ABFM EXAM ACTUAL EXAM 200 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+

ABFM EXAM 2023-2024 ACTUAL EXAM 200 QUESTIONS AND

CORRECT DETAILED ANSWERS WITH RATIONALES

(VERIFIED ANSWERS) |ALREADY GRADED A+

1. A 42-year-old Asian male presents for follow-up of elevated blood pressure. He

has no additional chronic medical problems and is otherwise asymptomatic. An

examination is significant for a blood pressure of 162/95 mm Hg but is otherwise

unremarkable.

Laboratory Findings

Sodium 138 mEq/L (N 135-145)

Potassium 3.9 mEq/L (N 3.5-5.5)

Fasting glucose 86 mg/dL

BUN 14 mg/dL (N 10-20)

Creatinine 0.6 mg/dL (N 0.6-1.3)

Urine microalbumin negative

According to the American College of Cardiology/American Heart Association

2017 guidelines, which one of the following would be the most appropriate

medication to initiate at this time?

A) Clonidine (Catapres), 0.1 mg twice daily

B) Hydralazine, 25 mg three times daily

C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily

D) Metoprolol tartrate (Lopressor), 25 mg twice daily

E) Triamterene (Dyrenium), 50 mg daily - ANSWER- C

Rationale: This patient has hypertension and according to both JNC 8 and

American College of Cardiology/American

Heart Association 2017 guidelines, antihypertensive treatment should be

initiated. For the general

non-African-American population, monotherapy with an ACE inhibitor, an

angiotensin receptor blocker,

a calcium channel blocker, or a thiazide diuretic would be appropriate for

initial management. It is also

appropriate to initiate combination antihypertensive therapy as an initial

management strategy, although

patients should not take an ACE inhibitor and an angiotensin receptor

blocker simultaneously. Studies have shown that blood pressure control is

achieved faster with the initiation of combination therapy compared to

monotherapy, without an increase in morbidity.

Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient.

-Blockers, vasodilators, B-blockers, and potassium-sparing diuretics are not

recommended as initial choices for the treatment of hypertension.

2. 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?

A) Only symptomatic residents on the same unit

B) Only symptomatic residents in the entire facility

C) All asymptomatic residents on the same unit

D) All residents of the facility regardless of symptoms

E) All staff regardless of symptoms - ANSWER- C

Rationale: 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.

3. A 24-year-old female presents with a 2-day history of mild to moderate pelvic

pain. She has had two male sex partners in the last 6 months and uses oral

contraceptives and sometimes condoms. A physical examination reveals a

temperature of 36.4°C (97.5°F) and moderate cervical motion and uterine

tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows

only WBCs.

The initiation of antibiotics for treatment of pelvic inflammatory disease in this

patient

A) is appropriate at this time

B) requires an elevated temperature, WBC count, or C-reactive protein level

C) should be based on the results of gonorrhea and Chlamydia testing

D) should be based on the results of pelvic ultrasonography - ANSWER- A

Rationale: Pelvic inflammatory disease (PID) is a clinical diagnosis, and

treatment should be administered at the time

of diagnosis and not delayed until the results of the nucleic acid amplification

testing (NAAT) for

gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an

at-risk woman presenting with

lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or

adnexal tenderness that can

range from mild to severe. There is often a mucopurulent discharge or WBCs

on saline microscopy. Acute phase indicators such as fever, leukocytosis, or an

elevated C-reactive protein level may be helpful but are

neither sensitive nor specific. A positive NAAT is not required for diagnosis

and treatment because an

upper tract infection may be present, or the causative agent may not be

gonorrhea or Chlamydia. PID

should be considered a polymicrobial infection. Pelvic ultrasonography may

be used if there is a concern

about other pathology such as a tubo-ovarian abscess.

4. A 24-year-old patient wants to start the process of transitioning from female to

male. He has been working with a psychiatrist who has confirmed the diagnosis of

gender dysphoria.

Which one of the following would be the best initial treatment for this patient?

A) Clomiphene

B) Letrozole (Femara)

C) Leuprolide (Eligard)

D) Spironolactone (Aldactone)

E) Testosterone - ANSWER- E

Rationale: For patients with gender dysphoria or gender incongruence who

desire hormone treatment, the treatment goal is to suppress endogenous sex

hormone production and maintain sex hormone levels in the normal range for

their affirmed gender. For a female-to-male transgender patient this is most

easily accomplished with testosterone. When testosterone levels are

maintained in the normal genetic male range, gonadotropins and ovarian

hormone production is suppressed, which accomplishes both goals for

hormonal treatment without the need for additional gonadotropin

suppression from medications such as leuprolide. Clomiphene can increase

serum testosterone levels, but only in the presence of a functioning testicle.

Letrozole is an estrogen receptor antagonist, but it would not increase serum

testosterone levels. Spironolactone has androgen receptor blocking effects and

would not accomplish either of the hormone treatment goals.