ABFM Core Knowledge and Fundamentals 2 — Questions and Answers
Question 1: A 58-year-old man with hypertension and CKD stage 3 needs antihypertensive therapy. Which class is preferred as first-line in this setting?
- Thiazide diuretic
- ACE inhibitor (Correct answer)
- Beta-blocker
- Calcium channel blocker
Correct answer: ACE inhibitor
ACE inhibitors (or ARBs) are first-line in CKD with hypertension due to their nephroprotective effects by reducing intraglomerular pressure.
Question 2: According to the USPSTF, at what age should average-risk adults begin colorectal cancer screening?
- 40 years
- 45 years (Correct answer)
- 50 years
- 55 years
Correct answer: 45 years
The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.
Question 3: Which finding on knee X-ray is most characteristic of osteoarthritis?
- Periarticular osteopenia
- Joint space narrowing with osteophytes (Correct answer)
- Erosions at joint margins
- Soft tissue swelling without bony changes
Correct answer: Joint space narrowing with osteophytes
Osteoarthritis classically shows joint space narrowing, subchondral sclerosis, subchondral cysts, and osteophyte formation on X-ray.
Question 4: A patient is started on warfarin for atrial fibrillation. Which INR range is the target for stroke prevention?
- 1.0–1.5
- 1.5–2.0
- 2.0–3.0 (Correct answer)
- 3.0–4.0
Correct answer: 2.0–3.0
The therapeutic INR range for atrial fibrillation anticoagulation is 2.0–3.0, balancing stroke prevention against bleeding risk.
Question 5: Which vaccine is recommended annually for all persons aged 6 months and older?
- Pneumococcal vaccine
- Influenza vaccine (Correct answer)
- Tdap vaccine
- MMR vaccine
Correct answer: Influenza vaccine
The influenza vaccine is recommended annually for all persons ≥6 months of age due to antigenic drift of influenza strains each season.
Question 6: A 35-year-old woman is 8 weeks pregnant and screened for gestational diabetes. Which test is used at this early gestational age?
- 1-hour 50 g glucose challenge test
- 2-hour 75 g OGTT
- Fasting plasma glucose
- Hemoglobin A1c (Correct answer)
Correct answer: Hemoglobin A1c
Hemoglobin A1c or fasting plasma glucose is used in early pregnancy to screen for preexisting (overt) diabetes, not gestational diabetes.
Question 7: Which clinical feature best distinguishes bacterial tonsillitis from viral pharyngitis?
- Fever
- Tonsillar exudate
- Absence of cough with exudate, tender anterior cervical adenopathy (Correct answer)
- Sore throat severity
Correct answer: Absence of cough with exudate, tender anterior cervical adenopathy
The Centor/McIsaac criteria use absence of cough, tonsillar exudate, tender anterior cervical lymphadenopathy, and fever to predict streptococcal pharyngitis.
ABFM Core Knowledge and Fundamentals 2
A 58-year-old man with hypertension and CKD stage 3 needs antihypertensive therapy.
Which class is preferred as first-line in this setting?