ABFM Assessment and Evaluation 2 — Questions and Answers
Question 1: A 58-year-old male with hypertension presents for routine follow-up. His office BP is 148/92 mmHg on two readings. Which approach best confirms a diagnosis of sustained hypertension before intensifying therapy?
- Order ambulatory blood pressure monitoring (ABPM) (Correct answer)
- Repeat BP in 1 week in the office
- Start a second antihypertensive immediately
- Order renal artery Doppler ultrasound
Correct answer: Order ambulatory blood pressure monitoring (ABPM)
ABPM is the gold standard for confirming sustained hypertension and ruling out white-coat hypertension before escalating therapy.
Question 2: When using the PHQ-9 to screen for depression, which score indicates moderately severe depression requiring prompt clinical action?
- 5–9
- 10–14
- 15–19 (Correct answer)
- 20–27
Correct answer: 15–19
PHQ-9 scores of 15–19 indicate moderately severe depression, warranting active treatment initiation such as pharmacotherapy and/or psychotherapy.
Question 3: A family physician administers a Mini-Cog to an elderly patient. The patient recalls 1 of 3 words and draws a normal clock. How should this result be interpreted?
- Positive screen — further dementia evaluation warranted (Correct answer)
- Negative screen — no cognitive impairment
- Indeterminate — repeat in 6 months
- Normal for age — no action needed
Correct answer: Positive screen — further dementia evaluation warranted
On the Mini-Cog, recalling 1–2 words with a normal clock is a positive screen (score ≤2 triggers further evaluation).
Question 4: Which spirometry pattern is most consistent with COPD on pulmonary function testing?
- FEV1/FVC >0.70 with reduced TLC
- FEV1/FVC <0.70 post-bronchodilator with normal TLC
- FEV1/FVC <0.70 post-bronchodilator with air trapping (Correct answer)
- FEV1/FVC >0.70 with reduced DLCO only
Correct answer: FEV1/FVC <0.70 post-bronchodilator with air trapping
COPD is defined by a post-bronchodilator FEV1/FVC <0.70, and air trapping (elevated RV/TLC) on full PFTs confirms obstructive physiology.
Question 5: A 45-year-old woman presents with fatigue and weight gain. TSH is 8.2 mIU/L and free T4 is low. Which diagnosis does this pattern confirm?
- Central hypothyroidism
- Subclinical hypothyroidism
- Overt primary hypothyroidism (Correct answer)
- Euthyroid sick syndrome
Correct answer: Overt primary hypothyroidism
Overt primary hypothyroidism is defined by an elevated TSH with a low free T4, indicating inadequate thyroid hormone production.
Question 6: Which validated tool is recommended by USPSTF for screening alcohol use disorder in primary care adults?
- CAGE questionnaire
- AUDIT-C (Correct answer)
- MAST
- DAST-10
Correct answer: AUDIT-C
The AUDIT-C (Alcohol Use Disorders Identification Test–Concise) is widely recommended for primary care alcohol misuse screening.
Question 7: A 30-year-old woman has a BMI of 27 kg/m² and a fasting glucose of 112 mg/dL. Her HbA1c is 5.9%. How should she be classified?
- Normal glucose tolerance
- Prediabetes (Correct answer)
- Type 2 diabetes mellitus
- Gestational diabetes risk only
Correct answer: Prediabetes
Fasting glucose 100–125 mg/dL and/or HbA1c 5.7–6.4% meets criteria for prediabetes per ADA guidelines.
ABFM Assessment and Evaluation 2
A 58-year-old male with hypertension presents for routine follow-up.
His office BP is 148/92 mmHg on two readings.
Which approach best confirms a diagnosis of sustained hypertension before intensifying therapy?