ABPS Medical Knowledge & Clinical Practice Standards 2 — Questions and Answers
Question 1: A 58-year-old patient with type 2 diabetes presents with an HbA1c of 9.2%. Which medication class has the strongest evidence for reducing cardiovascular mortality in this population?
- Sulfonylureas
- SGLT-2 inhibitors (Correct answer)
- Alpha-glucosidase inhibitors
- Thiazolidinediones
Correct answer: SGLT-2 inhibitors
SGLT-2 inhibitors (e.g., empagliflozin, canagliflozin) have demonstrated significant reductions in cardiovascular mortality in major outcomes trials such as EMPA-REG OUTCOME.
Question 2: Which of the following is the most appropriate first-line pharmacotherapy for newly diagnosed hypertension in a 45-year-old Black patient without comorbidities?
- ACE inhibitor
- Beta-blocker
- Thiazide diuretic or calcium channel blocker (Correct answer)
- Angiotensin receptor blocker
Correct answer: Thiazide diuretic or calcium channel blocker
JNC/AHA guidelines recommend thiazide diuretics or calcium channel blockers as first-line agents in Black patients due to lesser efficacy of ACE inhibitors and ARBs as monotherapy in this population.
Question 3: A physician is managing a patient on warfarin for atrial fibrillation whose INR is consistently supratherapeutic. Which factor most commonly causes warfarin sensitivity to increase?
- High dietary vitamin K intake
- CYP2C9 loss-of-function polymorphism (Correct answer)
- Concurrent use of rifampin
- Increased carbamazepine dosing
Correct answer: CYP2C9 loss-of-function polymorphism
CYP2C9 loss-of-function variants reduce warfarin metabolism, increasing plasma levels and anticoagulation effect.
Question 4: According to current USPSTF guidelines, at what age should average-risk adults begin colorectal cancer screening?
- 40 years
- 45 years (Correct answer)
- 50 years
- 55 years
Correct answer: 45 years
The USPSTF updated its 2021 guidelines to recommend colorectal cancer screening beginning at age 45 for average-risk adults.
Question 5: A 70-year-old woman is found to have a vertebral compression fracture on imaging. Her T-score on DEXA scan is -2.7. Which medication provides both antifracture efficacy and has the best evidence for reducing hip fractures?
- Calcium and vitamin D supplementation alone
- Alendronate (Correct answer)
- Calcitonin nasal spray
- Denosumab as first-line in all cases
Correct answer: Alendronate
Alendronate (a bisphosphonate) has robust evidence from randomized controlled trials for reducing hip, vertebral, and non-vertebral fractures in osteoporosis.
Question 6: Which clinical finding is most specific for diagnosing acute appendicitis on physical examination?
- Rovsing's sign
- McBurney's point tenderness (Correct answer)
- Rebound tenderness at any location
- Psoas sign
Correct answer: McBurney's point tenderness
McBurney's point tenderness (two-thirds of the way from the umbilicus to the right anterior superior iliac spine) is the most classic and specific physical finding for appendicitis.
Question 7: A patient with chronic kidney disease stage 3b develops anemia. What is the most appropriate initial diagnostic step before initiating treatment?
- Start erythropoiesis-stimulating agents immediately
- Check serum ferritin and transferrin saturation (Correct answer)
- Transfuse packed red blood cells
- Begin oral iron supplementation empirically without testing
Correct answer: Check serum ferritin and transferrin saturation
Iron deficiency must be assessed with serum ferritin and transferrin saturation before initiating erythropoiesis-stimulating agents, as iron deficiency must be corrected first.
ABPS Medical Knowledge & Clinical Practice Standards 2
A 58-year-old patient with type 2 diabetes presents with an HbA1c of 9.2%.
Which medication class has the strongest evidence for reducing cardiovascular mortality in this population?