ABIM MCQ 2 — Questions and Answers
Question 1: A 58-year-old man with type 2 diabetes presents with progressive exertional dyspnea and a reduced ejection fraction of 35%. His current medications include metformin and linagliptin. Which antidiabetic agent has been shown to reduce hospitalization for heart failure in this patient population?
- Empagliflozin (Correct answer)
- Glipizide
- Pioglitazone
- Sitagliptin
Correct answer: Empagliflozin
SGLT2 inhibitors like empagliflozin reduce hospitalization for heart failure and cardiovascular death in patients with type 2 diabetes and established cardiovascular disease.
Question 2: A 45-year-old woman is found to have a serum calcium of 11.2 mg/dL on routine labs. PTH is elevated at 92 pg/mL. She is asymptomatic with a creatinine of 1.0 mg/dL and a DEXA T-score of -1.8. What is the most appropriate management?
- Observation with annual monitoring (Correct answer)
- Parathyroidectomy
- Cinacalcet therapy
- Bisphosphonate therapy
Correct answer: Observation with annual monitoring
Asymptomatic primary hyperparathyroidism without meeting surgical criteria (T-score ≤ -2.5, age <50, serum Ca >1 mg/dL above normal, creatinine clearance <60) is managed with observation.
Question 3: A 72-year-old man with atrial fibrillation on warfarin presents with INR of 8.2 and no active bleeding. Which is the most appropriate immediate management?
- Hold warfarin and give oral vitamin K (Correct answer)
- Hold warfarin only
- Give fresh frozen plasma
- Give 4-factor PCC immediately
Correct answer: Hold warfarin and give oral vitamin K
For elevated INR >8 without bleeding, holding warfarin and giving low-dose oral vitamin K (1-2.5 mg) safely and predictably reverses supratherapeutic anticoagulation.
Question 4: A 29-year-old woman in the third trimester of pregnancy presents with right upper quadrant pain, nausea, and hypertension of 158/104 mmHg. Labs show AST 320 U/L, platelets 85,000/µL, and LDH 950 U/L. What is the diagnosis?
- HELLP syndrome (Correct answer)
- Acute fatty liver of pregnancy
- Preeclampsia without severe features
- Cholestasis of pregnancy
Correct answer: HELLP syndrome
HELLP syndrome is characterized by hemolysis (elevated LDH), elevated liver enzymes, and low platelets in the setting of hypertensive disorders of pregnancy.
Question 5: A patient with chronic kidney disease stage 4 presents with hyperkalemia of 6.1 mEq/L, peaked T waves on ECG, and normal QRS duration. What is the first-line treatment to stabilize the cardiac membrane?
- Intravenous calcium gluconate (Correct answer)
- Sodium bicarbonate infusion
- Regular insulin with dextrose
- Sodium polystyrene sulfonate
Correct answer: Intravenous calcium gluconate
IV calcium gluconate stabilizes the cardiac membrane within minutes and is always the first step when ECG changes are present, before any treatment to lower potassium.
Question 6: A 50-year-old man presents with symmetric proximal muscle weakness, elevated CK of 4,800 U/L, and an erythematous rash on his upper eyelids and knuckles. What autoantibody is most specifically associated with this condition?
- Anti-Jo-1 (Correct answer)
- Anti-dsDNA
- Anti-Sm
- Anti-centromere
Correct answer: Anti-Jo-1
Anti-Jo-1 (anti-synthetase) antibody is associated with dermatomyositis and polymyositis, often with interstitial lung disease as part of the antisynthetase syndrome.
Question 7: A 66-year-old man with COPD presents with a 2-day history of increased sputum production, purulent sputum, and worsening dyspnea. SpO2 is 88% on room air. ABG shows pH 7.32, PaCO2 58 mmHg, PaO2 52 mmHg. What is the most appropriate respiratory support?
- Non-invasive positive pressure ventilation (NIPPV) (Correct answer)
- High-flow nasal cannula
- Intubation and mechanical ventilation
- Simple face mask at 10 L/min
Correct answer: Non-invasive positive pressure ventilation (NIPPV)
NIPPV (BiPAP) is the preferred intervention for acute hypercapnic respiratory failure in COPD exacerbations, reducing intubation rates and mortality.
ABIM MCQ 2
A 58-year-old man with type 2 diabetes presents with progressive exertional dyspnea and a reduced ejection fraction of 35%.
His current medications include metformin and linagliptin.
Which antidiabetic agent has been shown to reduce hospitalization for heart failure in this patient population?