ABIM Test 2

Question 1

A 58-year-old man with type 2 diabetes presents with a serum creatinine of 2.1 mg/dL (baseline 1.0) after starting an NSAID for knee pain two weeks ago. Which mechanism best explains this acute kidney injury?

Accepted Answer

Inhibition of prostaglandin-mediated afferent arteriolar dilation

Answer

NSAIDs inhibit prostaglandin synthesis, reducing afferent arteriolar dilation that is critical for maintaining GFR in states of low effective circulating volume (as in diabetic nephropathy).

Question 2

A 45-year-old woman with Graves' disease is started on methimazole. Six weeks later she develops a fever, sore throat, and absolute neutrophil count of 200/µL. What is the most appropriate next step?

Accepted Answer

Discontinue methimazole immediately and initiate G-CSF

Answer

Agranulocytosis is a rare but life-threatening complication of methimazole; the drug must be stopped immediately, and G-CSF may be used to accelerate neutrophil recovery.

Question 3

A 72-year-old woman is hospitalized for pneumonia. On day 3 she develops a maculopapular rash, eosinophilia, and rising creatinine. Urinalysis shows WBC casts and eosinophiluria. Which diagnosis is most likely?

Accepted Answer

Acute interstitial nephritis

Answer

The triad of rash, eosinophilia, and eosinophiluria with WBC casts after antibiotic exposure is classic for acute interstitial nephritis.

Question 4

A 55-year-old man with heart failure (EF 30%) is found to have a potassium of 3.0 mEq/L. He is on lisinopril, carvedilol, and furosemide. Which potassium-sparing intervention has demonstrated a mortality benefit in this population?

Accepted Answer

Spironolactone

Answer

Spironolactone (and eplerenone) are aldosterone antagonists shown in RALES and EPHESUS trials to reduce mortality in heart failure with reduced ejection fraction.

Question 5

A 38-year-old woman presents with episodic severe headache, diaphoresis, and palpitations. Her blood pressure during an episode is 210/120 mmHg. 24-hour urine metanephrines are markedly elevated. Which antihypertensive should be initiated first?

Accepted Answer

Phenoxybenzamine

Answer

Alpha-blockade with phenoxybenzamine must be established before beta-blockade in pheochromocytoma to prevent unopposed alpha-mediated hypertensive crisis.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Test 2