ABPS Medical Knowledge & Clinical Practice Standards 5

Question 1

A 45-year-old woman with HIV and a CD4 count of 150 cells/μL presents with fever, night sweats, and weight loss. Chest X-ray shows upper lobe cavitary lesions. What is the most likely diagnosis?

Accepted Answer

Pulmonary tuberculosis

Answer

Upper lobe cavitary lesions with constitutional symptoms in an immunocompromised patient are classic for pulmonary tuberculosis, which is a major opportunistic infection in HIV.

Question 2

Which of the following findings on echocardiography is most diagnostic of cardiac tamponade?

Accepted Answer

Right ventricular diastolic collapse and inferior vena cava plethora

Answer

Cardiac tamponade on echocardiography classically shows right ventricular diastolic collapse, right atrial collapse, and IVC plethora due to elevated intrapericardial pressure.

Question 3

A 30-year-old woman presents with symmetric proximal muscle weakness, elevated CK, and a heliotrope rash. What is the most likely diagnosis?

Accepted Answer

Dermatomyositis

Answer

The combination of proximal muscle weakness, elevated CK, and heliotrope rash (violaceous periorbital discoloration) is pathognomonic for dermatomyositis.

Question 4

A physician suspects a drug-drug interaction when prescribing clarithromycin to a patient on simvastatin. What is the mechanism of this interaction?

Accepted Answer

Clarithromycin inhibits CYP3A4, increasing simvastatin levels and myopathy risk

Answer

Clarithromycin is a potent CYP3A4 inhibitor that reduces simvastatin metabolism, dramatically increasing simvastatin plasma levels and risk of myopathy or rhabdomyolysis.

Question 5

A 55-year-old man with a 10-year history of GERD undergoes upper endoscopy showing columnar metaplasia of the distal esophagus confirmed on biopsy. What is this condition and its significance?

Accepted Answer

Barrett's esophagus, a precancerous condition requiring surveillance

Answer

Barrett's esophagus is intestinal metaplasia of the esophageal mucosa caused by chronic GERD and carries increased risk of esophageal adenocarcinoma, requiring endoscopic surveillance.

(ABPS) American Board of Physician Specialties Certification Practice Test

(ABPS) American Board of Physician Specialties Certification Practice Test

ABPS Medical Knowledge & Clinical Practice Standards 5