ABFM ABFM Clinical Decision Making 1 — Questions and Answers
Question 1: A 45-year-old male presents with chest pain radiating to the left arm and diaphoresis. Which initial diagnostic test is most critical according to ABFM clinical guidelines?
- 12-lead ECG (Correct answer)
- Chest X-ray
- Cardiac troponin
- Complete blood count
Correct answer: 12-lead ECG
A 12-lead ECG should be obtained within 10 minutes of presentation for any patient with suspected acute coronary syndrome.
Question 2: When applying evidence-based medicine in family practice, which study design provides the highest level of evidence for clinical decision making?
- Case series
- Cohort study
- Randomized controlled trial (Correct answer)
- Cross-sectional study
Correct answer: Randomized controlled trial
Randomized controlled trials are considered the gold standard for evaluating treatment efficacy due to their controlled design and reduced bias.
Question 3: A 60-year-old woman with type 2 diabetes has an HbA1c of 9.2%. According to ABFM guidelines, what is the most appropriate next step?
- Recheck HbA1c in 6 months
- Intensify glycemic management (Correct answer)
- Refer immediately to endocrinology
- Start insulin without further evaluation
Correct answer: Intensify glycemic management
An HbA1c of 9.2% indicates poor glycemic control and requires intensification of the treatment regimen per ADA and ABFM guidelines.
Question 4: Which clinical decision support tool is most appropriate for estimating 10-year cardiovascular risk in a primary care patient?
- Framingham Heart Score (Correct answer)
- CHADS2 score
- CURB-65 score
- Wells criteria
Correct answer: Framingham Heart Score
The Framingham Heart Score (or Pooled Cohort Equations) is the recommended tool for estimating 10-year atherosclerotic cardiovascular disease risk in primary care.
Question 5: In shared decision making, which element is MOST essential for family physicians to incorporate with patients?
- Providing only physician-recommended options
- Discussing patient values and preferences (Correct answer)
- Delegating decisions to specialists
- Avoiding discussion of risks
Correct answer: Discussing patient values and preferences
Shared decision making requires eliciting and incorporating patient values and preferences alongside clinical evidence to reach a mutually agreed-upon care plan.
Question 6: A 35-year-old pregnant woman at 28 weeks gestation presents with new-onset headache and blood pressure of 158/102 mmHg. What is the most appropriate clinical decision?
- Prescribe analgesics and follow up in one week
- Diagnose preeclampsia and manage urgently (Correct answer)
- Recommend rest and recheck in 48 hours
- Order an outpatient MRI
Correct answer: Diagnose preeclampsia and manage urgently
New-onset hypertension with symptoms after 20 weeks gestation meets criteria for preeclampsia and requires urgent evaluation and management.
ABFM ABFM Clinical Decision Making 1
A 45-year-old male presents with chest pain radiating to the left arm and diaphoresis.
Which initial diagnostic test is most critical according to ABFM clinical guidelines?