ABFM Practice and Application 2 — Questions and Answers
Question 1: A 58-year-old man with type 2 diabetes presents with a blood pressure of 148/92 mmHg on three separate visits. Which antihypertensive class is preferred as first-line therapy in this patient?
- Beta-blocker
- ACE inhibitor (Correct answer)
- Calcium channel blocker
- Alpha-blocker
Correct answer: ACE inhibitor
ACE inhibitors (or ARBs) are preferred in diabetic patients with hypertension due to their nephroprotective effects.
Question 2: A family physician is reviewing quality metrics and notices 40% of eligible patients are overdue for colorectal cancer screening. Which practice improvement strategy is most effective for population-level screening gaps?
- Relying on patients to self-schedule colonoscopies
- Implementing a proactive recall system with standing orders (Correct answer)
- Increasing appointment duration to discuss screening
- Delegating all screening discussions to nurses only
Correct answer: Implementing a proactive recall system with standing orders
Proactive recall systems with standing orders allow staff to identify and contact overdue patients without requiring a physician visit.
Question 3: A 72-year-old woman on warfarin for atrial fibrillation presents with an INR of 5.8 but no active bleeding. What is the most appropriate management?
- Hold warfarin and administer IV vitamin K
- Hold warfarin and give oral vitamin K 1–2.5 mg (Correct answer)
- Continue warfarin at the same dose and recheck in one week
- Administer fresh frozen plasma immediately
Correct answer: Hold warfarin and give oral vitamin K 1–2.5 mg
For supratherapeutic INR without bleeding, holding warfarin and giving low-dose oral vitamin K is recommended to lower INR safely.
Question 4: Which of the following best describes the role of the patient-centered medical home (PCMH) model in family medicine practice?
- Restricting care to episodic urgent visits only
- Coordinating comprehensive, continuous, accessible, and patient-centered care (Correct answer)
- Eliminating specialist referrals to reduce costs
- Focusing exclusively on preventive care services
Correct answer: Coordinating comprehensive, continuous, accessible, and patient-centered care
The PCMH model emphasizes team-based, coordinated, continuous, and accessible care centered on the whole patient across the lifespan.
Question 5: A 45-year-old woman presents with a 6-month history of fatigue, weight gain, cold intolerance, and constipation. TSH is 12 mIU/L with low free T4. What is the first-line treatment?
- Liothyronine (T3) replacement
- Levothyroxine (T4) replacement (Correct answer)
- Methimazole
- Radioactive iodine ablation
Correct answer: Levothyroxine (T4) replacement
Levothyroxine is the standard first-line treatment for primary hypothyroidism due to its long half-life and predictable conversion to T3.
Question 6: A physician implements a point-of-care A1C testing device in the office. Which principle of practice improvement does this best represent?
- Reducing provider autonomy
- Improving care through technology to enhance efficiency and same-visit decision-making (Correct answer)
- Replacing laboratory services entirely
- Shifting costs to the patient
Correct answer: Improving care through technology to enhance efficiency and same-visit decision-making
Point-of-care testing enables same-visit treatment adjustments, improving efficiency and care coordination.
Question 7: A 35-year-old pregnant woman at 28 weeks gestation screens positive on the 1-hour glucose challenge test (GCT) with a value of 155 mg/dL. What is the next step?
- Diagnose gestational diabetes and start insulin
- Perform a 3-hour 100g oral glucose tolerance test (OGTT) (Correct answer)
- Repeat the 1-hour GCT in 4 weeks
- Initiate dietary counseling without further testing
Correct answer: Perform a 3-hour 100g oral glucose tolerance test (OGTT)
A positive 1-hour GCT requires a 3-hour OGTT to confirm or rule out gestational diabetes mellitus.
ABFM Practice and Application 2
A 58-year-old man with type 2 diabetes presents with a blood pressure of 148/92 mmHg on three separate visits.
Which antihypertensive class is preferred as first-line therapy in this patient?