Free Ultimate ABIM Test Question and Answers — Questions and Answers
Question 1: A 69-year-old woman with no history of illness shows up with a terrible headache and a temperature of up to 104°F after just one day. She also reports sporadic episodes of expressive aphasia, nausea, and phono- and phonophobia. A physical examination is noteworthy for a lady who appears sick and has a fever of 103.8°F orally, a blood pressure of 150/70, and a pulse of 100. She keeps her eyes closed, seems to be slightly uncomfortable with the headache, and fights off passive neck flexion. The motor and sensory system exams are routine and show no signs of papilledema. The patient has a "normal" head CT after taking two blood cultures and starting therapy. 380 mg/dL of protein, 35 mg/dL of glucose, 400 WBC, 42% neutrophils, 35% lymphocytes, and 6% monocytes can all be found in the hazy CSF obtained through lumbar puncture. Few polymorphonuclear cells and Gram-positive bacilli are seen in the CSF Gram stain. What would be a risk factor for meningitis in this patient?
- Exposure to 2-year old granddaughter who is unvaccinated against Haemophilus influenza type b
- Age>50 and consumption of soft cheese (Correct answer)
- Lack of vaccination to Neisseria meningitidis
- Age>65 and lack of immunization against Strep. Pneumoniae
Correct answer: Age>50 and consumption of soft cheese
Gram-positive bacteria associated with Listeria monocytogenes meningitis can be seen in the CSF Gram stain. Gram-positive diplococci include Streptococcus pneumonia and H. influenzae, whereas Gram-negative diplococci include Neisseria meningitidis. Respiratory diseases, including Strep pneumonia, N meningitidis, and H influenzae type b, can spread from person to person by airborne droplets. Listeria monocytogenes is spread trans-placentally to fetuses and by consumption of infected foods (meats, vegetables, and cheeses have all been linked in the past). The CDC website may find a current list of contaminated items and their producers. Extreme ages (adults >50 and infants one month), pregnancy, immunosuppressed states, alcoholism, CKD, chronic liver disease, and diabetes mellitus are the only risk factors for Listeria monocytogenes. This patient would be at risk for Listeria meningitis due to her advanced age and intake of tainted food. (B) This patient does not have a history of asplenia, has not traveled to a location where meningococcal disease is endemic, and does not have complement deficiency, so immunization is unnecessary. It will not protect Listeria monocytogenes. (C) Starting at age 65, this patient should have had routine immunizations against Strep. Pneumonia. He is now 69 years old. Currently, ACIP guidelines advise conjugated Prevnar 13 followed by Pneumovax23 six to twelve months later, but this won't protect against Listeria monocytogenes. (D) Since routine vaccination against Haemophilus influenza type b was introduced in 1990, HIB meningitis has significantly decreased in children and (through herd immunity) in adults. Currently, H. influenzae type b meningitis mainly affects youngsters without vaccinations and seldom affects adults. This patient may be at risk for H. influenzae meningitis but not Listeria monocytogenes meningitis due to exposure to an unvaccinated youngster.
Question 2: An emergency department (ED) referral brings a 24-year-old patient in for a diagnosis of shortness of breath. Reviewing the ED data revealed that the patient had minor respiratory distress, intermittent stridor, and frequent episodes of shortness of breath over the previous four months. At each presentation, oxygen saturation levels were normal. Intramuscular epinephrine and albuterol administered as empiric therapy did not affect the symptoms. The symptoms always went away on their own. The patient's prior medical history is uneventful, and they are taking no drugs. The vital signs and physical exams are also typical right now. Which of the subsequent diagnoses is more likely?
- Chronic rhinosinusitis
- Reactive airways disease
- Paradoxical vocal cord motion (Correct answer)
- Angioedema
- Laryngospasm
Correct answer: Paradoxical vocal cord motion
The intermittent symptoms of this patient are most consistent with upper respiratory obstruction. The diagnosis most likely to be made is paradoxical vocal cord movements. Due to improper adduction of the vocal cords during inspiration in patients with paradoxical vocal cord motion, stridor, and respiratory discomfort ensue. <br> One sign of this potential diagnosis is a history of repeated visits to the ED for respiratory distress without any other obvious explanation. Exercise, among other things, can cause the symptoms to appear, and they usually go away independently. Although spirometry will show normal expiration and aberrant inspiratory function, it may be mistaken as asthma. The preferred diagnostic technique is laryngoscopy, which makes it possible to see the unusual cord movement in real-time.
Question 3: A 30-year-old man with a piece of steak lodged in his throat arrives at the emergency room. He claims that this has now occurred twice. He claims that he just received a diagnosis of eosinophilic esophagitis. Which of the following statements is accurate for eosinophilic esophagitis (EOE)?
- We can determine which foods are causing EOE by patch testing
- We can determine which foods are causing EOE by skin prick testing
- Besides diet elimination, there is no other treatment for EOE
- One must rule out reflux-induced eosinophilia prior to diagnosis of EOE (Correct answer)
Correct answer: One must rule out reflux-induced eosinophilia prior to diagnosis of EOE
Before a diagnosis of EOE, reflux-induced eosinophilia must be ruled out. Elevated eosinophils are another side effect of reflux. Before an EOE diagnosis, one must take high-dosage PPI for eight weeks and have a repeat biopsy. As the precise pathophysiology of EOE is unclear, (A) there is no tested method to identify if or which foods cause EOE. (B) Since the precise pathophysiology of EOE is unclear, there is no tested method to identify if or which foods cause EOE. (D) EOE needs 15 eosinophils/hpf or more. (E) Treatment for EOE has included an elimination diet in addition to using steroids.
Question 4: The best method for determining a food allergy is:
- History and lhE bloodwork
- History and skin testing
- lgE bloodwork only
- Skin testing only (Correct answer)
- Oral challenge
Correct answer: Skin testing only
Among the listed choices, skin (prick) testing is selected as the best method because it directly detects IgE-mediated immediate hypersensitivity to specific allergens. (Worth noting: the textbook gold standard for confirming a true food allergy is the oral food challenge, which here is marked wrong — review this key if your source emphasizes that standard.)
Question 5: You are meeting a 20-year-old male complaining for the previous two months about "puffy eyes" and "swollen ankles." Additionally, he says that his pee "sort of looks frothy and foamy." His vital signs during the examination are within normal ranges, and the funduscopy is uneventful but for minor bilateral edema 2+ in the bilateral feet to the ankle. He has never experienced any health issues or operations. His tests show an average serum creatinine level and a considerable 4-plus protein level without blood or bacteria in the urine. He has a kidney biopsy, which on light microscopy appears normal, but, on electron microscopy, reveals widespread podocyte effacement. Negative immunofluorescence results. Which medical intervention is ideal for this patient?
- Rituximab
- Tacrolimus
- Cyclophosphamide
- Cyclosporine
- Corticosteroids (Correct answer)
Correct answer: Corticosteroids
Minimal Change Disease most likely affects this patient. Minimal Change Disease most frequently affects very young children, while it can also affect older kids and teenagers. Because no apparent signs of pathology are detectable with light microscopy alone, minimal change illness is unusual. On the visceral epithelial cells, characteristic electron microscopy observations include podocyte effacement, vacuolation, and development of microvilli. The first line of therapy should always be corticosteroids. Prednisone oral tablets should be used once every other day for the first 8 to 16 weeks (or until remission is established), after which the dosage should be decreased if proteinuria disappears or drops to a superficial level. Relapses frequently occur even after remission (only one-third of individuals experience a single episode). If it is discovered that the patient has steroid resistance (which 25% of patients have), tacrolimus, cyclosporine, or cyclophosphamide would be utilized. Patients who experience relapses often might also utilize these.
Question 6: The COPD symptom that frequently develops several years before the onset of airflow restriction is:
- Dyspnea (Correct answer)
- Cough
- Cyanosis
- Chest pain
Correct answer: Dyspnea
Dyspnea (shortness of breath, especially on exertion) is the COPD symptom that commonly appears years before measurable airflow limitation and usually drives patients to seek care. Cough, cyanosis, and chest pain tend to occur later or are nonspecific, so dyspnea is the earliest hallmark.
Question 7: During an asthma attack, confusion, bradycardia, and paradoxical breathing signify:
- Moderate exacerbation
- Impending stroke
- Co-existing myocardial infarction
- Imminent respiratory arrest (Correct answer)
Correct answer: Imminent respiratory arrest
During an asthma attack, confusion, bradycardia (slow heart rate), and paradoxical breathing (inward movement of the abdomen during inhalation instead of the normal outward movement) are signs of severe respiratory distress and impending respiratory arrest. These symptoms indicate that the person's airway is severely constricted, and their breathing is becoming inadequate, which can lead to a complete cessation of breathing if not promptly addressed. Immediate medical intervention is crucial in such cases to prevent respiratory arrest and potentially save the person's life.
Free Ultimate ABIM Test Question and Answers
A 69-year-old woman with no history of illness shows up with a terrible headache and a temperature of up to 104°F after just one day.
She also reports sporadic episodes of expressive aphasia, nausea, and phono- and phonophobia.
A physical examination is noteworthy for a lady who appears sick and has a fever of 103.8°F orally, a blood pressure of 150/70, and a pulse of 100.
She keeps her eyes closed, seems to be slightly uncomfortable with the headache, and fights off passive neck flexion.
The motor and sensory system exams are routine and show no signs of papilledema.
The patient has a "normal" head CT after taking two blood cultures and starting therapy. 380 mg/dL of protein, 35 mg/dL of glucose, 400 WBC, 42% neutrophils, 35% lymphocytes, and 6% monocytes can all be found in the hazy CSF obtained through lumbar puncture.
Few polymorphonuclear cells and Gram-positive bacilli are seen in the CSF Gram stain.
What would be a risk factor for meningitis in this patient?
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