ABIM Test 5

Question 1

A 44-year-old woman presents with fatigue, constipation, and hypercalcemia (Ca 11.8 mg/dL). PTH is 98 pg/mL (elevated). Renal function is normal and she is asymptomatic. Which criterion would make parathyroidectomy indicated per current guidelines?

Accepted Answer

Age under 50 years

Answer

Current AACE/AAES guidelines recommend parathyroidectomy for asymptomatic primary hyperparathyroidism in patients under 50 years of age.

Question 2

A 71-year-old man with cirrhosis (Child-Pugh B) presents with confusion, asterixis, and a serum ammonia of 140 µmol/L. He recently started a high-protein diet. What is the most appropriate treatment?

Accepted Answer

Lactulose titrated to 2–3 soft stools per day

Answer

Lactulose is first-line for acute hepatic encephalopathy, acidifying colonic contents and trapping ammonia for fecal excretion; rifaximin is added for secondary prophylaxis.

Question 3

A 48-year-old woman presents with a 3-week history of productive cough, night sweats, and 12-pound weight loss. She emigrated from Southeast Asia 2 years ago. Chest X-ray shows right upper lobe cavitary infiltrate. AFB smear of sputum is positive. How many negative sputum cultures are required before she can be removed from airborne isolation?

Accepted Answer

Three consecutive negative smears collected 8 hours apart

Answer

CDC guidelines require three consecutive negative AFB smears from respiratory specimens collected at least 8 hours apart before discontinuing airborne infection isolation.

Question 4

A 55-year-old man with a history of peptic ulcer disease presents with melena and hemodynamic instability. After resuscitation, upper endoscopy reveals a Forrest Ia (active spurting) duodenal ulcer. What is the most appropriate endoscopic therapy?

Accepted Answer

Combination therapy: epinephrine injection plus thermal coagulation or clip

Answer

Combination endoscopic therapy (epinephrine injection plus a second modality such as thermal coagulation or hemoclip) is superior to monotherapy for high-risk stigmata including active spurting.

Question 5

A 64-year-old man with long-standing hypertension presents with sudden severe tearing chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 140/85 in the left. CT angiography shows a type A aortic dissection. What is the definitive management?

Accepted Answer

Emergency surgical repair

Answer

Stanford type A aortic dissection involving the ascending aorta is a surgical emergency; medical management alone carries a mortality of approximately 1–2% per hour.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Test 5