ABFM NEWEST ACTUAL EXAM STUDY GUIDE WITH COMPLETE QUESTIONS AND CORRECT ANSWERS RATED A+, Exams of Nursing

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ABFM ITE NEWEST EXAM STUDY GUIDE

WITH COMPLETE QUESTIONS AND

CORRECT ANSWERS RATED A+

An otherwise healthy 55-year-old male who is visiting from Arizona presents to your office with a 4-week history of intermittent fevers, night sweats, dry cough, weight loss, and myalgia. The patient has no other recent history of travel. Correct Answer Valley Fever (medical name coccidioidomycosis or "cocci" for short) is an infection in the lungs caused by the fungus coccidioides spp., which grows in soils in areas of low rainfall, high summer temperatures and moderate winter temperatures, such as: throughout Arizona, the San Joaquin and Central Valleys of California, southern parts of Nevada, New Mexico and western Texas, east-central Utah, south-eastern Washington, and the semiarid and arid soils of Central and South America. First-line pharmacotherapy for diabetic gastroparesis Correct Answer Metoclopramide, Erythromycin Antibiotic time-out Correct Answer Occurs 48-72h after first administration, part of antibiotic stewardship programme to ensure judicious use.

Prehn's sign Correct Answer Physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion. Treatment of epididymitis Correct Answer Bed rest, antibiotics, scrotal support, and ice compresses. In sexually active adults <35 years of age, gonorrhea and Chlamydia are the most common causative organisms. Ceftriaxone, 250 mg intramuscularly or intravenously once, with oral doxycycline, 100 mg twice daily for 10 days, would be appropriate. In men over the age of 35 or those with a history of recent urinary tract surgery or instrumentation, enteric organisms are the most likely cause and monotherapy with oral levofloxacin or ofloxacin for 10 days would be recommended. fA healthy 2-month-old female is brought to your office for a routine well baby examination by both of her parents, who have no concerns. The parents refuse routine recommended vaccines for their daughter because of their personal beliefs. You want to incorporate patient-centeredness and are also concerned about improving the health of the population. You decide to follow the CDC recommendations by? Correct Answer Having the parents sign a refusal to vaccinate form.

Prepatellar bursitis is a common superficial bursitis caused by microtrauma from repeated kneeling and crawling. Other terms for this include housemaid's knee, coal miner's knee, and carpet layer's knee. It is usually associated with minimal to no pain. Correct Answer The proper management of prepatellar bursitis is conservative and includes ice, compression wraps, padding, elevation, analgesics, and modification of activity. There is little evidence that a corticosteroid injection is beneficial, even though it is often done. If inflammatory bursitis is suspected, a corticosteroid injection may be helpful. Fluid aspiration is indicated if septic bursitis is suspected. Surgery can be considered for significant enlargement of a bursa if it interferes with function. Absolute contraindication to fibrinolytic therapy Correct Answer A history of an ischemic stroke within the past 3 months unless the stroke is diagnosed within 4½ hours. Treatment of sudden SNHL likely idiopathic Correct Answer Oral Prednisolone (recommended dosage is 1 mg/kg/day with a maximum dosage of 60 mg daily for 10-14 days) Ottawa Ankle rules: negative i.e. ankle sprain Correct Answer Compression combined with lace-up ankle support or an air cast, along with cryotherapy, is recommended and can increase mobility. Early mobilization, including weight bearing as tolerated for daily activities, is associated with better long-term outcomes than prolonged rest.

Risk factor for atrial fibrillation Correct Answer Alcohol use Assessing response to oral iron therapy in iron deficiency anaemia Correct Answer Reticulocyte count Use of IV contrast in those with shellfish allergies Correct Answer No correlation Shoulder pain with weak internal rotation Correct Answer Subscapularis Shoulder pain with weak external rotation Correct Answer Infraspinatus, teres minor Shoulder pain with weak abduction Correct Answer Supraspinatus, deltoid First line imaging modality for acute abdominal pain in children Correct Answer Ultrasonography First line anti-hypertensives in African-Caribbean patients Correct Answer Calcium-channel blockers, Thiazides (e.g. Chlorthalidone) Hospice care eligibility is based on Correct Answer Life expectancy (6 months or less)

Depression in adolescents (12-18yo) should be screened annually with PHQ-2 then PHQ-A Correct Answer Psychotherapy SSRIs: Fluoxetine, Citalopram

• Venlafaxine should be avoided in adolescents because it is associated with a statistically increased risk of suicidal behavioupr or ideation. GLP-1 receptor agonist that lowers risk of recurrent cardiovascular events Correct Answer Liraglutide Sickle cell disease increases risk of stroke Correct Answer All sickle cell patients 2-16 years of age should be screened with transcranial Doppler ultrasonography Non-specific lower back pain Correct Answer Does not require imaging regardless whether radiculopathy present
• An initial plain film would be appropriate if there were a history of recent significant trauma, or even a history of minor trauma in an elderly patient.
• Immediate MRI would be appropriate in the presence of other red flags
• Unless symptoms persist despite a trial of at least 6 weeks of medical management and physical therapy

NSAIDs then skeletal muscle relaxant e.g. Cyclobenzaprine A walking program is the best choice for long-term benefit because it is much more affordable than physical therapy Occupations causing silicosis Correct Answer Stone cutting, sand blasting, mining, and quarrying HOCM systolic murmur intensifies with Valsava's and is the most common primary cardiomyopathy Correct Answer First-line treatment with beta-blockers, CCBs (non-dipines) if beta-blockers not tolerated BPSD of dementia can be treated (off-label) with antipsychotics Correct Answer Aripiprazole produces small reductions in behavioral and psychological symptoms of dementia, and it has the least adverse effects of the atypical antipsychotics. Both typical and atypical antipsychotics increase the risk of mortality in patients with dementia. The typical antipsychotics are more commonly associated with extrapyramidal side effects. Diabetes mellitus and agranulocytosis are associated with the atypical antipsychotics, including Risperidone. Periodic monitoring of serum glucose levels and CBCs is recommended.

For patients who have been taking antipsychotics for >/= 3 months and whose symptoms have stabilized, or for patients who have not responded to an adequate trial of an antipsychotic, it is recommended that the drug be tapered slowly with goal of stopping. Secondary prevention of coronary heart disease Correct Answer Patients <75 years of age with established coronary artery disease should be on high-intensity statin regimens if tolerated. These regimens include Atorvastatin, 40-80 mg/day, and Rosuvastatin, 20-40 mg/day. Moderate-intensity regimens include Simvastatin, 40 mg/day. Subclinical hyperthyroidism patients are at higher risk for several health conditions, including atrial fibrillation, heart failure, and osteoporosis. Correct Answer The American Thyroid Association recommends treating patients with complications who are either over age 65 or have a TSH level <0.1 U/mL. BPPV characteristics Correct Answer Rotational vertigo with test- related head movements, latency period 5-20s sometimes up to 60s, associated with torsional upbeating nystagmus. Preferred antidepressant in elderly Correct Answer Escitalopram. Amitriptyline, Imipramine, and paroxetine are highly anticholinergic and sedating, and according to the Beers Criteria, they can cause orthostatic hypotension.

COPD screening with spirometry Correct Answer All patients with a smoking history and symptoms of COPD such as a chronic cough with sputum production and/or chronic and progressive dyspnea. No screening if asymptomatic despite smoking history. The dietary herbal supplement with the highest risk for drug interactions is Correct Answer St John's wort Splint for distal radial fracture Correct Answer Sugar tong Worrisome characteristics of palpitations Correct Answer Patients with a history of cardiovascular disease, palpitations that affect their sleep, or palpitations that occur at work have an increased risk of an underlying cardiac cause. HPV screening in women 21-29yo Correct Answer Current recommendations are for a Pap test with cytology every 3 years for women age 21-29 years with normal results, and the frequency does not change with an increased number of normal screens. Annual HPV screening in patients age 21-29 years has very little effect on cancer prevention and leads to an increase in procedures and treatments without significant benefit.

Patient who has had a sleeve gastrectomy should avoid Correct Answer NSAIDs as it is thought to increase the risk of anastomotic ulcerations or perforations Confirming proteinuria in those with positive dipstick protein or with symptoms of nephrotic syndrome Correct Answer Spot urine PCR The only evidence-based treatment that confers significant benefits to children with autism is Correct Answer Intensive behavioral interventions, which should be initiated before 3 years of age. What is the advantage of the recombinant zoster vaccine (Shingrix) compared to the live zoster vaccine (Zostavax)? Correct Answer Increased efficacy (97% vs 51%) Which one of the following findings in a patient's history greatly increases her risk of an accidental opiate-related overdose? Correct Answer Concurrent use of opiates with Benzodiazepines The most common cause of chronic cough in adults is upper airway cough syndrome (used to be called postnasal drip syndrome). Correct Answer Patients might have nasal symptoms such as rhinorrhoea or congestion. Physical findings can include swollen turbinates and posterior pharyngeal cobblestoning, or they can be unremarkable. Initial treatment may include the use of

decongestants, oral or intranasal antihistamines, intranasal corticosteroids, or saline nasal rinses. Constipation-predominant IBS Correct Answer Polyethylene glycol, a long-chain polymer of ethylene oxide, is a large molecule that causes water to be retained in the colon, which softens the stool and increases the number of bowel movements. Pain control with opioids Correct Answer Most orally administered immediate-release opioids such as morphine, oxycodone, and hydromorphone reach their peak effect at about 1 hour, at which time additional medication can be given if the patient is still in pain. Intravenous opioids reach their peak effect at about 10 minutes and intramuscular and subcutaneous opioids at about 20- 30 minutes. Pulmonary hypertension secondary to COPD Correct Answer 2DE is the preferred initial noninvasive testing modality when pulmonary hypertension is suspected. Supplemental oxygen should be recommended when the PaO2 is <60 mm Hg, because it has been shown to improve mortality by lowering pulmonary arterial pressures. Type of anti-hypertensives that can reduce severity of OSA Correct Answer Aldosterone antagonists.

Resistant hypertension is common in patients with obstructive sleep apnea. Resistant hypertension is also associated with higher levels of aldosterone, which can lead to secondary pharyngeal oedema, increasing upper airway obstruction. PCOS treatment Correct Answer Not desiring pregnancy: low- dose COCP (caution melasma), Spironolactone, Finasteride Desiring pregnancy: Letrozole > Clomiphene Initial evaluation of hypogonadism Correct Answer FSH and LH Internal tibial torsion Correct Answer Usually resolves by 5yo, surgery may be considered in patients older than 8yo who have a severe residual deformity, especially if it is symptomatic or cosmetically unacceptable. Yersinia pestis is an aerobic fermentative gram-negative rod. It causes a zoonotic infection with humans as the accidental host. The disease is spread by a bite from a flea vector, direct contact with infected tissue, or inhalation of infectious aerosols from a person with pulmonary plague. Correct Answer Plague occurs in two regions in the western United States. One region includes northern New Mexico, northern Arizona, and southern Colorado,

and the other region includes California, southern Oregon, and far western Nevada. Greatest risk factor for developing osteoarthritis in older adults Correct Answer Obesity Preferred initial evaluation of acute mesenteric ischaemia Correct Answer CT Angiography Contraindication of oestrogen-containing contraception methods Correct Answer Smokers >35 years of age and in patients with migraine with aura. Highest cure rate of basal cell carcinoma Correct Answer Mohs surgery Pharmacotherapy to reduce alcohol consumption and increase abstinence Correct Answer Acamprosate Valvular heart disease in Marfan's syndrome Correct Answer Aortic insufficiency/regurgitation in 80-100%, increases with age and is progressive. May also be associated with mitral valve prolapse. Haemoptysis work-up Correct Answer CXR normally but CT Chest if high risk for malignancy (age, smoking history)

If findings are normal, patient should be observed for 2-6 weeks. If there is a recurrence of haemoptysis further evaluation is indicated, which should include an interval history, a repeat examination, and CT Chest. Severe symptomatic aortic stenosis requires surgical intervention i.e. valve replacement Correct Answer Pressure mean gradient

40 mmHg, aortic valve area <1 cm2 and peak aortic jet velocity 4.0 m/s

• ACE inhibitors may improve symptoms in patients with aortic stenosis who are not surgical candidates. Rome IV criteria for IBS Correct Answer Recurrent abdominal pain associated with two or more additional symptoms at least 1 day per week in the last 3 months. These symptoms include pain related to defaecation, a change in stool frequency, or a change in stool form. Screening for GDM in pregnancy Correct Answer From 24w Proximal fifth metatarsal stress fracture (Jones fracture) management Correct Answer Particularly prone to non-union and completion of the fracture. Because complete non-weight bearing or surgical intervention may be necessary with this high-risk fracture, MRI is indicated as the most sensitive test.

• It has been shown that active patients have shorter healing times and return to activity sooner with surgical management.
• If the nonsurgical option is chosen the patient is given an initial posterior splint and followed up in 3-5 days, then placed in a short non-weight-bearing cast for 6 weeks, at which time a repeat radiograph is taken. If the radiograph shows healing, the patient can return to gradual weight bearing. If the radiograph does not show proper healing, then the period of non-weight bearing is extended. Adolescent physiologic gynaecomastia Correct Answer One half of all adolescent males, usually bilateral but left sided more common if unilateral, typically resolves 6-24m after onset. Identify highest percentage of previously unrecognised chronic Hepatitis C Correct Answer One-time screening for adults born between 1945 and 1965. First-line treatment for persistent allergic rhinitis Correct Answer Intranasal steroids on top of allergen avoidance and patient education Most reliable measure to protect children from lead toxicity in the United States Correct Answer Eliminating the sources of lead in the community

What should be avoided to minimise the risk of postpartum haemorrhage? Correct Answer Routine episiotomy Initial management for VF and pulseless VT Correct Answer Defibrillation Mild transaminitis with negative HepB and HepC Correct Answer Serum ferritin (to check for hereditary haemochromatosis) on top of USS Liver Treatment of mid substance Achilles tendinopathy Correct Answer An eccentric gastrocnemius-strengthening program Pseudofolliculitis barbae is a common condition affecting the face and neck in people with tightly curled hair. Correct Answer Clippers generally result in a less close shave and contribute less. Olecranon bursitis Correct Answer The diagnosis can be made from his history and the physical examination, with no additional workup. Conservative Rx recommended as initial treatment (ice, compression dressings, and avoidance of activities that aggravate the problem), aspiration for symptomatic relief if there is significant enlargement or symptoms, or for diagnosis and culture if septic bursitis is suspected.

The bursa may be injected with a corticosteroid, but this could cause skin atrophy or infection. Surgical bursectomy can be offered for refractory cases lasting over 3 months. Treatment of DVT/PE in pregnancy, cancer-associated thrombosis Correct Answer SC LMWH e.g. Dalteparin, Enoxaparin Medications to decrease mortality in patients with symptomatic heart failure Correct Answer Aldosterone antagonists, beta- blockers Anticoagulation in those with malignancy Correct Answer SC LMWH preferred (NOACs not studied in area of malignancy yet) Mental health screening for refugees Correct Answer Depression, anxiety, and post-traumatic stress disorder AST:ALT ratio for alcoholic liver disease Correct Answer 3: Perioperative management of chronic anticoagulation therapy Correct Answer For low-risk patients, it is recommended that Warfarin be discontinued 5 days prior to surgery and restarted 12- 24 hours postoperatively. Treatment for Henoch-Schonlein purpura Correct Answer Supportive

• Analgesics
• Adequate hydration Steroids
  • For GI inflammation
  • Relieves pain Seek care if
  • Stomach pain is sudden or severe
  • Blood in stool
  • Vomiting with inability to keep fluids down
  • Puffy face, hands or feet (sign of renal malfunction) Hypoxaemia following acute illness Correct Answer Prescriptions for supplemental home oxygen should not be renewed for patients who have recently been hospitalized for acute illnesses without assessing them for ongoing hypoxaemia. No apparent benefit derived from supplemental oxygen once their oxygen saturation is 88% or greater on room air. Leser-Trelat sign Correct Answer Abrupt onset of multiple seborrheic keratoses, which is an unusual finding that often indicates an underlying malignancy, most commonly an adenocarcinoma of the stomach.

Rocky Mountain Spotted Fever Correct Answer Caused by Rickettsia rickettsii, spread by ticks

• Sx: petechial rash on palms and soles (migrating to wrists, ankles, then trunk), headache, fever. Endemic to East Coast (in spite of its name).
• Rx: Doxycycline History of pancreatitis in patients with diabetes Correct Answer Both Sitagliptin, a DPP-4 inhibitor, and Liraglutide, a GLP- 1 receptor agonist, should be avoided or used with caution. Head lice in children Correct Answer If suspected, the child should remain in class and should not be treated unless there is a clear diagnosis and live lice are seen. They should however, be discouraged from close contact with others until treated appropriately with a pediculicide. Nits are louse eggs and do not necessarily represent an active, infectious case of head lice. After first cycle of treatment, apart from home eradication measures and regular nit combing, patient may return to class with retreatment in a week's time.

• Wash any recently used bedding and clothing with hot water or expose them for 5 minutes to a temperature >130°F to kill lice and eggs. Items that cannot be washed or dried in this manner or dry- cleaned should be sealed in a plastic bag for 2 weeks. Falsely lowers HbA1c in diabetics Correct Answer Haemolytic anaemia, HAART for HIV, chronic liver disease, pregnancy, Vit C and E, acute blood loss Lithium toxicity, more prevalent in the elderly Correct Answer Often presents with signs and symptoms related to the gastrointestinal tract (nausea, vomiting, and diarrhoea, which can further worsen toxicity), heart (arrhythmias and conduction delays), and central nervous system (coarse tremors, ataxia, agitation, and confusion). Common cause of neonatal sepsis Correct Answer GBS, E coli Most common cause of tinnitus Correct Answer SNHL Pearly Penile Papules (PPP) Correct Answer Common and benign, and present as small, skin coloured, dome-shaped papules in a circular pattern around the coronal sulcus. Angiokeratomas (may appear solely on the glans of the penis, but are also found on the scrotum, abdomen, thighs, groin, and

extremities) Correct Answer Usually asymptomatic, circumscribed, red or bluish papules. When found on shaft of the penis, the suprapubic region, or the sacral region; can be associated with Fabry disease. Chronic tension-type headaches Correct Answer Amitriptyline may reduce headache duration and severity Painful diabetic peripheral neuropathy Correct Answer Pregabalin In sepsis, a serum lactate value >36 g/dL (4 mmol/L) is correlated with increased severity of illness and poorer outcomes even if hypotension is not yet present. Correct Answer Patients should receive isotonic intravenous fluids such as normal saline or lactated Hartmann's solution at an initial rate of 30 mL/kg in the first 3 hours using small boluses of approximately 500 mL. MRI Breasts Correct Answer Reserved for women at very high risk for breast cancer such as those with genetic mutations, a history of breast irradiation, or a very high-risk family history. To reduce dosing error in children, apart from appropriate education to parents Correct Answer Oral syringe should be provided

In treatment of Bipolar Disorder, treatment with SSRI as monotherapy should be avoided Correct Answer A combination of antidepressants such as an SSRI, plus a mood stabilizer, which includes anticonvulsants (Lamotrigine, Divalproex), atypical antipsychotics (Quetiapine) - as typical antipsychotics increases risk of QT prolongation, or Lithium, but this is considered second- line therapy. Long-term maintenance therapy with a mood stabilizer is recommended in patients with bipolar I disorder due to the high risk of recurrent mania. NOT Haloperidol. Leading cause of cancer death in men in the United States Correct Answer Lung cancer A useful adjunct to Buprenorphine in the treatment of opioid use disorder to help increase the rates of abstinence and decrease stress-related opioid cravings Correct Answer Clonidine (0.1-0.3 mg every 6-8 hours) The presence of RBC casts on microscopic examination of a spun urine sediment is pathognomonic for Correct Answer Acute glomerulonephritis Mallet finger Correct Answer The inability to actively extend the DIP joint is a hallmark.

The inability to passively extend the DIP joint completely may be an indication of trapped soft tissue or bone that may require surgery. Up to one-third of distal extensor tendon injuries are associated with an avulsion fracture, and if the avulsion is greater than 30% of the joint space, referral to an orthopaedic is recommended. Otherwise, immobilization of the DIP joint in extension for 6 - 8 weeks. Pneumococcal vaccination Correct Answer Both PCV13 and PPSV23 are recommended for patients with chronic renal failure. Indications for PPSV23 alone in immunocompetent persons younger than 65 include chronic lung disease, diabetes mellitus, chronic heart disease, smoking, and alcoholism. Treatment of acute Bell's palsy Correct Answer Antiviral medication along with corticosteroids is significantly more effective than corticosteroids alone. The medications are most effective if started within 72 hours of symptom onset. Test to confirm diagnosis of Cushing's Correct Answer 24h urinary free cortisol Obesity hypoventilation syndrome (carbon dioxide retention - PaCO2 >45 mm Hg, in an individual with a BMI > 30 kg/m2) Correct Answer Restrictive pattern on spirometry

Sever's disease Correct Answer Most common cause of heel pain in children and adolescents 8-12 years of age. Voice hoarseness Correct Answer Complete vocal rest, including no whispering or throat clearing, is the most effective and quickest initial remedy for short-duration laryngitis, whether viral or due to vocal overuse or abuse. Second Degree Heart Block (Mobitz I) - progressively prolonged PR then dropped QRS Correct Answer A pacemaker is not recommended in patients who are asymptomatic. It is recommended in symptomatic patients, however, and is guided by electrophysiologic studies. Primary prevention of cardiovascular disease Correct Answer Low-dose aspirin therapy is recommended in patients 50-59 years of age who have a risk of CVD of at least 10% (not <50yo regardless of dose due to increased risk of GI bleeds) A U.S. hospital or birthing center seeking to be certified as "Baby Friendly" by the Baby-Friendly Hospital Initiative Correct Answer Providing no other food or fluids to breastfeeding infants without a medical indication Pituitary microadenoma Correct Answer Microadenomas <10 mm in size that are secreting prolactin may be treated with a dopaminergic agent such as Bromocriptine. This will lower the prolactin level and shrink the adenoma.

Nonprolactin-secreting adenomas, especially those >10 mm in size (macroadenomas), require neurosurgical evaluation. Bariatric surgery Correct Answer Inclusion criteria include a BMI

/= 40 kg/m2 without coexisting medical problems or a BMI >/= 35 kg/m2 with one or more severe obesity-related co-morbidities such as diabetes mellitus.

• It does result in reduced all-cause mortality and more weight loss. Thereafter:
• Avoid NSAIDs
• Eat three meals and one or two snacks daily. Very dry foods, bread, and fibrous vegetables are most likely to cause problems.
• Fluids should be avoided during meals and for 15-30 minutes before and after meals.
• Those desiring pregnancy should wait 12-18 months after surgery.
• BMD be done every 2 years. Acute bronchitis in adults is usually viral Correct Answer Indications for a chest radiograph include: bloody sputum, rusty- colored sputum, or dyspnoea; a pulse rate >100 beats/min; a respiratory rate >24/min; or a temperature >37.8°C (100.0°F). A chest radiograph is also indicated if there are abnormal findings

on a chest examination such as fremitus, egophony, or focal consolidation. Infective endocarditis prophylaxis with Amoxicillin 2g

• Clindamycin or azithromycin can be used in patients with a penicillin allergy. If the penicillin allergy is not associated with anaphylaxis, angioedema, or urticaria, then cephalexin would be an appropriate antibiotic choice. Correct Answer Currently antibiotics are indicated for prosthetic cardiac valves, previous infective endocarditis, unrepaired cyanotic congenital heart disease or a repaired congenital defect with a residual shunt, and a cardiac transplant with valve regurgitation due to a structurally abnormal valve. Septic arthritis Correct Answer Diagnostic test of choice is analysis of synovial fluid obtained through arthrocentesis. Most appropriate psychotherapy for patients with obsessive- compulsive disorder Correct Answer CBT Molluscum contagiosum is a common disease during childhood, but can also occur in adolescents and adults. It is caused by a poxvirus and is characterized by flesh-colored, dome-shaped papules with central umbilication, most commonly on the trunk, axilla, popliteal or antecubital fossae, and crural folds. Correct Answer If lesions are asymptomatic and not inflamed, the initial