation; This is an oncologic emergency with
the patient presenting symptoms of superior vena cava syndrome
After ensuring that the patient is hospitalized and stable, the initial treatment options
include intravenous corticosteroids, chemotherapy, radiation, and occasionally
intravascular stenting.
What is hyperviscocity syndrome? - Answers-Hyperviscosity syndrome is an oncologic
emergency associated with leukemia, multiple myeloma, and Waldenström
macroglobulinemia. It is treated with chemotherapy and plasmapheresis
What medications are involved in SMART therapy for asthma? - Answers-single
maintenance and reliever therapy (SMART) approach for asthma control, combination
therapy with an inhaled corticosteroid and a long-acting bronchodilator is used as both
controller and rescue medication
Formoterol is the only medication available in the United States recommended for use
in SMART therapy due to its rapid onset of action (Budesonide/Formoterol, Symbicort)
What is an indication for long term rather than short term proton pump inhibitor therapy?
- Answers-Gastroprotection in users of high dose NSAIDs at high risk for GI bleeding
Greatest risk factor for alzheimers? - Answers-age
Most appropriate initial pharmacotherapy for a temoporomandibular disorder in an
otherwise healthy 54 yo male? - Answers-The initial first-line pharmacologic therapy for
temporomandibular disorders is naproxen. Cyclobenzaprine may also be added if there
is evidence of muscle spasm (A recommendation). If this is unsuccessful, other options
include a trial of amitriptyline or gabapentin. Opioid therapy is not appropriate first-line
treatment for temporomandibular disorders. Corticosteroid injections should be avoided
due to potential cartilage damage (B recommendation).
Most common causes of thyroiditis? - Answers-Thyroiditis, a general term for
inflammation of the thyroid gland, is associated with thyroid gland dysfunction. It is
classified based on clinical symptoms: painless or painful, acute or subacute, and
underlying etiology (medication-induced, infection, radiation-induced, or autoimmune).
The most common forms of thyroiditis include Hashimoto, subacute, and postpartum.
Thyroiditis often results in a triphasic disease pattern of thyroid dysfunction:
hyperthyroidism due to the release of preformed thyroid hormone from damaged thyroid
cells followed by hypothyroidism when the thyroid stores are depleted. Eventually
normal thyroid function is restored, or the patient develops permanent hypothyroidism.
This patient presents with symptoms commonly seen in thyroid disease. Further testing
reveals elevated TSH and thyroid peroxidase (TPO) levels. Elevated TPO levels are
found in 95% of patients with Hashimoto thyroiditis. In addition, this patient's family
, history includes rheumatoid arthritis, another autoimmune disease, making Hashimoto
thyroiditis the most likely diagnosis. Treatment is lifelong thyroid hormone therapy
Elevated TPO levels are found in 95% of patients with what type of thyroiditis? -
Answers-Hashimotos
What kinds of medications are linked to thyroiditis? - Answers-Several medications are
linked to thyroiditis, including lithium, amiodarone, interferon-alfa, interleukin-2, immune
checkpoint inhibitors, and tyrosine kinase inhibitors
When would post partum thyroiditis occur? - Answers-s. Postpartum thyroiditis occurs
within 1 year of delivery, miscarriage, or medical abortion, not 2-3 years
How do you treat subacute thyroiditis? - Answers-Subacute thyroiditis is self-limited and
often occurs after upper respiratory infections, causing thyroid pain and dysphagia due
to inflammatory destruction of thyroid follicles.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Sometimes corticosteroids, a beta-blocker, or both
Mild discomfort (eg, sore throat, mild neck tenderness, muscle aches, low-grade fever)
is treated with high doses of aspirin or NSAIDs. In moderately or severely symptomatic
cases (eg, high fever, tachycardia, shortness of breath), corticosteroids (eg, prednisone
15 to 30 mg orally once a day, gradually decreasing the dose over 3 to 4 weeks)
eradicate all symptoms within 48 hours.
Bothersome symptoms of hyperthyroidism may be treated with a short course of a beta-
blocker. If hypothyroidism is pronounced or persists, thyroid hormone replacement
therapy may be required, rarely permanently.
In 2022 the American Gastroenterological Association published 10 best practice
statements to assist clinicians in addressing this issue. Key recommendations include
regular review and documentation of the indication for any ongoing PPI use, and to
consider discontinuing PPIs for any patient without a clear indication.
Strategies for PPI discontinuation include tapering or abrupt discontinuation. Rebound
acid hypersecretion can lead to a temporary increase in symptoms in either approach. If
deprescribing is attempted but not tolerated, patients may reasonably be continued on
the lowest effective dose
in, in some situations the benefits of PPIs do clearly outweigh the risks. Such indications
include Barrett esophagus, severe erosive esophagitis, eosinophilic esophagitis, and
high risk for upper gastrointestinal (GI) bleeding.
Risk factors for GI bleeding include prior ulcer, age >65, high-dose NSAID therapy, or
concurrent use of aspirin, corticosteroids, or anticoagulants. Such patients should be
advised to use PPIs indefinitely.
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