ABFM Practice and Application 3 — Questions and Answers
Question 1: A 68-year-old man with COPD continues to smoke 1 pack per day. Which intervention has the strongest evidence for improving long-term quit rates?
- Nicotine replacement therapy alone
- Brief counseling alone
- Combination of pharmacotherapy and behavioral counseling (Correct answer)
- E-cigarette use as a substitute
Correct answer: Combination of pharmacotherapy and behavioral counseling
Combining pharmacotherapy (such as varenicline or NRT) with behavioral counseling produces the highest long-term smoking cessation rates.
Question 2: A family practice uses a registry to identify patients with uncontrolled hypertension. This approach is an example of which care model component?
- Reactive care
- Population health management (Correct answer)
- Disease-specific episodic care
- Fee-for-service billing optimization
Correct answer: Population health management
Using a patient registry to identify and proactively manage high-risk patients is a core population health management strategy.
Question 3: A 52-year-old woman presents with postmenopausal bleeding. What is the most appropriate initial evaluation?
- Reassurance and repeat evaluation in 6 months
- Pap smear alone
- Transvaginal ultrasound and/or endometrial biopsy (Correct answer)
- Pelvic MRI as first-line imaging
Correct answer: Transvaginal ultrasound and/or endometrial biopsy
Postmenopausal bleeding must be evaluated for endometrial cancer with transvaginal ultrasound and/or endometrial sampling.
Question 4: A 28-year-old woman requests contraception. She has migraines with aura. Which contraceptive method is contraindicated?
- Progestin-only pills (minipill)
- Levonorgestrel IUD
- Combined oral contraceptive pills (Correct answer)
- Copper IUD
Correct answer: Combined oral contraceptive pills
Combined oral contraceptives containing estrogen are contraindicated in women with migraines with aura due to increased stroke risk.
Question 5: Which of the following best describes 'pay-for-performance' (P4P) in value-based care models relevant to family medicine?
- Paying physicians more for each visit they schedule
- Reimbursing practices based on achieving quality metrics and patient outcomes (Correct answer)
- Eliminating copays for preventive services
- Basing salary on years of experience only
Correct answer: Reimbursing practices based on achieving quality metrics and patient outcomes
Pay-for-performance ties reimbursement to achieving specific quality metrics and outcome benchmarks rather than volume of services.
Question 6: A 10-year-old boy is brought in by his mother because of academic difficulties and hyperactivity reported by teachers for over 6 months. Assessment confirms ADHD. What is the first-line treatment for a child this age?
- Atomoxetine alone
- Behavioral therapy alone
- Stimulant medication combined with behavioral therapy (Correct answer)
- Antidepressant medication
Correct answer: Stimulant medication combined with behavioral therapy
For school-age children with ADHD, the combination of stimulant medication and behavioral therapy is the most effective first-line treatment.
Question 7: A 40-year-old man has a fasting LDL of 195 mg/dL with no other cardiovascular risk factors. What is the most appropriate next step per ACC/AHA guidelines?
- Start high-intensity statin immediately without further discussion
- Initiate lifestyle modification and reassess in 3–6 months before considering statin (Correct answer)
- Prescribe ezetimibe as first-line therapy
- Refer immediately to cardiology
Correct answer: Initiate lifestyle modification and reassess in 3–6 months before considering statin
For primary prevention with elevated LDL but no high-risk features, a trial of lifestyle modification is appropriate before initiating statin therapy.
ABFM Practice and Application 3
A 68-year-old man with COPD continues to smoke 1 pack per day.
Which intervention has the strongest evidence for improving long-term quit rates?