ABPS Medical Knowledge & Clinical Practice Standards 3 — Questions and Answers
Question 1: A 35-year-old woman presents with symmetric arthritis of small joints of her hands, morning stiffness lasting >1 hour, and positive anti-CCP antibodies. Which disease-modifying agent is the current first-line treatment?
- Hydroxychloroquine
- Methotrexate (Correct answer)
- Prednisone monotherapy
- Etanercept
Correct answer: Methotrexate
Methotrexate remains the anchor DMARD and standard first-line therapy for rheumatoid arthritis due to its efficacy, safety profile, and extensive evidence base.
Question 2: Which electrocardiographic finding is pathognomonic for hyperkalemia at a serum potassium level typically >6.5 mEq/L?
- ST-segment depression
- Peaked T-waves progressing to sine wave pattern (Correct answer)
- Delta waves
- Prolonged QT interval
Correct answer: Peaked T-waves progressing to sine wave pattern
Severe hyperkalemia produces peaked T-waves, then PR prolongation, QRS widening, and ultimately a sine wave pattern that can precede fatal arrhythmias.
Question 3: A 62-year-old male smoker presents with a new persistent cough and hemoptysis. CT shows a 3.2 cm spiculated pulmonary mass. What is the most appropriate next step?
- Repeat CT in 6 months
- PET scan alone without tissue diagnosis
- Bronchoscopy or CT-guided biopsy for tissue diagnosis (Correct answer)
- Empiric antibiotics for 4 weeks
Correct answer: Bronchoscopy or CT-guided biopsy for tissue diagnosis
A spiculated mass >3 cm with this presentation has high suspicion for malignancy and requires tissue diagnosis via bronchoscopy or CT-guided biopsy before staging or treatment.
Question 4: Which of the following best describes the mechanism of action of glucagon-like peptide-1 (GLP-1) receptor agonists in type 2 diabetes?
- Inhibit renal glucose reabsorption by blocking SGLT-2
- Stimulate insulin secretion in a glucose-dependent manner and suppress glucagon (Correct answer)
- Sensitize peripheral tissues to insulin via PPAR-gamma activation
- Block ATP-sensitive potassium channels to stimulate insulin release
Correct answer: Stimulate insulin secretion in a glucose-dependent manner and suppress glucagon
GLP-1 receptor agonists enhance glucose-dependent insulin secretion, suppress glucagon, slow gastric emptying, and promote satiety through GLP-1 receptor activation.
Question 5: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' CT head is negative. What is the most critical next step?
- Discharge with analgesics and neurology follow-up in 1 week
- MRI brain without contrast
- Lumbar puncture for xanthochromia (Correct answer)
- Empiric antibiotic therapy for meningitis
Correct answer: Lumbar puncture for xanthochromia
A thunderclap headache with negative CT requires lumbar puncture to detect xanthochromia, which confirms subarachnoid hemorrhage missed by CT in up to 5-10% of cases.
Question 6: A 50-year-old woman presents with episodic hypertension, diaphoresis, and palpitations. Serum metanephrines are elevated. What is the definitive treatment?
- Lifelong alpha-blocker therapy
- Surgical resection after adequate alpha-blockade (Correct answer)
- Beta-blocker monotherapy
- Radiofrequency ablation
Correct answer: Surgical resection after adequate alpha-blockade
Pheochromocytoma is treated with surgical resection, but adequate preoperative alpha-blockade (e.g., phenoxybenzamine) is mandatory before beta-blockade to prevent hypertensive crisis.
Question 7: Which of the following is the most common cause of community-acquired pneumonia (CAP) requiring hospitalization in immunocompetent adults?
- Mycoplasma pneumoniae
- Streptococcus pneumoniae (Correct answer)
- Legionella pneumophila
- Haemophilus influenzae
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae remains the most common identifiable bacterial cause of CAP in hospitalized immunocompetent adults.
ABPS Medical Knowledge & Clinical Practice Standards 3
A 35-year-old woman presents with symmetric arthritis of small joints of her hands, morning stiffness lasting >1 hour, and positive anti-CCP antibodies.
Which disease-modifying agent is the current first-line treatment?