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November 2010 ABPOPPM In-training Exam Page 1 of 50

Module 4: Medicine

A 75 year-old male complains of progressive, painful cracking of the skin on both feet for the past 7 months.
His sole and elbow are shown. Social history includes smoking one pack of cigarettes daily.

Which of the following is associated with the skin disorder?


A. Arthritis
B. Hepatitis
C. Lymphoma
D. Diabetes

Correct Answer: A

Suggested Readings:
McCall Calvin O, Lawley Thomas J, "Chapter 53. Eczema, Psoriasis, Cutaneous Infections, Acne, and Other
Common Skin Disorders" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL,
Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2864389. Gudjonsson Johann E, Elder James T, "Chapter
18. Psoriasis" (Chapter). Wolff K, Goldsmith LA, Katz SI, Gilchrest B, Paller AS, Leffell DJ: Fitzpatrick's
Dermatology in General Medicine, 7e: http://www.accessmedicine.com/content.aspx?aID=2983780
November 2010 ABPOPPM In-training Exam Page 2 of 50

Module 4: Medicine

A 19 year-old male presents with colicky abdominal pain, painful ankle arthritis and microhematuria.
Cutaneous biopsy revealed IgA immunoreactivity around post capillary venules.

Which of the following is the most correct diagnosis?

A. Tinea pedis and corpus


B. Guttate psoriasis
C. Lyme disease
D. Henoch-Scholein purpura

Correct Answer: D

Suggested Readings:
Wolff K, Johnson RA, "Section 14. The Skin in Immune, Autoimmune, and Rheumatic Disorders" (Chapter).
Wolff K, Johnson RA: Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e:
http://www.accessmedicine.com/content.aspx?aID=5187962. Langford Carol A, Fauci Anthony S, "Chapter
319. The Vasculitis Syndromes" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL,
Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2859426.
November 2010 ABPOPPM In-training Exam Page 3 of 50

Module 4: Medicine

A 30 year-old male presents with scaling feet that have not improved following 6 weeks of griseofulvin therapy.
On further questioning he admits he had a sore on his penis several months ago. Past medical history includes
an itchy rash from a previous course of penicillin.

Which of the following is the most appropriate therapy?

A. Terbinafine
B. Corticosteroid
C. Cutaneous biopsy
D. Doxycycline

Correct Answer: D

Suggested Readings:
Wolff K, Johnson RA, "Section 30. Sexually Transmitted Infections" (Chapter). Wolff K, Johnson RA:
Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e:
http://www.accessmedicine.com/content.aspx?aID=5197627. Lukehart Sheila A, "Chapter 162. Syphilis"
(Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's
Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2869111.
.
November 2010 ABPOPPM In-training Exam Page 4 of 50

Module 4: Medicine

A 58 year-old female presents for evaluation of excessively dry feet, arms and legs of many years duration. A
recent forearm cutaneous biopsy demonstrates hyperkeratosis and a lack of a granular cell layer.

Which of the following is the best diagnosis?

A. Verrucae plantaris
B. Tinea pedis and corporis
C. Icthyosis vulgaris
D. Generalized psoriasis

Correct Answer: C

Suggested Readings:
Fleckman Philip, DiGiovanna John J, "Chapter 47. The Ichthyoses" (Chapter). Wolff K, Goldsmith LA, Katz
SI, Gilchrest B, Paller AS, Leffell DJ: Fitzpatrick's Dermatology in General Medicine, 7e:
http://www.accessmedicine.com/content.aspx?aID=2977821. Wolff K, Johnson RA, "Section 4. Ichthyoses"
(Chapter). Wolff K, Johnson RA: Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e:
http://www.accessmedicine.com/content.aspx?aID=5200435
November 2010 ABPOPPM In-training Exam Page 5 of 50

Module 4: Medicine

A 91 year-old male with DM2 presents with a non-painful ulcer at the pulp of the second toe, as shown, of 6
wks duration. He’s undergone a recent attempted revascularization. Medications include cephalexin and
metformin. Vascular examination reveals non-palpable pedal pulses and Doppler wave forms are monophasic.
The ABI is 0.35. Radiographs demonstrate a 3mm wide zone of osteolysis of the distal phalanx. The family
refuses amputation.

Which of the following therapies is most appropriate for the affected toe?

A. Clopidigrel (Plavix)
B. Digital amputation
C. Hyperbaric oxygen therapy
D. Topical hydrogen peroxide

Correct Answer: C

Suggested Readings:
HBOT: http://emedicine.medscape.com/article/1464149-overview Rapp Joseph H, Sarkar Rajabrata, Owens
Christopher D, "Chapter 12. Blood Vessel & Lymphatic Disorders" (Chapter). McPhee SJ, Papadakis MA,
Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=777652 .
November 2010 ABPOPPM In-training Exam Page 6 of 50

Module 4: Medicine

A 45 year-old female with DM2 presents for several painful plantar keratoses. Dermatology consultation
diagnosed the facial papules as dermatosis papulosa nigrans (DPN). The plantar keratoses are noted to be on
the weight bearing and non-weight bearing aspects of the soles.

Which of the following best describes DPN?

A. Human papilloma viral infection


B. Genetically predisposed, benign
C. Adult comedones
D. Pre-cancer

Correct Answer: B

Suggested Readings:
Emedicine; http://emedicine.medscape.com/article/1056854-overview
DermNetZ; http://dermnetnz.org/lesions/dermatosis-papulosa-nigra.html
November 2010 ABPOPPM In-training Exam Page 7 of 50

Module 4: Medicine

A 55 year-old female presents with painful lower legs of several months duration. She has recently been
prescribed 1000 units of vitamin D daily.

In addition to reducing symptoms of osteomalacia, treating vitamin D deficiency may:

A. Aggravate hypertension
B. Have anti-verrucae activity
C. Reduce risk of multiple sclerosis
D Reverse osteoarthritis

Correct Answer: C

Suggested Readings:
Expanding roles of vitamin D. Giovannucci E.:J Clin Endocrinol Metab. 2009 Feb;94(2):418-20.
Emedicine; http://emedicine.medscape.com/article/126187-overview
November 2010 ABPOPPM In-training Exam Page 8 of 50

Module 4: Medicine

A 48 year-old female runner inquires about the potential health benefits of taking multiple vitamins.

Which of the following has been shown to decrease cancer rates and overall mortality in women?

A. Vitamin C plus vitamin E


B. Vitamin C plus beta carotene
C. Vitamin E plus beta carotene
D. None of the above

Correct Answer: D

Suggested Readings:
Baron Robert B, "Chapter 29. Nutritional Disorders" (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.:
CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=16152.
J Natl Cancer Inst. 2009 Jan 7;101(1):14-23. Epub 2008 Dec 30.Vitamins C and E and beta carotene
supplementation and cancer risk: a randomized controlled trial. Lin J et al
November 2010 ABPOPPM In-training Exam Page 9 of 50

Module 4: Medicine

A 61 year-old male presents with progressively painful ankles and knees over the past 6 months that have failed
to improve with NSAIDs and gabapentin. He reports dyspnea, fever and productive cough as well as an
unintended 10 pound weight loss over the preceding 2 months. He is a former smoker with an 80 pack-year
history. Examination reveals clubbing of the digits. Laboratory findings reveal an elevated ESR and CRP,
while rheumatologic serology was negative. His chest contrast CT is shown.

Which of the following is the most likely diagnosis?

A. Seronegative arthropathy
B. Hypertrophic osteoarthropathy
C. Rheumatic fever
D. Chronic obstructive pulmonary disease

Correct Answer: B

Suggested Readings:
Langford Carol A, Gilliland Bruce C, "Chapter 330. Arthritis Associated with Systemic Disease and Other
Arthritides" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J:
Harrison's Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2876604.
http://cme.medscape.com/viewarticle/719754_2
November 2010 ABPOPPM In-training Exam Page 10 of 50

Module 4: Medicine

An 85 year-old female with DM2 is seen for a slow healing leg ulcer. No edema, erythema, elevated
temperature or drainage is noted. Examination reveals patient height of 58 inches; weight is 90 lbs. Recent
laboratory findings include decreased albumen, leukocyte count and pre-albumen. The HgA1C is 7.0%.

Which of the following is most likely responsible for the slow healing?

A. Nutritional impairment
B. Peripheral arterial disease
C. Uncontrolled diabetes
D. Chronic venous insufficiency

Correct Answer: A

Suggested Readings:
Baron Robert B, "Chapter 29. Nutritional Disorders" (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.:
CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=16152.
Berger Timothy G, "Chapter 6. Dermatologic Disorders" (Chapter). McPhee SJ, Papadakis MA, Tierney LM,
Jr.: CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=747.
November 2010 ABPOPPM In-training Exam Page 11 of 50

Module 4: Medicine

A 60 year-old male with a history of hepatic encephalopathy due to chronic alcohol abuse is seen for a painful
metatarsal fracture.

Which of the following drugs is the safest analgesic for this patient?

A. Oxycodone
B. Naproxen
C. Meloxicam
D. Acetaminophen

Correct Answer: D

Suggested Readings:
"Hepatic Encephalopathy." Quick Answers to Medical Diagnosis and Therapy:
http://www.accessmedicine.com/quickam.aspx. Bacon Bruce R, "Chapter 302. Cirrhosis and Its
Complications" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J:
Harrison's Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2876461.
http://www.clinicalcorrelations.org/?p=962
November 2010 ABPOPPM In-training Exam Page 12 of 50

Module 4: Medicine

A 57 year-old male with DM2 is seen in the ED after incurring a steam burn at work. His entire left leg is
severely burned. He weighs 70 kg. Fluid needs for burn victims in the acute phase can be calculated using the
Parkland formula, as follows: (2-4 ml of crystalloid) X (% BSA burn) X (body weight in kg).

Which of the following is the best estimate of the total volume of intravenous replenishment that will be
required over the first 24 hours?

A. 50 ml
B. 5040 ml
C. 2520 ml
D. 25 ml

Correct Answer: B

Suggested Readings:
Sheridan Robert L, "Chapter 94. Thermal Injuries" (Chapter). Wolff K, Goldsmith LA, Katz SI, Gilchrest B,
Paller AS, Leffell DJ: Fitzpatrick's Dermatology in General Medicine, 7e:
http://www.accessmedicine.com/content.aspx?aID=2974407. Emedicine Burns Management:
http://emedicine.medscape.com/article/769193-treatment
November 2010 ABPOPPM In-training Exam Page 13 of 50

Module 4: Medicine

A 61 year-old female with DM2 presents to the ED complaining of new onset fatigue and difficulty breathing.
She denies chest pain but is diaphoretic.

Which of the following is the most sensitive serum test to detect myocardial infarction?

A. Troponin
B. Myoglobin
C. Creatinine kinase
D. C-reactive protein

Correct Answer: A

Suggested Readings:
Alpert Joseph S, Thygesen Kristian S, Jaffe Allan S, White Harvey D, "A Universal Definition of Myocardial
Infarction for the Twenty-First Century" (Update). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL,
Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/updatesContent.aspx?aid=1001567. Noeller Thomas P, "Emergency
Medicine: ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation
Myocardial Infarction" (Update). Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM: Tintinalli's
Emergency Medicine: A Comprehensive Study Guide, 6e:
http://www.accessmedicine.com/updatesContent.aspx?aid=1001232.
November 2010 ABPOPPM In-training Exam Page 14 of 50

Module 4: Medicine

A 48 year-old male is being seen for foot care. Past medical history includes seizures and moderate
developmental retardation. During care, he gives out a short cry and turns blue. As rhythmic muscle
contractions begin he bites his tongue.

All of the following should be performed EXCEPT:

A. Place the patient in a prone position


B. Remove eyeglasses
C. Loosen clothing
D. Place a gauze pad in the mouth

Correct Answer: D

Suggested Readings:
Middleton Donald B, "Chapter 9. Seizures" (Chapter). South-Paul JE, Matheny SC, Lewis EL: CURRENT
Diagnosis & Treatment in Family Medicine, 2e: http://www.accessmedicine.com/content.aspx?aID=3032647 .
Lowenstein Daniel H, "Chapter 363. Seizures and Epilepsy" (Chapter). Fauci AS, Braunwald E, Kasper DL,
Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2901171 .
November 2010 ABPOPPM In-training Exam Page 15 of 50

Module 4: Medicine

A 56 year-old obese female complains of stiff, painful ankles and knees. Significant findings on physical
examination include dry skin and brittle nails, as well as a delayed relaxation phase of the deep tendon reflexes.
Laboratory findings are unremarkable.

Based on the suspected diagnosis which of the following additional tests is most helpful?

A. Creatinine
B. Potassium
C. Hemoglobin A1C
D. TSH

Correct Answer: D

Suggested Readings:
Jameson J. L, Weetman Anthony P, "Chapter 335. Disorders of the Thyroid Gland" (Chapter). Fauci AS,
Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal
Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2877285. Clinical manifestation of
hypothyroidism: http://www.medscape.com/viewarticle/433851_2
November 2010 ABPOPPM In-training Exam Page 16 of 50

Module 4: Medicine

A 53 year-old male complains of severe foot and leg muscle spasms of several months duration. He also
describes symptoms consistent with paresthesias of his feet, hands and around his mouth. Examination reveals
weakness of the neck extensors, proximal musculature, thin brittle nails and hyperactive deep tendon reflexes.

Laboratory findings reveal:

Test Result
CBC Within normal ranges
Alkaline phosphatase Normal
Muscle biopsy Atrophy without fiber degeneration
Calcium Decreased
Phosphate Elevated

Which of the following tests would confirm the diagnosis?

A. PTH
B. TSH
C. Creatinine
D. Serum glucose

Correct Answer: A

Suggested Readings:
"Hypoparathyroidism & Pseudohypoparathyroidism." Quick Answers to Medical Diagnosis and Therapy:
http://www.accessmedicine.com/quickam.aspx. Brown, Jr. Robert H, Amato Anthony A, Mendell Jerry R,
"Chapter 382. Muscular Dystrophies and Other Muscle Diseases" (Chapter). Fauci AS, Braunwald E, Kasper
DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2907497
November 2010 ABPOPPM In-training Exam Page 17 of 50

Module 4: Medicine

A 78 year-old male retired fire fighter presents with painful chronic achilles tendonitis. Examination reveals
moderately severe lower limb swelling bilaterally and painful a left achilles tendon insertion. Past medical
history includes prostatic hypertrophy. Chest radiograph is shown.

Which of the following is the most likely cause of the bilateral limb swelling?

A. Deep venous thrombophlebitis


B. Chronic obstructive pulmonary disease
C. Chronic renal failure
D. Lymphedema praecox

Correct Answer: B

Suggested Readings:
Reilly, Jr. John J, Silverman Edwin K, Shapiro Steven D, "Chapter 254. Chronic Obstructive Pulmonary
Disease" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J:
Harrison's Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2899309.
Chesnutt Mark S, Gifford Alex H, Prendergast Thomas J, "Chapter 9. Pulmonary Disorders" (Chapter).
McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=2740 .
November 2010 ABPOPPM In-training Exam Page 18 of 50

Module 4: Medicine

A 38 year-old male runner presents with bilateral heel pain of 6 months duration. He has been unresponsive to
rest and orthoses. Past medical history reveals back stiffness every morning that lasts about 90 minutes.
Examination reveals palpable tenderness at the tibial tuberosities, iliac crests and posterior heels. Laboratory
findings reveal mild anemia, elevated ESR and CRP, however RA factor, anti-CCP, and ANA are absent.

Based on the clinical presentation, which of the following is the most likely diagnosis?

A. Achilles tendonosis
B. Ankylosing spondylitis
C. Rheumatoid arthritis
D. Haglund’s deformities

Correct Answer: B

Suggested Readings:
Taurog Joel D, "Chapter 318. The Spondyloarthritides" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser
SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2862753. Hu Serena S, Tribus Clifford B, Tay Bobby K,
Bhatia Nitin N, "Chapter 5. Disorders, Diseases, & Injuries of the Spine" (Chapter). Skinner HB: CURRENT
Diagnosis & Treatment in Orthopedics, 4e: http://www.accessmedicine.com/content.aspx?aID=2319334 .
November 2010 ABPOPPM In-training Exam Page 19 of 50

Module 4: Medicine

A 45 year-old male presents with a swollen, painful left ankle of 12 hours duration. He has a history of heroin
use. Synovial fluid analysis reveals WBCs of 125,000/mcL, with 95% PMNs. There are gram + cocci present.

Based on these findings, which of the following should be ordered first?

A. Empiric antibiotics
B. MRI
C. Surgical drainage
D. Immobilization

Correct Answer: C

Suggested Readings:
Hellmann David B, Imboden John B, "Chapter 20. Musculoskeletal & Immunologic Disorders" (Chapter).
McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=10083. Wilson Scott C, Skinner Harry B, "Chapter 8.
Orthopedic Infections" (Chapter). Skinner HB: CURRENT Diagnosis & Treatment in Orthopedics, 4e:
http://www.accessmedicine.com/content.aspx?aID=2321297.
November 2010 ABPOPPM In-training Exam Page 20 of 50

Module 4: Medicine

A 44 year-old obese diabetic female is seen in the ED with severe right upper abdominal pain, fever and
vomiting 3 weeks post osteotomy bunionectomy which is healing uneventfully to date. Laboratory findings
reveal the WBC count elevated at 15,000/mcL; serum total bilirubin, aminotransferase, alkaline phosphatase
and amylase are all elevated. The abdominal sonogram is shown.

Which of the following is the most likely diagnosis?

A. Coronary syndrome
B. Appendicitis
C. Bowel obstruction
D. Cholecystitis

Correct Answer: D

Suggested Readings:
Friedman Lawrence S, "Chapter 16. Liver, Biliary Tract, & Pancreas Disorders" (Chapter). McPhee SJ,
Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=7993. Rush Micheal D, Winslett Sonia, Wisdom Kimberley
D, "Chapter 212. Diabetes Mellitus" (Chapter). Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM:
Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 6e:
http://www.accessmedicine.com/content.aspx?aID=606123 .
November 2010 ABPOPPM In-training Exam Page 21 of 50

Module 4: Medicine

A 44 year-old who is a new runner presents with anterior leg cramps of three days duration. Review of systems
reveals episodes of wheezing, difficulty breathing, chest tightness, and productive cough, all worse at night.
Examination reveals the patient is afebrile with normal pulse rate and blood pressure. Biomechanical findings
are significant for ankle equinus, rearfoot and forefoot varus, all bilateral. The patient is worked up for medial
tibial stress syndrome.

Which of the following should be suspected based on the constitutional findings and history?

A. Upper respiratory infection


B. Asthma
C. Pneumonia
D. Coronary artery disease

Correct Answer: B

Suggested Readings:
Chesnutt Mark S, Gifford Alex H, Prendergast Thomas J, "Chapter 9. Pulmonary Disorders" (Chapter).
McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=2740 Hueston William J, "Chapter 26. Respiratory
Problems" (Chapter). South-Paul JE, Matheny SC, Lewis EL: CURRENT Diagnosis & Treatment in Family
Medicine, 2e: http://www.accessmedicine.com/content.aspx?aID=3033474 .
November 2010 ABPOPPM In-training Exam Page 22 of 50

Module 4: Medicine

A 33 year-old male presents for chronic bilateral heel pain. Review of systems reveals a recent bout of urinary
frequency, urgency, and dysuria. Urinalysis shows hematuria. Urine microscopy is seen below.

Which of the following is the most likely diagnosis?

A. Non specific urethritis of Reiter’s disease


B. Bladder carcinoma
C. Acute bacterial cystitis
D. Voiding dysfunction disorder

Correct Answer: C

Suggested Readings:
Stamm Walter E, "Chapter 282. Urinary Tract Infections, Pyelonephritis, and Prostatitis" (Chapter). Fauci AS,
Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal
Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2899464. Meng Maxwell V, Stoller
Marshall L, Walsh Thomas J, "Chapter 23. Urologic Disorders" (Chapter). McPhee SJ, Papadakis MA, Tierney
LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=11857 .
November 2010 ABPOPPM In-training Exam Page 23 of 50

Module 4: Medicine

A 72 year-old female presents with bilateral calf and foot swelling of several weeks duration. Past medical
history includes chronic refractory hypertension and worsening pulmonary edema. There is bilateral pitting
edema but no redness or heat. One month ago an ACE inhibitor was started by her internist. Recent laboratory
findings reveal elevated BUN and serum creatinine.

Which of the following is the most accurate diagnosis?

A. Deep venous thrombophlebitis


B. Chronic renal failure
C. Chronic obstructive pulmonary disease
D. Cellulitis

Correct Answer: B

Suggested Readings:
Watnick Suzanne, Morrison Gail, "Chapter 22. Kidney Disease" (Chapter). McPhee SJ, Papadakis MA, Tierney
LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=11374 .
Sutters Michael, "Chapter 11. Systemic Hypertension" (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.:
CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=3177080
.
November 2010 ABPOPPM In-training Exam Page 24 of 50

Module 4: Medicine

A 68 year-old diabetic female presents with worsening peripheral edema of several months duration.
Medications include furosemide, metformin and lisinopril. Dyspnea and abdominal fullness is reported on the
review of systems. Urinalysis finds proteinuria. The serum albumin concentration is decreased.

Which of the following is the most accurate diagnosis?

A. Cellulitis
B. Lymphedema praecox
C. Chronic venous hypertension
D. Nephrotic syndrome

Correct Answer: D

Suggested Readings:
Gonzales Ralph, Nadler Paul L, "Chapter 2. Common Symptoms" (Chapter). McPhee SJ, Papadakis MA,
Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=79. Watnick Suzanne, Morrison Gail, "Chapter 22. Kidney
Disease" (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment
2010: http://www.accessmedicine.com/content.aspx?aID=11374 .
November 2010 ABPOPPM In-training Exam Page 25 of 50

Module 4: Medicine

A 68 year-old female presents 10 days status post digital arthroplasty of the right fifth toe with a painful leg
cramp of 3 days duration. Medications include tamoxefen and pioglitazone. Review of systems reveals
breathlessness when walking but the patient denies claudication symptoms. The surgical site is healing well and
the sutures are removed.

Which of the following is the best course of action?

A. Order chest radiographs


B. Obtain ankle brachial index
C. Recommend a course of stretching
D. Order D-dimer study

Correct Answer: D

Suggested Readings:
Goldhaber Samuel Z, "Chapter 256. Deep Venous Thrombosis and Pulmonary Thromboembolism" (Chapter).
Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of
Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2880540. Liem Timothy K, Moneta
Gregory L, "Chapter 24. Venous and Lymphatic Disease" (Chapter). Brunicardi FC, Andersen DK, Billiar TR,
Dunn DL, Hunter JG, Matthews JB, Pollock RE: Schwartz's Principles of Surgery, 9e:
http://www.accessmedicine.com/content.aspx?aID=5014541
November 2010 ABPOPPM In-training Exam Page 26 of 50

Module 4: Medicine

A 55 year-old female presents with heel pain of 3 months duration. Review of systems reveals gnawing,
burning, epigastric pain with nausea, triggered by foods. Medications include ibuprofen 800mg TID. A recent
endoscopy image is shown.

Which of the following is the best recommendation?

A. Referral for pain management


B. Substitute acetaminophen for ibuprofen
C. Add misoprostol (Cytotec)
D. Referral for H. pylori eradication

Correct Answer: D

Suggested Readings:
Valle John D, "Chapter 287. Peptic Ulcer Disease and Related Disorders" (Chapter). Fauci AS, Braunwald E,
Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2899580. Hasler William L, "Chapter 39. Nausea,
Vomiting, and Indigestion" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL,
Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2863966 .
November 2010 ABPOPPM In-training Exam Page 27 of 50

Module 4: Medicine

A 78 year-old female is referred for a painful left foot, present for several weeks. Past medical history includes
COPD, chronic severe RA and PAD. Medications include prednisone and inhalers. Examination reveals non-
palpable pedal pulses, however biphasic arterial sounds are heard and the ABI is 0.7 bilaterally. CBC is WNL.

Which of the following is the most likely diagnosis?

A. Decubitus ulcer
B. Ischemic ulcer
C. Felty’s syndrome
D. Vasculitic ulcer

Correct Answer: D

Suggested Readings:
Seo Philip, Stone John H, "Chapter 43. Miscellaneous Forms of Vasculitis" (Chapter). Imboden JB, Hellmann
DB, Stone JH: CURRENT Rheumatology Diagnosis & Treatment, 2e:
http://www.accessmedicine.com/content.aspx?aID=2727646. Powell Frank C, Hackett Bridget C, "Chapter 32.
Pyoderma Gangrenosum" (Chapter). Wolff K, Goldsmith LA, Katz SI, Gilchrest B, Paller AS, Leffell DJ:
Fitzpatrick's Dermatology in General Medicine, 7e:
http://www.accessmedicine.com/content.aspx?aID=2952781.
November 2010 ABPOPPM In-training Exam Page 28 of 50

Module 4: Medicine

A 72 year-old female with DM2 and chronic kidney disease is evaluated for bilateral edema of the feet and legs.
Hemodialysis was recently started. Medications include metformin and lisinopril. The patient requests
clarification about what her nephrologist told her about her diet.

All of the following need to be restricted EXCEPT:

A. Fluids
B. Salt substitutes
C. Phosphate
D. Fiber

Correct Answer: D

Suggested Readings:
Liu Kathleen D, Chertow Glenn M, "Chapter 275. Dialysis in the Treatment of Renal Failure" (Chapter). Fauci
AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal
Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2881053 .
http://www.medicinenet.com/script/main/art.asp?articlekey=78054
November 2010 ABPOPPM In-training Exam Page 29 of 50

Module 4: Medicine

A 68 year-old male with DM2 presents for a pre-operative consult for foot surgery. Past medical history is
positive for progressive elevations of serum creatinine to 2.0 mg/dL. Current medications include furosemide,
metformin, amlodipine and atorvastatin. Internal medicine is consulted.

Which of the following medications will most likely be discontinued?

A. Furosemide
B. Metformin
C. Amlodipine
D. Atorvastatin

Correct Answer: B

Suggested Readings:
Powers Alvin C, "Chapter 338. Diabetes Mellitus" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL,
Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2891108
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125663
November 2010 ABPOPPM In-training Exam Page 30 of 50

Module 4: Medicine

A 73 year-old female with DM1, on hemodialysis, requires an oral antibiotic for an infected foot ulcer.
Clindamycin is chosen due to a penicillin allergy. A nephrology consult is ordered. The patient weighs 180 lbs
and her serum creatinine is 2.0 mg/dL.

Which of the following will most likely to be recommended?

A. Administer drug before dialysis


B. Administer normal dose of the drug
C. Skip dosing every other day
D. Reduce the total dose by one-half

Correct Answer: B

Suggested Readings:
Gomella LG, Haist SA, "Chapter 6. Laboratory Diagnosis: Urine Studies" (Chapter). Gomella LG, Haist SA:
Clinician's Pocket Reference: The Scut Monkey, 11e:
http://www.accessmedicine.com/content.aspx?aID=2700536. Arora, P et al, “Chronic Renal Disease”:
http://emedicine.medscape.com/article/238798-overview
November 2010 ABPOPPM In-training Exam Page 31 of 50

Module 4: Medicine

A 73 year-old female presents to the ED with progressive chest pain over the last several hours.

Which of the following is most consistent with the EKG shown?

A. Normal sinus rhythm


B. Bradycardia
C. Coronary occlusion
D. Pulmonary embolism

Correct Answer: C

Suggested Readings:
Castellanos Agustin, Jr. Alberto I, Myerburg Robert J, "Chapter 13. The Resting Electrocardiogram" (Chapter).
Fuster V, O’Rourke RA, Walsh RA, Poole-Wilson P, Eds. King SB, Roberts R, Nash IS, Prystowsky EN,
Assoc. Eds.: Hurst's The Heart, 12e: http://www.accessmedicine.com/content.aspx?aID=3058152 .
Barrett KE, Barman SM, Boitano S, Brooks H, "Chapter 30. Origin of the Heartbeat & the Electrical Activity of
the Heart" (Chapter). Barrett KE, Barman SM, Boitano S, Brooks H: Ganong's Review of Medical Physiology,
23e: http://www.accessmedicine.com/content.aspx?aID=5243592 .
November 2010 ABPOPPM In-training Exam Page 32 of 50

Module 4: Medicine

A 52 year-old male presents to the ED with difficulty walking, shortness of breath and palpitations.

Which of the following is most consistent with the EKG shown?

A. Normal sinus rhythm


B. Ventricular tachycardia
C. Coronary occlusion
D. Pulmonary embolism

Correct Answer: B

Suggested Readings:
Ritchie James V, Juliano Michael L, Thurman R. J, "Chapter 23. ECG Abnormalities" (Chapter). Knoop KJ,
Stack LB, Storrow AB, Thurman RJ: The Atlas of Emergency Medicine, 3e:
http://www.accessmedicine.com/content.aspx?aID=6007764. Barrett KE, Barman SM, Boitano S, Brooks H,
"Chapter 30. Origin of the Heartbeat & the Electrical Activity of the Heart" (Chapter). Barrett KE, Barman SM,
Boitano S, Brooks H: Ganong's Review of Medical Physiology, 23e:
http://www.accessmedicine.com/content.aspx?aID=5243592 .
November 2010 ABPOPPM In-training Exam Page 33 of 50

Module 4: Medicine

The podiatric resident, assisting the ED specialist, reviews a 43 year-old male's medical H&P related to a "heart
murmur". Palpation of the chest reveals an apical impulse that is laterally displaced and sustained.

Which of the following is the most correct site to auscultate a suspected aortic valve murmur?

A. Right upper sternal border


B. Left upper sternal border
C. Left lower sternal border
D. Apex of the heart

Correct Answer: A

Suggested Readings:
Kusumoto Fred M, "Chapter 10. Cardiovascular Disorders: Heart Disease" (Chapter). McPhee SJ, Hammer
GD: Pathophysiology of Disease, 6e: http://www.accessmedicine.com/content.aspx?aID=5367630
LeBlond RF, Brown DD, DeGowin RL, "Chapter 8. The Chest: Chest Wall, Pulmonary, and Cardiovascular
Systems; The Breasts" (Chapter). LeBlond RF, Brown DD, DeGowin RL: DeGowin's Diagnostic Examination,
9e: http://www.accessmedicine.com/content.aspx?aID=3661355
November 2010 ABPOPPM In-training Exam Page 34 of 50

Module 4: Medicine

A 62 year-old male is evaluated for ongoing DM2. Routine laboratory findings reveal an HgA1c of 7.0%.

Which of the following is the most appropriate course of action for this patient?

A. Increase oral hypoglycemics


B. Institute insulin therapy
C. Alter diet
D. Council and repeat test in 3 months

Correct Answer: D

Suggested Readings:
Powers Alvin C, "Chapter 338. Diabetes Mellitus" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL,
Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2891108
http://en.wikipedia.org/wiki/Glycated_hemoglobin
November 2010 ABPOPPM In-training Exam Page 35 of 50

Module 4: Medicine

A 67 year-old female with DM2 presents for foot care. She provides a list of medications and a log of recent
blood pressures recorded by the nursing staff.

Observation Systolic Diastolic


Monday 152 90
Thursday 156 95
Saturday 159 96
Tuesday 150 95

Which of the following best characterizes the stage of hypertension?

A. Pre-hypertension
B. Stage 1(mild-moderate)
C. Stage 2 (severe)
D. Insufficient data to stage

Correct Answer: B

Suggested Readings:
Rashidi Arash, Rahman Mahboob, Wright, Jr. Jackson T, "Chapter 70. Diagnosis and Treatment of Hypertension"
(Chapter). Fuster V, O’Rourke RA, Walsh RA, Poole-Wilson P, Eds. King SB, Roberts R, Nash IS, Prystowsky EN,
Assoc. Eds.: Hurst's The Heart, 12e: http://www.accessmedicine.com/content.aspx?aID=3056147 Sutters Michael,
"Chapter 11. Systemic Hypertension" (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical
Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=3177080
November 2010 ABPOPPM In-training Exam Page 36 of 50

Module 4: Medicine

A 73 year-old with DM2 presents for primary foot care complaining of swollen feet. Review of systems reveals
recent onset weight gain and dyspnea. After changing internists last month, lisinopril (Zesteril), rosiglitazone
(Avandia) and atorvastatin (Lipitor) were initiated. Examination reveals blood pressure of 135/85 and bilateral
2+ pitting leg and foot edema.

Which of the following is the most likely cause of the leg edema?

A. Cirrhosis
B. Uncontrolled hypertension
C. Acute renal failure
D. Adverse drug reaction to rosiglitazone

Correct Answer: D

Suggested Readings:
"Edema, Lower Extremity." Quick Answers to Medical Diagnosis and Therapy:
http://www.accessmedicine.com/quickam.aspx. McGuire Darren K, Inzucchi Silvio E, "Cardiovascular
Considerations for the Use of Thiazolidinedione Medications" (Update). Fauci AS, Braunwald E, Kasper DL,
Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/updatesContent.aspx?aid=1001451 .
November 2010 ABPOPPM In-training Exam Page 37 of 50

Module 4: Medicine

A 27 year-old male presents for oral antifungal therapy to treat severe onychomycosis. Review of systems is
significant for a recent onset of low-grade fever, migrating myalgias and arthralgias. Recent baseline laboratory
findings reveal:

Test Result Normal Range


ALT (SGPT) (IU/L) 127 9-60
AST (SGOT) (IU/L) 65 10-40
GGT (IU/L) 48 0-51
Bilirubin (mg/dL) 1.0 0.2–1.2
Direct Bilirubin (mg/dL) 0.2 0–0.3
Alkaline phosphatase (IU/L) 105 30-120

Which of the following conditions is most likely?

A. Reiter’s syndrome
B. Viral hepatitis
C. Cholecystitis
D. Crohn’s disease

Correct Answer: B

Suggested Readings:
Dienstag Jules L, "Chapter 298. Acute Viral Hepatitis" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser
SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2873725. Gonzales R, Kutner JS, "Disease Screening"
(Chapter). Gonzales R, Kutner JS: CURRENT Practice Guidelines In Primary Care 2009:
http://www.accessmedicine.com/content.aspx?aID=560515
November 2010 ABPOPPM In-training Exam Page 38 of 50

Module 4: Medicine

A 78 year-old female presents with foot and ankle edema as shown. She became short of breath walking into the
office and reports recently having to sit up to sleep. BP is 130/85 at 82 bpm. Medications include
levothyroxine and HCTZ. Her sleep is disturbed by a chronic cough and frequent trips to the bathroom. The
extremities exhibit pitting edema of the feet and are warm to cool.

Which of the following is the most likely


diagnosis?

A. Upper respiratory infection


B. Myxedema
C. Diabetes mellitus
D. Congestive heart failure

Correct Answer: D

Suggested Readings:
Bashore Thomas M, Granger Christopher B, Hranitzky Patrick, Patel Manesh R, "Chapter 10. Heart Disease"
(Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=3671. Ellison David H, "Chapter 2. Disorders of
Extracellular Volume: Hypovolemia & Hypervolemia" (Chapter). Lerma EV, Berns JS, Nissenson AR:
CURRENT Diagnosis & Treatment: Nephrology & Hypertension:
http://www.accessmedicine.com/content.aspx?aID=6334487
November 2010 ABPOPPM In-training Exam Page 39 of 50

Module 4: Medicine

A 68 year-old female presents requesting a refill of a quinine sulfate prescription. She has been experiencing
leg cramps that wake her up at night. The physical exam and review of systems is essentially unremarkable.
She denies any drug allergies.

The request should not be honored as quinine sulfate (Qualaquin) has been shown to cause which of the
following disorders?

A. Thrombocytopenia
B. Stevens-Johnson syndrome
C. Hepatic toxicity
D. Cardiac arrhythmia

Correct Answer: A

Suggested Readings:
Shapiro Theresa A, Goldberg Daniel E, "Chapter 39. Chemotherapy of Protozoal Infections: Malaria"
(Chapter). Brunton LL, Lazo JS, Parker KL: Goodman & Gilman's The Pharmacological Basis of Therapeutics,
11e: http://www.accessmedicine.com/content.aspx?aID=946964. FDA Quinine Warning:
http://www.medscape.com/viewarticle/724798
November 2010 ABPOPPM In-training Exam Page 40 of 50

Module 4: Medicine

A 43 year-old female presents with poorly localized pain in her feet and knees of many months duration. She
awakens frequently at night and has trouble falling back to sleep. She has shoulder and neck stiffness, along
with irritable bowel symptoms, with depression. She recently underwent sleep apnea evaluation as shown.

Which of the following is the most likely cause of his symptoms?

A. Fibromyalgia
B. Rheumatoid arthritis
C. Plantar fasciitis
D. Hypochondriasis

Correct Answer: A

Suggested Readings:
Langford Carol A, Gilliland Bruce C, "Chapter 329. Fibromyalgia" (Chapter). Fauci AS, Braunwald E, Kasper
DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2863176. Hellmann David B, Imboden John B, "Chapter
20. Musculoskeletal & Immunologic Disorders" (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.:
CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=10083
November 2010 ABPOPPM In-training Exam Page 41 of 50

Module 4: Medicine

A 78 year-old male complains of progressive, scaly, brown discolored lower legs of several years duration.
Similar lesions are seen on the forearms. A punch biopsy taken from a peripheral, raised, hyperkeratotic ridge
demonstrates cornoid lamellae formation.

Which of the following is the most likely diagnosis?

A. Porokeratosis of Mibelli
B. Squamous cell carcinoma
C. Chronic contact dermatitis
D. Majocchi's granuloma

Correct Answer: A

Suggested Readings:
Porokeratosis of Mibelli: http://emedicine.medscape.com/article/1059123-overview
Porokeratosis: http://www.dermis.net/dermisroot/en/41100/diagnose.htm
November 2010 ABPOPPM In-training Exam Page 42 of 50

Module 4: Medicine

A73 year-old female presents with painful, stiff ankles and feet of several years duration. Past medical history
is significant for bouts of cold fingers and toes that turn red. She also has a history of GERD. Examination
reveals red macules on the palms, soles and face. A positive ANA test and a negative HIV antibody screening
are reported.

Which of the following is the most likely diagnosis?

A. Kaposi's sarcoma
B. Psoriasis
C. Rheumatoid arthritis
D. Scleroderma

Correct Answer: D

Suggested Readings:
Hummers Laura K, Wigley Fredrick M, "Chapter 26. Scleroderma" (Chapter). Imboden JB, Hellmann DB,
Stone JH: CURRENT Rheumatology Diagnosis & Treatment, 2e:
http://www.accessmedicine.com/content.aspx?aID=2725959. Wolff K, Johnson RA, "Section 14. The Skin in
Immune, Autoimmune, and Rheumatic Disorders" (Chapter). Wolff K, Johnson RA: Fitzpatrick's Color Atlas &
Synopsis of Clinical Dermatology, 6e: http://www.accessmedicine.com/content.aspx?aID=5187962 .
November 2010 ABPOPPM In-training Exam Page 43 of 50

Module 4: Medicine

A 37 year-old male complains of painful heels and is also concerned about proper use of sunscreens.

All of the following are true regarding sun exposure EXCEPT:

A. Protection against both UV-A and UV-B is important


B. Sunscreen usage causes vitamin D deficiency
C. A SPF 15 product filters out more than 93% of UV-B radiation
D. Leg freckles can be caused by tanning beds

Correct Answer: B

Suggested Readings:
Williams Hywel C, Langan Sinéad, Flohr Carsten, "Chapter 3. Public Health in Dermatology" (Chapter). Wolff
K, Goldsmith LA, Katz SI, Gilchrest B, Paller AS, Leffell DJ: Fitzpatrick's Dermatology in General Medicine,
7e: http://www.accessmedicine.com/content.aspx?aID=2965333. Sunscreens:
http://emedicine.medscape.com/article/1119992-overview
November 2010 ABPOPPM In-training Exam Page 44 of 50

Module 4: Medicine

An 80 year-old male is referred by internal medicine for gait evaluation and possible orthotic management. He
presents with his daughter who reports memory loss and difficulty walking. Examination reveals generalized
cognitive impairment as well as bilateral paresis and slowed gait. The CBC, cobalamin, Vitamin D level, TSH,
hepatic function panel and VDRL are all unremarkable.

Based upon the clinical presentation which of the following is most consistent with early stage onset of the
condition below?

A. Parkinson's disease
B. Cerebral vascular accident
C. Hypothyroidism
D. Alzheimer's disease

Correct Answer: D

Suggested Readings:
Alzeheimer’s Disease: http://emedicine.medscape.com/article/1134817-overview
MRI: http://www.sciencecodex.com/mri
November 2010 ABPOPPM In-training Exam Page 45 of 50

Module 4: Medicine

A 72 year-old male complains of difficulty walking. His spouse reports his kicking, hitting and talking during
sleep. Examination reveals a resting tremor, rigidity, bradykinesia, and postural instability.

Which of the following is the most likely diagnosis?

A. Cerebral vascular accident


B. Dementia
C. Parkinson's disease
D. Hyperthyroidism

Correct Answer: C

Suggested Readings:
Parkinsons Disease: http://emedicine.medscape.com/article/1151267-overview2. Figure retrieved from
www.wikipedia.org - Sir William Richard Gowers Parkinson Disease sketch (1886)
November 2010 ABPOPPM In-training Exam Page 46 of 50

Module 4: Medicine

A 68 year-old female with painful bunions returns to your practice after a 2 year hiatus. Up until now she has
been in good health and was planning on the foot surgery. Pre-operative chest radiographs indicate a 1cm right
upper lobe mass.

Which of the following is the most likely recommendation for the patient?

A. Proceed with foot surgery and evaluate mass in post-operative period


B. Admit; General Surgery consult
C. Defer foot surgery and refer to Oncology
D. Proceed with foot surgery under local anesthesia only

Correct Answer: C

Suggested Readings:
Cornett Patricia A, Dea Tiffany O, "Chapter 39. Cancer" (Chapter). McPhee SJ, Papadakis MA, Tierney LM,
Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=8950897. Lung cancer treatment:
http://emedicine.medscape.com/article/279960-treatment
November 2010 ABPOPPM In-training Exam Page 47 of 50

Module 4: Medicine

A recent study of dual energy laser therapy for onychomycosis followed a predefined protocol of treatments on
days 1, 14, 42, and 120. Cultures were evaluated with measurements taken from standardized photographs and
graded by an expert panel over 180 days. An independent research organization assigned patients to the
treatment or control group in advance of treatment.

Which of the following levels of medical evidence best characterizes this study?

A. Meta-analysis
B. Systematic review
C. Randomized controlled
D. Cohort study

Correct Answer: C

Suggested Readings:
Dawson B, Trapp RG, "Chapter 1. Introduction to Medical Research" (Chapter). Dawson B, Trapp RG: Basic
& Clinical Biostatistics, 4e: http://www.accessmedicine.com/content.aspx?aID=2046000. MA Turlik and D
Kushner: Levels of evidence of articles in podiatric medical journals J Am Podiatr Med Assoc 2000 90: 300-
302.
November 2010 ABPOPPM In-training Exam Page 48 of 50

Module 4: Medicine

A 76 year-old female is evaluated by the podiatry resident on a vascular rotation for critical limb ischemia on
the right, along with an acutely painful right lower quadrant abdominal mass. Significant past history includes
total hysterectomy for uterine cancer 3 years ago. Abdominal CT with contrast is shown.

Which of the following arteries has been infiltrated by the tumor and caused the limb ischemia?

A. Aorta
B. Internal iliac
C. External iliac
D. Common iliac

Correct Answer: C

Suggested Readings:
Sabel Michael S, "Chapter 44. Oncology" (Chapter). Doherty GM: CURRENT Diagnosis & Treatment:
Surgery, 13e: http://www.accessmedicine.com/content.aspx?aID=5316764 .
http://www.imaios.com/en/e-Anatomy/Limbs/Leg-arteries-bones-3D
November 2010 ABPOPPM In-training Exam Page 49 of 50

Module 4: Medicine

A 67 year-old male complains of "crawling" sensations in both feet that disturb his sleep several nights a week
and are relieved by pacing. Examination reveals barely palpable pedal pulses, DTRs are normal, and decreased
vibratory sensation bilaterally. Laboratory findings reveal the CBC, serum iron and serum glucose to be WNL.

Which of the following is most useful for the patent at this time?

A. Night splints
B. Requip (ropinirole)
C. Pletal (cilostazol)
D. Daily walking program

Correct Answer: B

Suggested Readings:
Aminoff Michael J, Kerchner Geoffrey A, "Chapter 24. Nervous System Disorders" (Chapter). McPhee SJ,
Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:
http://www.accessmedicine.com/content.aspx?aID=12507. Czeisler Charles A, Winkelman John W,
Richardson Gary S, "Chapter 28. Sleep Disorders" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL,
Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e:
http://www.accessmedicine.com/content.aspx?aID=2897429 .
November 2010 ABPOPPM In-training Exam Page 50 of 50

Module 4: Medicine

A 61 year-old presents with painful burning blisters limited to the right buttock down to his foot of 1 week
duration. Past medical history is significant for DM2, metastatic colon cancer and hypogammaglobulinemia.

Based on the suspected diagnosis which of the following vaccines may have prevented the condition?

A. Varicella zoster
B. Diptheria, Pertussis, Tetanus
C. Measles, Mumps, Rubella
D. Human papilloma virus

Correct Answer: A

Suggested Readings:
Berger Timothy G, "Chapter 6. Dermatologic Disorders" (Chapter). McPhee SJ, Papadakis MA, Tierney LM,
Jr.: CURRENT Medical Diagnosis & Treatment 2010: http://www.accessmedicine.com/content.aspx?aID=747 .
Shingles at emedicine: http://emedicine.medscape.com/article/788310-diagnosis