ABFM Family Medicine ITE 2019 Exam Updated Completely 100%Solved (with Detailed Solutions) 200Q&As Assured A+.
1. A 42-year-old female presents for
... [Show More] follow-up after being treated for recurrent respiratory problems at
an urgent care facility. She is feeling a little better after a short course of oral prednisone and use of an
albuterol (Proventil, Ventolin) inhaler. She has had a gradual increase in shortness of breath, a chronic
cough, and a decrease in her usual activity level over the past year. She has brought a copy of a recent
chest radiograph report for your review that describes panlobular basal emphysema. She does not have
a history of smoking, secondhand smoke exposure, or occupational exposures. Spirometry in the office
reveals an FEV1/FVC ratio of
0.67 with no change after bronchodilator administration.
Which one of the following underlying conditions is the most likely cause for this clinical
presentation?
A) 1-Antitrypsin deficiency
B) Bronchiectasis
C) Diffuse panbronchiolitis
D) Interstitial lung disease
E) Left heart failure {{Correct Ans- A
Explanation
This patient presents with symptoms of chronic obstructive lung disease, and spirometry confirms
airflow limitation or obstruction with an FEV1/FVC <0.7. Her age, the lack of tobacco smoke or
occupational
exposures, and the chest radiograph findings are typical of 1-antitrypsin deficiency. While left heart
failure, interstitial lung disease, bronchiectasis, and diffuse panbronchiolitis are all causes of chronic
cough, they are not necessarily associated with the development of COPD and these spirometry
findings.
Furthermore, the radiologic findings in this patient are not consistent with these conditions. Left heart
ABFM Family Medicine ITE 2019 Exam Updated
Completely 100%Solved (with Detailed Solutions)
200Q&As Assured A+.
failure would present with pulmonary edema on a chest radiograph and volume restriction on
pulmonary
function testing. Bronchiectasis would present with bronchial dilation and bronchial wall thickening on a
chest radiograph. Interstitial lung disease would present with reticular or increased interstitial markings.
Diffuse panbronchiolitis would present with diffuse small centrilobular nodular opacities al ong with
hyperinflation.
2. An otherwise healthy 57-year-old male presents with mild fatigue, decreased libido, and erectile
dysfunction. A subsequent evaluation of serum testosterone reveals hypogonadism.
Which one of the following would you recommend at this time?
A) No further diagnostic testing
B) A prolactin level
C) A serum iron level and total iron binding capacity
D) FSH and LH levels
E) Karyotyping {{Correct Ans- D
Explanation
In men who are diagnosed with hypogonadism with symptoms of testosterone deficiency and
unequivocally
and consistently low serum testosterone concentrations, further evaluation with FSH and LH levels is
advised as the initial workup to distinguish between primary and secondary hypogonadism. If secondary
hypogonadism is indicated by low or inappropriately normal FSH and LH levels, prolactin and serum iron
levels and measurement of total iron binding capacity are recommended to determine secondary causes
of hypogonadism, with possible further evaluation to include other pituitary hormone l evels and MRI of
the pituitary. If primary hypogonadism is found, karyotyping may be indicated for Klinefelter's
syndrome.
3. A 4-year-old female is brought to your office because of a history of constipation over the past several
months. Her mother reports that the child has 1-2 bowel movements per week composed of small
lumps of hard stool. She strains to have the bowel movements, and they are painful. The child eats
normally like her two siblings. [Show Less]