ABPS Medical Knowledge & Clinical Practice Standards 4 — Questions and Answers
Question 1: A 28-year-old woman with a history of migraines presents seeking contraception. Which contraceptive method is contraindicated due to increased stroke risk?
- Progestin-only pill
- Intrauterine device (copper)
- Combined estrogen-progestin oral contraceptives (Correct answer)
- Depot medroxyprogesterone acetate
Correct answer: Combined estrogen-progestin oral contraceptives
Combined hormonal contraceptives containing estrogen are contraindicated in women with migraines with aura due to significantly increased ischemic stroke risk (WHO category 4).
Question 2: A 65-year-old male with COPD has an FEV1/FVC ratio of 0.58 and FEV1 of 42% predicted. According to GOLD criteria, what stage is his COPD?
- GOLD 1 (Mild)
- GOLD 2 (Moderate)
- GOLD 3 (Severe) (Correct answer)
- GOLD 4 (Very Severe)
Correct answer: GOLD 3 (Severe)
GOLD stage 3 (Severe) is defined by post-bronchodilator FEV1 of 30-49% predicted; an FEV1 of 42% predicted falls within this category.
Question 3: Which of the following laboratory findings is most consistent with a diagnosis of hemolytic anemia?
- Decreased reticulocyte count with low LDH
- Elevated LDH, elevated indirect bilirubin, and low haptoglobin (Correct answer)
- Elevated haptoglobin with normal reticulocytes
- Low MCV with elevated ferritin
Correct answer: Elevated LDH, elevated indirect bilirubin, and low haptoglobin
Hemolytic anemia is characterized by elevated LDH (from RBC lysis), elevated indirect bilirubin (from heme breakdown), decreased haptoglobin (bound by free hemoglobin), and elevated reticulocytes.
Question 4: According to ABPS standards, which of the following best reflects the principle of evidence-based medicine in clinical practice?
- Applying the most recent published study to every patient regardless of individual factors
- Integrating best research evidence with clinical expertise and patient values (Correct answer)
- Prioritizing clinical experience over published literature
- Following consensus opinion when randomized trial data are unavailable
Correct answer: Integrating best research evidence with clinical expertise and patient values
Evidence-based medicine as defined by Sackett integrates the best available research evidence with clinical expertise and patient preferences/values for individualized decision-making.
Question 5: A patient on long-term corticosteroids develops new polyuria and polydipsia. Fasting blood glucose is 142 mg/dL. What is the most likely diagnosis?
- Type 1 diabetes mellitus triggered by steroids
- Steroid-induced hyperglycemia/diabetes (Correct answer)
- Hyperosmolar hyperglycemic state
- SIADH from steroid use
Correct answer: Steroid-induced hyperglycemia/diabetes
Corticosteroids cause insulin resistance and increased hepatic gluconeogenesis, leading to steroid-induced hyperglycemia, which commonly manifests with postprandial glucose elevation.
Question 6: A 72-year-old man presents with painless gross hematuria. He has a 40 pack-year smoking history. What is the most important next diagnostic step?
- Urine culture and empiric antibiotics
- Cystoscopy and urine cytology (Correct answer)
- Repeat urinalysis in 4-6 weeks
- CT abdomen without contrast
Correct answer: Cystoscopy and urine cytology
Painless gross hematuria in an older male smoker is bladder cancer until proven otherwise; cystoscopy with urine cytology is the standard diagnostic approach.
Question 7: Which of the following is a key component of the ABPS's approach to Maintenance of Certification (MOC)?
- A single board examination at career onset with no reassessment
- Continuous participation in self-assessment, lifelong learning, and periodic recertification (Correct answer)
- Annual hospital credentialing without formal examination
- Specialty-specific CME credits only, with no cognitive testing
Correct answer: Continuous participation in self-assessment, lifelong learning, and periodic recertification
ABPS MOC requires ongoing physician participation in self-assessment, continuing medical education, and periodic recertification examinations to ensure currency of medical knowledge.
ABPS Medical Knowledge & Clinical Practice Standards 4
A 28-year-old woman with a history of migraines presents seeking contraception.
Which contraceptive method is contraindicated due to increased stroke risk?