ABFM CKSA 22-23 Latest Update -

ABFM CKSA 22-23 Latest Update - Actual Exam from Credible Source with 150 Questions and 100% Verified Detailed Correct Answers Guaranteed A+ Approved by Professor

A 10-year-old male is brought to the emergency department with a history of group A β- hemolytic Streptococcus confirmed with a throat culture 2 weeks ago. His parents gave him antibiotics for 3 days then stopped them because his symptoms were gone. He now has a temperature of 38.9°C (102.0°F), a heart rate of 122 beats/min, and right hip and left knee pain with swelling. A targetoid erythematous rash is present across his chest and back.

In addition to resuming antibiotic therapy, which one of the following would be the most appropriate initial pharmacologic therapy for this condition in this patient?

• Acetaminophen
• Gabapentin (Neurontin)
• Hydrocodone
• Naproxen - CORRECT ANSWER: ANSWER: D

Fever, erythema marginatum, and polyarthritis within 7-14 days of acute strep pharyngitis is consistent with acute rheumatic fever. Once the diagnosis of acute rheumatic fever is made, NSAIDs such as naproxen (10 to 20 mg/kg/day in two divided doses) should be administered along with appropriate antibiotic therapy. The therapeutic response of arthritis to NSAIDs is often remarkable.

Acetaminophen has not been shown to be a superior analgesic for acute rheumatic fever. Gabapentin is not indicated, especially considering that the pain does not have a neuropathic etiology. Opioids would not be considered first-line treatment because of their adverse effects and the usual dramatic response to NSAIDs alone.

A 12-hour-old newborn is seen in the nursery for routine newborn care. The prenatal course and delivery were unremarkable. An examination is normal except for a single 1- 1 / 4

cm wide dimple on the sacrum, 1 cm superior to the anus. The dimple has a tuft of dark

hair. At this point you would recommend:

• routine follow-up at the 12-month well child check
• ultrasonography

C. MRI

• a fistulogram/sinogram
• a dermatology consultation - CORRECT ANSWER: ANSWER: B

Recognizing clinically significant abnormalities on the newborn examination is important. One of the more serious conditions to assess for during a newborn examination is occult spinal dysraphism (OSD), a term that encompasses a spectrum of congenital anomalies involving the spine and/or surrounding structures. Early detection and treatment of OSD can prevent long-term irreversible neurologic impairment.

A sacral dimple can be a sign of OSD. Newborns with small (<5 mm) sacral dimples located within 2.5 cm of the anal verge, and without other skin findings such as hair, do not need imaging to rule out OSD because there is very low incidence of abnormal findings. If one dorsal midline skin lesion is seen, then meticulous assessment for other skin lesions is warranted to determine whether two or more dimples are present, as this increases the risk of OSD. The dimple described here does not meet the low-risk criteria described, which makes imaging necessary in this case.

Ultrasonography is recommended as the first-line imaging test. It can accurately detect spinal dysraphism and does not require sedation. A pediatric neurosurgery consultation would be indicated if the ultrasound examination was abnormal. MRI is the next step in evaluation and should be considered initially for patients with an abnormal neurologic examination or multiple dimples, which increase the risk of OSD, but would not be necessary in this case. A follow-up examination without imaging would be unacceptable at this time given the findings described and the urgency of early diagnosis. The optimal timing of the ultrasound examination is debatable and some studies have found improved accuracy of ultrasonography at a corrected gestational age of 42.5 weeks compared to ultrasonography performed within a couple days of birth. If there are no neur

A 12-year-old female is brought to your office as a new patient for evaluation of an earache. During the evaluation you learn that the child has been living in a household 2 / 4

where there was interpersonal violence impacting her mother. You are told that the child's father is now incarcerated. Considering how adverse childhood experiences affect behavior and health, this child is at greatest risk for which one of the following?

• Alcohol use disorder
• Attention-deficit disorder
• Borderline personality disorder
• Dissociative disorder
• Schizophrenia - CORRECT ANSWER: ANSWER: A

Of the options listed, this child is at greatest risk for alcohol use disorder as a consequence of adverse childhood experiences (ACEs). Many health-related factors are associated with cumulative ACEs. As ACEs increase so do the risks for alcohol use disorder, substance use disorder, depression, suicide attempts, smoking, poor self-rated health, and sexually transmitted infections. ACEs are also associated with multiple medical conditions that can contribute to chronic disease burden and even premature mortality. These can include diabetes, cancer, heart disease, and chronic lung disease.

A 13-year-old female is brought to your office with a 3-week history of left groin pain that is most bothersome after she participates in physical education class at her middle school. She does not recall a specific injury and does not participate in extracurricular sports. She had an upper respiratory infection about a month ago but has otherwise been well. An examination reveals a BMI at the 95th percentile for her age. Her vital signs are within normal limits. A musculoskeletal examination is remarkable for limited internal rotation of the hip. Which one of the following is the most likely diagnosis?

• Adductor muscle strain
• Apophysitis of the anterior superior iliac spine
• Legg-Calvé-Perthes disease
• Slipped capital femoral epiphysis
• Transient synovitis - CORRECT ANSWER: ANSWER: D

The most common hip disorder in adolescents (ages 8-15) is slipped capital femoral epiphysis (SCFE). Early diagnosis and treatment are critical in preventing disability related to early-onset degenerative disease of the hip. In the past, SCFE has been more common in boys than in girls, but that prevalence is changing due to the rise in obesity. 3 / 4

SCFE should be suspected in an adolescent who has unexplained pain in the hip, groin, thigh, or knee. It is rarely associated with trauma, overuse, or prior illness. On examination the most indicative sign is limited internal rotation of the involved hip.Bilateral radiographs of the hips, including frog-leg lateral views, should be obtained in any adolescent who presents with a new limp and pain in the groin, hip, thigh, or knee

(SOR C).

Adductor muscle strain (groin strain) is very uncommon in adolescents. Patients suspected of having a groin strain should also undergo radiography. Apophysitis of the anterior superior iliac spine is common in adolescents but is caused by overuse. It is mostly seen in runners, dancers, and ice hockey and soccer players ages 14-18. Legg- Calvé-Perthes disease and transient synovitis are more common in children under age

• The presenting symptoms of hip pain and a limp are similar to SCFE.

A 13-year-old who was assigned female at birth has been diagnosed with gender dysphoria. His parents fully support their child and affirm his gender as male. On examination the patient has a sexual maturity rating of Tanner stage 3. Which one of the following steps would be appropriate for optimal support and therapy for this patient?

• Encouraging conversion of the patient's gender identity to be congruent with the

gender assigned at birth

• Recommending delaying any gender-affirming treatment until he is at least 18 years

old to prevent adverse psychosocial outcomes of puberty suppression

• Ordering genetic testing and ultrasonography to confirm the gender assigned at birth
• Recommending GnRH analogue treatment - CORRECT ANSWER: ANSWER: D

Not all family physicians provide gender-affirming care to transgender or gender-diverse adolescents. However, consistent evidence shows adolescents with gender incongruence who receive puberty blockers have improved mental health outcomes compared with adolescents who do not receive this treatment, so it is important for family physicians to recognize the indications for timely treatment or referral. The World Professional Association for Transgender Health (WPATH) recommends medical therapy with GnRH analogues for adolescent patients at Tanner stage 2 or later with significant, sustained gender dysphoria. Patients should have the emotional maturity to be able to understand and consent to therapy, and any comorbid mental health conditions should be controlled enough to allow for informed consent to therapy.Medical therapy for gender dysphoria includes puberty blockers early in puberty, and masculinizing or feminizing therapy, offered later in life. Hormonal intervention therapy should not be offered to transgender children prior to puberty. Puberty suppression is

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