ABFM ABFM Clinical Decision Making 2 — Questions and Answers
Question 1: When evaluating a patient with suspected deep vein thrombosis, which scoring system helps guide the clinical decision for further testing?
- NIHSS
- Wells DVT criteria (Correct answer)
- Ottawa knee rules
- HEART score
Correct answer: Wells DVT criteria
The Wells DVT criteria stratify pretest probability of DVT to guide appropriate use of D-dimer testing or imaging.
Question 2: A family physician must decide whether to prescribe antibiotics for acute otitis media in a 3-year-old. According to evidence-based guidelines, what is most appropriate for uncomplicated cases?
- Immediate antibiotics for all cases
- Watchful waiting for 48-72 hours in mild cases (Correct answer)
- Refer all cases to ENT
- Prescribe antifungals first
Correct answer: Watchful waiting for 48-72 hours in mild cases
Current guidelines support watchful waiting for 48-72 hours in children over 2 years with non-severe unilateral acute otitis media before initiating antibiotics.
Question 3: Which principle of clinical reasoning involves generating the most likely diagnosis first and then ruling out dangerous alternatives?
- Bayesian reasoning (Correct answer)
- Illness script matching
- Anchoring heuristic
- Illness severity scoring
Correct answer: Bayesian reasoning
Bayesian reasoning uses pretest probability and diagnostic test results to update the likelihood of a diagnosis in a stepwise fashion.
Question 4: A 70-year-old man with COPD presents with acute worsening dyspnea. Which initial clinical decision is MOST appropriate?
- Order pulmonary function tests
- Assess oxygen saturation and administer supplemental O2 if needed (Correct answer)
- Schedule spirometry for next week
- Prescribe a new inhaler without evaluation
Correct answer: Assess oxygen saturation and administer supplemental O2 if needed
Acute dyspnea in a COPD patient requires immediate assessment of oxygen saturation and supplemental oxygen administration if hypoxic.
Question 5: According to ABFM clinical guidelines, which approach best prevents medication errors in primary care?
- Relying solely on patient memory for medication lists
- Reconciling medications at every visit using multiple sources (Correct answer)
- Avoiding polypharmacy discussions
- Delegating medication review to pharmacies only
Correct answer: Reconciling medications at every visit using multiple sources
Medication reconciliation using multiple sources (patient, pharmacy, records) at every visit is the most effective strategy to prevent medication errors.
Question 6: When a clinical guideline conflicts with an individual patient's values, what is the recommended approach in family medicine?
- Always follow the guideline strictly
- Dismiss the guideline entirely
- Apply the guideline as a default but individualize care based on patient context (Correct answer)
- Refer the patient to a specialist
Correct answer: Apply the guideline as a default but individualize care based on patient context
Guidelines provide population-level recommendations but must be individualized in family medicine, balancing evidence with the patient's unique values and circumstances.
ABFM ABFM Clinical Decision Making 2
When evaluating a patient with suspected deep vein thrombosis, which scoring system helps guide the clinical decision for further testing?