ABIM MCQ 2

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?

Accepted Answer

Empagliflozin

Answer

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?

Accepted Answer

Observation with annual monitoring

Answer

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?

Accepted Answer

Hold warfarin and give oral vitamin K

Answer

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?

Accepted Answer

HELLP syndrome

Answer

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?

Accepted Answer

Intravenous calcium gluconate

Answer

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.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM MCQ 2