Download ABFM ITE REAL EXAM COMPLETE 200 ACTUAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RA and more Exams Nursing in PDF only on Docsity!
What is the criteria for chorioamnionitis? How would you treat? - ANSWER: Maternal Fever >38 plus one of the following.... -Uterine tenderness -Fetal tachycardia (>160bpm) -Maternal leukocytosis -Maternal tachycardia -Foul-smelling amniotic fluid Tx: Amp+ gent OR Clinda + Gent (if allergic to amp) 76 yo is brought by her daughter who is concerned about her mother's memory. 6 months ago, daughter took over mom's checkbook after she failed to pay bills. Her mother seems unable to knit, something she enjoyed for years. She has difficulty finding the words to complete a thought. Dx? A. PT has dementia B. Pt is delirious C. The patient is depressed D. The pt has mild cog impairment - ANSWER: The patient has dementia -Progressive impairment -Lead to loss of social and functional abilities Greatest risk factor for developing dementia? A. Family Hx B. Phys Activity C. Aging D. Lack of mental exercise - ANSWER: Aging What is Mild Cognitive Impairment? - ANSWER: -Complaint of memory impairment -Objective memory loss -Preserved general cog fnx -Intact activities of daily living -High risk of developing dementia 80 yo with 1yr becoming more sedentary w/difficulty completing ADLs, 2 falls. Stepwise progression of deficits, can't manage finances, no change in mood/personality. PMHx of diabetes, smoker, HTN. R grip is weaker vs L, no tremor. 1/5 on mini-cog test and the pt attempts to joke about not being able to perform word recall. A. Alzheimer's B. Lewy Body
ABFM ITE REAL EXAM COMPLETE 200 ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (CORRECT VERIFIED SOLUTIONS)
LATEST UPDATES |ALREADY GRADED A+ (BRAND
NEW!!)
C. Vascular D. Frontotemporal - ANSWER: C. Vascular -Hint is that it is stepwise progression -Preserved personality, but emotional incontinence 69yo with rigidity, short-stepped gait, and masked facies. He also has become more forgetful (mini-cog 2/5). Family thinks he sees things that aren't real. What kind of dementia? - ANSWER: Lewy Body
- Dementia -Parkinsonism + visual hallucinations -Significant visuospatial deficits 64 yo brought in after exposing himself in public. He has also been urinating in the kitchen sink and refuses to bathe. MMSE 26/30. Has some word-finding difficulties - ANSWER: Frontotemporal Key is this starts younger First thing is behavioral issues 76 yo, difficulty walking and his "feet seem stuck together." Gait is widened, but arm swing is maintained. Mild memory loss. Urge incontinence. - ANSWER: Normal Pressure Hydrocephalus -Key here is that the arm swing is maintained (less likely Parkinson's) 84 yo rapidly progressive dementia over 4 months. Has low-grade fever, very rigid, and has myoclonic jerks when startled. EEG shows triphasic sharp wave complexes - ANSWER: Creutzfeldt-Jakob Dz -Rapid with myoclonus -Tend to be younger, viral-like prions Which is proven to be protective against dementia? A. Estrogen B. Educational attainment C. Vit E D Turmeric - ANSWER: Educational Attainment USPSTF: Screening guideline for AAA - ANSWER: Men ages 65-75 one time who have ever smoked You identify a AAA in your pt. At what size should you refer for surgical intervention? A. 3-3. B. 4-4. C. 5-5. D. 6-6.5 - ANSWER: 5-5. How often should you monitor a 3-3.9 cm AAA? - ANSWER: Every 36 months
What is the most common source of acute arterial occlusion? - ANSWER: Thromboembolism from the heart! Think A Fib 76 yo M with Hx of HTN, HLD, and smoking presents with with blue painful toes in the setting of intact pulses. The most likely diagnosis is A. Acute Gout B. Raynaud's C. Cellulitis D. Blue Toe Syndrome - ANSWER: Blue Toe Syndrome Raynaud's secondary disease association - ANSWER: Scleroderma/Sclerosis SLE What is GDMT for HFrEF? - ANSWER: RAAS Inhibitor (ARNI or ACE) BB (carvedilol, metoprolol succ) MRAs (spironolactone) SGLT2 Inhibitor (empagliflozin) How to treat LOW RISK, stable angina - ANSWER: Stable Angina: pain only with exertion, alleviated at rest LOW RISK: Not LAD or multivessel disease (seen on stress) Tx: ASA, statin, BB/CCB. No PCI!! What is the appropriate first line test for hyperaldosteronism? - ANSWER: - Aldosterone/renin ratio -Hypokalemia, HTN Benign Esophageal Varices Treatment A. Propanolol B. Octreotide C. Ligation D. Repeat EGD 1-2yr E. Nothing - ANSWER: Repeat EGD in 1-2 years Mod risk? (Red whale sign or moderate size) = propanolol or ligation High Risk/Bleeding = Octreotide (From ITE 2022 #3) What are the indications for dental antibiotic prophylaxis? - ANSWER: -Infective endocarditis -Valve replacement -Hx of congenital heart defect (From ITE 2022)
What is CDC guidelines for treatment of urethritis, NAAT for gonorrhea is positive and Chlamydia is negative? - ANSWER: -Ceftriaxone 1g IM Gonorrhea: ceftriaxone once Chlamydia: doxy for 7 days (From ITE 2022) What is the Rotterdam Criteria for PCOS? - ANSWER: - Oligomenorrhea
- Hyperandrogenism -Presence of polycystic ovaries *You need 2/3 for diagnosis What is the most common cause of unconjugated hyperbilirubinemia? - ANSWER: - Elevated indirect bilirubin level
- Hemolysis!
- #2 is Gilbert's According to AAP, what age should you start BP screening? - ANSWER: -Start at age 3 When are triptans contraindicated? - ANSWER: -Pts with established CAD, cerebrovascular disease, or peripheral vasc disease -Multiple cardiovascular risk factors -High-risk migraine sx (basilar and hemiplegic migraines) What is HS commonly associated with? - ANSWER: Crohn's Disease DB Obesity PCOS Metabolic Syndrome What lab values would you expect in tumor lysis syndrome? - ANSWER: High cell turnover --> acute kidney failure 2/2 high uric acid -High uric acid -High K+, Phosphorus (both because of the kidneys not filtering) -Low Calcium because of the high phos When is cardiac stress testing contraindicated? - ANSWER: -After recent stroke or TIA -Severe symptomatic aortic stenosis When would a stress test be indicated in preop optimization? - ANSWER: Preop assessment when surgery is at least a moderate risk and the patient can't reach 4 METs of exertion (climbing a single flight of stairs) without cardiac symptoms
G2P2 delivered, had GDMA1 in pregnancy, here for 6wk f/u. How do you follow- up her diabetes? - ANSWER: A 2hr, 75g glucose tolerance test should be performed 4- 12wks post-partum following a preg in which gestational DB was diagnosed. What antihypertensive med is useful for both BP and OSA? - ANSWER: Spironolactone! Aldosterone can play a role in HTN and disordered breathing 17 yo, normal PFTs, still having episodic SOB/chest tightness. PFTs revealed normal expiratory findings including normal FEV1 and FVC, but had a flattened inspiratory flow loop (the bottom part) What is going on? - ANSWER: Vocal Cord Dysfunction! -Get nasolaryngoscopy to evaluate -Tx with breathing techniques What is first line tx for PTSD? - ANSWER: Trauma-focused psychotherapy MED: Fluoxetine Heat stroke vs heat exhaustion vs Heat Injury - ANSWER: Heatstroke: Neuro + > Heat Exhaustion: Neuro < Heat Injury: No neuro, >104. TX: Complete immersion to the neck in ice water (2-3C) What are the hormones for primary ovarian insufficiency? How would you tx? - ANSWER: Elevated FSH and LH Tx: HRT as soon as possible (within a year of dx) UTERUS: estrogen/progesterone (IUD) What are the hormones for PCOS? - ANSWER: LH >>>FSH What treatment is the most efficacious for Fibromyalgia? - ANSWER: Exercise!! FDA approved med is cymbalta, but exercise is better. What is the vision loss pattern of glaucoma? - ANSWER: Peripheral vision loss (increased pressure pushes on periphery of the ophthalmic) What is the vision loss pattern of macular degen? - ANSWER: Central vision loss How do you manage Levothyroxine in pregnancy? - ANSWER: -Increase by 30% by taking an extra dose 2 days per week for a total of 9 weekly doses -Then monitor TSH every 4 wks
In someone with stable angina and documentaed coronary atherosclerosis. positive stress test and underwent coronary angiography, which showed atherosclerotic dz without stenting.....What medications have been shown to decrease cardiac and all- cause mortality in pts with CAD? - ANSWER: - Xarelto What is first line treatment for bacterial sinusitis? - ANSWER: Tx: Augmentin for 5- days What should you monitor with SLE flare? - ANSWER: Anti-dsdna, complement, ESR/CRP, UA (for lupus nephritis), WBC, BMP What do you need prophylaxis for HIV with CD4 <200? What do you need prophylaxis for HIV with CD4 <100? What do you need prophylaxis for HIV with CD4 <50? - ANSWER: <200: Bactrim for PJP <100: Bactrim for Toxo <50: Azithro for MAC Pt sustains nondisplaced radial head fracture, how would you treat this? A. Immobilization for 3 days then ROM exercise B. Long arm posterior splint for 6 weeks C. Long arm cast for 6 weeks D. Referral to ortho for cast E. Referral to ortho for surgery - ANSWER: A. Immobilization for 3 days with ROM What is the best approach to vaccine hesitancy? - ANSWER: Presumptive approach rather than participatory What lab abnormalities would you expect in multiple myeloma? What is the difference between MGUS and MM? - ANSWER: MM LABS: -Elevated globulin
- Hypercalcemia -Renal Insufficiency (monoclonal light chains toxic to kidney) "CRAB" findings hyperCalcemia, Renal insuff, Anemia, Bone lytic lesions *MGUS is premalignant WITHOUT any CRAB findings, <10% clonal plasma cells When thinking of multiple myeloma, what test would you get after high globulin-to- albumin ratio? - ANSWER: -Serum and urine immunoelectrophoresis In an old person with depression, what class of meds is the best when considering adverse effects? - ANSWER: SSRIs! Better than SNRIs
What is the most common cause of AKI? - ANSWER: ATN What are pigmented, muddy brown casts associated with? - ANSWER: ATN What are the indications for urgent dialysis? - ANSWER: -Fluid Overload refractory to diuresis -K+ >6. -Uremic pericarditis or uremic encephalopathy -Severe met acidosis (pH <7.1) and hypervolemia -Acute poisoning In what cases do you want K+>4? - ANSWER: Known heart disease, arrhythmias, How does CKD change your potassium? - ANSWER: Increases! Kidney is responsible for excretion What are causes of Hypokalemia? - ANSWER: 1. GI Losses (Diarrhea, vom, bowel prep)
- Renal Losses (hypomag, RTAs, mineralocorticoid excess)
- Transcellular shift (refeeding syndrome, alkalosis, thyrotoxicosis, hypothermia) What meds cause low K+? - ANSWER: Thiazides, loops Corticosteroids Laxatives Causes of hyperkalemia - ANSWER: -Transcellular shift (insulin resistance or deficiency) -Excessive intake -Impaired excretion
- Medications -Crush injuries (muscular injuries, rhabdo) When do you need to limit potassium? - ANSWER: AFTER CKD3b What are some meds responsible for Hyperkalemia? - ANSWER: ACE/ARB Bactrim Heparin BB DIg NSAIDs Physical exam of Hyperkalemia? - ANSWER: -Muscle weakness -Ascending paralysis What tests do you need for Hyperkalemia? - ANSWER: - BMP -EKG (peaked T earliest sign)
-Acid/base status What medication stabilizes the cardiac membrane with K+? What meds used to shift? What meds used to eliminate? - ANSWER: Stabilize: calcium gluc Shift: Insulin (10U insulin followed by 25g glucose unless the glucose >250 you don't need it) Eliminate: lokelma, kayexylate *Lasix will help you excrete K+ If you have a pt who you are concerned is experiencing ACS, what do you do? - ANSWER: *Give O2, aspirin, and nitro *Repeat trop in 2-3 hours DAPT duration after stent placement:
- ACS Patients (DES or BMS)
- Stable CAD (DES)
- Stable CAD (BMS) - ANSWER: ACS PTs: tx for at least 12 months! Then you may stop P2Y12, but continue ASA indefinitely STABLE CAD: -BMS: tx for at least 1 month -DES: tx for at least 6 months *DAPT is aspirin + P2Y12 inhibitor (clopidogrel, ticagrelor, prasugrel) What are the symptoms/findings in pericarditis? - ANSWER: -Pleuritic chest pain
- Fever -Scratchy systolic and diastolic auscultatory findings (pericardial rub) You have a pt with acute STEMI.....how do you decide whether to perform PCI vs fibrinolytic? - ANSWER: If PCI can't be performed within 120 mins of first medical contact, fibrinolytic therapy (alteplase, tenecteplase, or reteplase) should be given -THEN after fibrinolytic therapy, transfer to a center where PCI can be performed within 24 hrs -Also make sure to give heparin and aspirin What is first line therapy for chronic stable angina? - ANSWER: Beta Blocker What is second line therapy for chronic stable angina after maximizing BB? - ANSWER: A long-acting nitrate (isosorbide mononitrate) or a CCB How do you reduce the risk for contrast-induced nephropathy in someone with reduced renal fnx? - ANSWER: Volume expansion with isotonic fluid
- CMP
- TSH
-Vit D
- RPR Which SSRIs are safe in pregnancy? - ANSWER: Citalopram, Escitalopram, Sertraline Which SNRI is also indicated in fibromyalgia? - ANSWER: Duloxetine What is the most effective treatment in pts with severe resistance (with medicine for depression) or psychotic depression? - ANSWER: ECT What medications are FDA approved for depression in pediatric populations? - ANSWER: Fluoxetine and escitalopram Fluoxetine (age 8 or greater) Escitalopram (age 12 or greater) Age 6-17yrs *****Zoloft (sertraline): age 6 (for OCD, not depression) *****Prozac (Fluoxetine): age 7 for OCD What's the timeline difference in baby blues vs postpartum depression? - ANSWER: Baby Blues: First 1-2 weeks PPD: >2 weeks, normally within first 3 mo after delivery *Pts should be screened for a minimum of 1year for postpartum depresson A 36 yo woman with bipolar I has been on lithium for 17 years. Which is most likely irreversible SE from tx? A. Polyuria B. Renal insuff C. Hypothyroidism D. Resting tremor - ANSWER: B. Renal insufficiency -This one is irreversible! The rest are reversible. What is the most common cause of encephalitis in children? What is the best test? - ANSWER: Viral pathogens! VIP is HSV and enterovirus. Test with viral PCR of CSF for both HSV and enterovirus. Viral culture is low sensitivity What medication should you use to treat bacterial meningitis in a kid >1 month? - ANSWER: Vanc + 3rd gen cephalosporin (such as cefotaxime)
What is empiric treatment for bact meningitis in an immunocompromised host? - ANSWER: Ceftriaxone, Vanc, and ampicillin What are the MCC of symmetric distal polyneuropathy? - ANSWER: -DM!! Then get CBC, b12, mma What constitutes a constitutional delay of growth and puberty? - ANSWER: -Height & Weight <5th percentile -Normal linear growth velocity -Delayed bone age -FHx of delayed puberty What heart condition is associated with Turner syndrome? - ANSWER: Bicuspid aortic valve What is the difference of a massive vs submassive PE? - ANSWER: Massive: high-risk, hemodynamically UNSTABLE Submassive: Int risk, hemodynamically stable w/ R ventricular strain How long do you treat 1st provoked PE? How long do you treat 1st provoked DVT? - ANSWER: At least 3 months (unless hemodynamically unstable, then consider 6-12mo) How long do you treat unprovoked or recurrent PE? How long do you treat unprovoked DVT? - ANSWER: Lifelong Which degree burns have blanching? - ANSWER: 1st degree (rapid refill) 2nd degree superficial (slow refill) ***2nd degree deep and beyond do not blanch What is one of the biggest benefits of weight loss surgery in regards to coexisting comorbities? - ANSWER: -T2DM! -Will have remission in 60-80% of pts How do you dx hypogonadism in males? What labwork do you need to obtain when supplementing testosterone? - ANSWER: Dx: 2 separate AM fasting total testosterone levels LABS: Hematocrit Stop the med if HCT >54% increase What is the most common cause of septic arthritis? - ANSWER: Staph Aureus (#1), followed by strep species
*Exercise is moderately effective for weight loss (even when added to diet) How often should you monitor weight when trying to lose weight? - ANSWER: Weekly! Your pt just got a sleeve gastrectomy. What should you tell her is the most likely complication in the first 6 months? - ANSWER: GERD --Dumping syndrome is much less common --Roux-en-Y gastric bypass would be preferred in those with Hx of GERD What is the #1 cause of death following bariatric surgery? - ANSWER: Pulmonary Embolism What is the most common nutritional deficiency after bariatric surgery? - ANSWER: Iron When you find TSH/T4 levels indicative of hyperthyroidism, what is your next step? - ANSWER: Radioactive Uptake Scan 60Yo 6wk hx of neck mass, confirmed on PE. What is the initial diagnostic test? - ANSWER: Get a TSH first!!! You notice a thyroid nodule and obtain a TSH. What would you do if the TSH was low? - ANSWER: 1. Get an US as well
- Get I-123 scan a. HOT: surgery b. COLD: FNA You notice a thyroid nodule and obtain a TSH. What would you do if the TSH was normal/high? - ANSWER: 1. Get an US in addition
- FNA!!! All of the following are common symptoms of hyperparathyroidism EXCEPT: A. Bone Pain B. Increased app C. Depression D. Renal Stones - ANSWER: Increased Appetite Bones, stones, and moans, psych groans LABS: elevated PTH, elevated Ca, normal Vit D TX: Parathyroidectomy if you can, cinacalcet if unable What diuretic can cause hypercalcemia? - ANSWER: Thiazides
(they also lose K) *May be helpful in calcium oxalate renal stones to decrease urine calcium levels What is the best test for diagnosing prolactinoma? - ANSWER: MRI brain w/ What is the normal progression of Subacute Thyroiditis of labs? - ANSWER: Initial thyrotoxicosis followed by a 4-6 month transient hypothyroidism What antibody level is most often elevated in Hashimoto Thyroiditis? - ANSWER: Hashimoto Thyroiditis= form of hypothyroidism -Elevated antithyroid peroxidase antibody in 99% of patients The presence of a thyroid bruit and chronic symptoms in a patient with thyrotoxicosis is highly suggestive of... - ANSWER: Graves Dz -Bruit: reflects increased blood flow to the thyroid You have a pt who has amenorrhea and is on risperidone. What lab abnormalities could you see and what is the cause? - ANSWER: -Antipsychotics and other meds with dopamine antagonistic properties can cause clinically significant elevations in prolactin What are the symptoms of Addison's disease? - ANSWER: ANDRENAL INSUFF -Fatigue, depression, lightheadedness upon standing, muscle weakness, weight loss, hyperpigmentation What are the first two steps for evaluation of male infertility? - ANSWER: 1. Semen analysis
- Oligozoospermia? Endocrine eval with FSH and early morning total testosterone What is the DSM-5 criteria for ODD? - ANSWER: Occurring over 6 months... -Losing temper -Easily annoyed -Antagonism toward authority figures -Deliberately annoying others -Placing blame on others -Being spiteful or vindictive What is treatment of croup in A. Mild Cases B. Mod/Severe - ANSWER: A. Oral dexamethasone B. Addition of epinephrine For acute low back pain, what should be the treatment pathway for medication? - ANSWER: -NSAID or Tylenol first
-Inability to bear weight for 4 steps both immediately after injury and @ time of exam -Inability to flex knee to 90 deg -Tenderness over head of the fibula -Isolated tenderness to patella without other bony tenderness You have a 62 yo M with DB and anemia who presents to your clinic. Which of the following anemias could falsely elevate his A1C? A. Hemolytic Anemia B. Sickle Cell Anemia C. Iron Def Anemia D. Acute blood loss - ANSWER: C (The others cause a loss of cells, would falsely lower) What are your c-peptide levels in T1DM vs T2DM? - ANSWER: T1DM: low C-peptide lvls with + anti-GAD antibodies T2DM: elevated C-peptide At what GFR should you stop a pt who is on Metformin? - ANSWER: < ***Do not start if GFR < What diabetes class is associated with risk of foot amputation? - ANSWER: SGLT- 2 Newly dx T2DM and HTN with CKD and creatinine of 2.4. Which medication would be safest with regard to renal function? A. Acarbose B. Glyburide C. Sitagliptin D. Glipizide - ANSWER: D. Glipizide Which long-acting insulin has the longest half-life? - ANSWER: Degludec (tresiba) 42hrs Which of the following meds would be outside the recs for a 15yo with T2DM, HTN, and HL? A. Metformin B. Sitagliptin C. Liraglutide D. Lisinopril E. Pravastatin - ANSWER: B. Sitagliptin Has not been licensed for use in kids
What are the 3 medication options approved for kids with DM? - ANSWER: - Metformin
- Liraglutide
- Insulin 19 yo admitted with diabetic ketoacidosis. Glucose 670, pH 7. 12, K 6.8, Na 130. Treatment with fluids and IV insulin is started. 3 hours later, glucose is 220, pH is 7.25, K: 6.1. What is now most appropriate? A. Start glucose B. Stop insulin C. Change IV fluid to 1/2 NS D. Add sodium bicarb - ANSWER: A. Start glucose! As soon as glucose is near 250 (to prevent cerebral edema so you don't lower the glucose too fast) What is the criteria for diabetic ketoacidosis? When do you need bicarb for ketoacidosis? - ANSWER: Anion gap > Glucose > pH <7. Bicarb < Serum and urine ketones BICARB: When pH <7 or HCO3 <10 (use 100 mEQ of sodium bicarb) What 2 medications are approved for tx of diabetic peripheral neuropathy? - ANSWER: - Pregabalin and duloxetine -Amitryptiline can also be used as 1st line -2nd: venlafaxine, gabapentin In a patient with diabetic foot ulcer, what is the best predictor of its ability to heal? A. Size B. Pulse C. Signs of infx D. Pt's blood sugar - ANSWER: Pulse!!! -Intact vascular supply (test with ABI if you want) What is the definition of charcot foot? - ANSWER: T2DM.... -Red, hot, swollen foot with neuropathy -Often PAINLESS -Causes foot collapse What does the AMA recommend physicians do during the Pre-Sports Physical? - ANSWER: Use this as an opportunity to initiate discussion on health-related topics
