ABFM Core Knowledge and Fundamentals 3 — Questions and Answers
Question 1: A 45-year-old man presents with fatigue and is found to have a fasting glucose of 118 mg/dL. How is this classified?
- Normal
- Impaired fasting glucose (prediabetes) (Correct answer)
- Type 2 diabetes
- Type 1 diabetes
Correct answer: Impaired fasting glucose (prediabetes)
Impaired fasting glucose (prediabetes) is defined as fasting glucose 100–125 mg/dL; values ≥126 mg/dL on two occasions indicate diabetes.
Question 2: Which of the following is the most common cause of community-acquired pneumonia in otherwise healthy adults?
- Haemophilus influenzae
- Streptococcus pneumoniae (Correct answer)
- Mycoplasma pneumoniae
- Staphylococcus aureus
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae remains the most common identifiable cause of community-acquired pneumonia across all age groups.
Question 3: A patient on metformin for type 2 diabetes is scheduled for a contrast CT scan. What is the recommended action regarding metformin?
- Continue metformin without change
- Discontinue metformin 48 hours before and restart 48 hours after if renal function is stable (Correct answer)
- Switch to insulin permanently before the scan
- Double the metformin dose post-procedure
Correct answer: Discontinue metformin 48 hours before and restart 48 hours after if renal function is stable
Metformin should be held 48 hours before and after iodinated contrast in patients at risk for contrast-induced nephropathy to prevent lactic acidosis.
Question 4: Which lipid abnormality pattern is most characteristic of metabolic syndrome?
- High LDL with low triglycerides
- High HDL with normal LDL
- High triglycerides with low HDL (Correct answer)
- Elevated total cholesterol only
Correct answer: High triglycerides with low HDL
Metabolic syndrome typically features hypertriglyceridemia and low HDL-cholesterol, along with abdominal obesity, hypertension, and impaired fasting glucose.
Question 5: A 70-year-old woman has a T-score of -2.7 on DXA. What does this indicate?
- Normal bone density
- Osteopenia
- Osteoporosis (Correct answer)
- Severe osteoporosis with fracture
Correct answer: Osteoporosis
Osteoporosis is defined by a T-score of -2.5 or lower; this patient's score of -2.7 meets diagnostic criteria for osteoporosis.
Question 6: Which of the following best describes the mechanism of action of statins?
- Inhibit bile acid reabsorption in the gut
- Inhibit HMG-CoA reductase in hepatocytes (Correct answer)
- Activate lipoprotein lipase
- Block intestinal cholesterol absorption
Correct answer: Inhibit HMG-CoA reductase in hepatocytes
Statins competitively inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis, reducing LDL levels.
Question 7: Which preventive service has the strongest evidence for reducing cervical cancer mortality?
- Annual Pap smear starting at age 18
- HPV vaccination and cervical cytology/co-testing per guidelines (Correct answer)
- Colposcopy every 5 years
- MRI pelvis screening annually after age 30
Correct answer: HPV vaccination and cervical cytology/co-testing per guidelines
HPV vaccination combined with Pap smear/co-testing per USPSTF/ACOG guidelines has the strongest evidence for reducing cervical cancer incidence and mortality.
ABFM Core Knowledge and Fundamentals 3
A 45-year-old man presents with fatigue and is found to have a fasting glucose of 118 mg/dL.
How is this classified?