Study Guide - American Board of Podiatric Medicine

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Study Guide
I.
General Information
The purpose of this study guide is to familiarize the candidate with the examination process leading to Board Certified or Board Qualified
classification conferred by the American Board of Podiatric Medicine (ABPM). The study guide will also cover information related to the
Self-Assessment examination (for re-credentialing purposes only).
The Qualification and Certification examinations are administered in web-based formats and are offered at Test Centers nationally.
Both are designed to measure different cognitive areas. The qualification examination is primarily designed to assess a candidate's
breadth of knowledge, while the certification examination is designed to assess the thought processes of the candidate when faced with
a number of clinical case presentations. In general, certification questions center on the appropriateness of data gathering for the history
and physical examination, the differential diagnosis process, the ordering and interpretation of diagnostic tests, and the adoption of
appropriate treatment options and case management regimens. Both portions of the examination focus on experience and clinically
relevant situations and avoid recall of obscure facts or eponyms.
The Self-Assessment examination, administered in a web-based format, is offered at Test Centers nationally, and consists of 100
questions in a variety of short answer forms, e.g. multiple choice, matching, etc. The self-assessment examination does not include a
“passing score”. Candidates are informed of their individual performance and also provided the aggregate data for the self-assessment
group for that year. Examinees will receive individual reports of their performance by mail approximately 6 weeks following the final
examination access date, as well as aggregate data for the group tested that year. Passing the self-assessment examination is not
required to maintain diplomate classification.
How to Study for the Examination
1.
Read this Study Guide to learn as much as you can about the examination process.
2.
Answer the sample qualification questions presented without looking at the answer key. Then score yourself and note any
pattern showing a weakness in any particular subject area. Review the certification question presented.
3.
References listed on the Suggested Reading List are only one resource and are provided as a guide. They are by no means
comprehensive. Candidates are advised to refer to current literature and journals for the most current information on a subject.
4.
Make time to prepare for the examinations. Cramming and intensive study may not be helpful. Candidates who prepare by
careful review are sometimes less anxious during the exam and may perform better.
II.
Examination Construction
The examinations are prepared by the Examination Committee. The Examination Committee is composed of Diplomates
representing a variety of geographic and clinical backgrounds, such as private practice, the military, academia, and the
Department of Veterans Affairs. Committee members are chosen for their expertise in the subject areas. The qualification and
certification examination are field tested and evaluated psychometrically to ensure quality, relevance, and clarity. The only
questions included in the examination are those that meet these criteria.
III.
Scoring
Scoring, the interpretation of scores, and the determination of what constitutes a passing score are the responsibility of the
Board of Directors, in consultation with the Board’s psychometricians. On occasion, a question may be double keyed (more than
one response is considered correct), or eliminated. The passing score is based upon a percentage of correct responses, and is
not done on a curve. Several statistical parameters are utilized to determine the passing score, and it may vary from year to
year. Candidates are typically advised of their results within eight weeks of the examination, after scoring has been completed.
The Board of Directors does not make the examination available to the candidate after the examination is given.
The certification examination consists of a series of questions representing a diversity of clinical situations and subject areas and
emphasizing different aspects of clinical acumen. For each question, the Examination Committee has specified a certain number
of agreed-upon salient aspects of the case, or “points to pass”. The number of “points to pass” required, for each case
presentation, varies depending upon the case.
The total number of questions needed to pass the certification examination is predetermined by the Board of Directors.
Candidates will be advised at the time of the examination as to the total number of questions comprising the certification
examination. Scoring is completed electronically. Upon reporting of examination results, candidates will be advised of the
number of questions (clinical cases presented) passed. The Board will not, however, specify individual question results, nor will
it make the questions available to the candidates for future review. This policy is necessary to maintain examination integrity.
IV.
Qualification Examination Content
The following subject areas are tested to determine Board Qualified or Board Certified classification, along with their approximate
proportional representation in the qualification examination. Categories may include imaging, laboratory (including gait studies),
pharmacology and special considerations in pediatric and geriatric patients, as is appropriate. Both local and systemic manifestations
of podiatrically relevant pathology will be assessed.
I)
Podiatric Orthopedics (50%):
Each section includes the general podiatric orthopedics knowledge that is required to assure the overall well-being of the
patient. Within the podiatric orthopedics section each of the following areas will represent approximately 8% (4% of the
total exam). These areas may include neurologic and rheumatologic manifestations of podiatric orthopedic pathology.
Biomechanics / Pathomechanics / Orthotics / Prosthetics
General Orthopedics
Pedorthics
Rehabilitation / Physical Therapy
Surgical Criteria
Trauma / Sports Medicine
II)
Podiatric Medicine (50%):
Each section includes the general medical knowledge that is required to assure the overall well-being of the patient (i.e.
primary care/triage). Within the podiatric medicine section each of the following areas will represent approximately 4%,
(2% of the total exam.)
Cardiology / Pulmonology
Dermatology
Emergencies
Endocrinology
Gastroenterology / Nephrology
General Medicine
Hematology / Oncology
Infectious Disease
Neurology
Peripheral Vascular Disease
Psychosocial / Public Health (includes biostatistics, community health and epidemiology)
Rheumatology
Wound Care
The qualification examination consists of 200 multiple-choice questions. Each question is followed by four or more responses, of which
there is a single best response available. Key words in the question stem, such as most, least, only, or except are highlighted to facilitate
comprehension. Specifically avoided are questions with responses such as "all of the above," "none of the above," or in which responses
are combined, such as "A. and C."
Set Questions. On occasion, a modification of the single-item multiple-choice format is presented in a "set" format, whereby a case
history is presented in paragraph form, and several multiple-choice questions follow, pertaining to the case history. Scoring of these
questions is identical to the single-item format, with each question individually scored.
In the qualification examination there is no penalty for guessing, therefore all questions should be answered. Ample time is scheduled for
completing the examination. Sample qualification examinations start on page 9. The answers appear at the end of the question section.
V.
The Certification Examination
The board certification examination consists of a variety of separate clinical scenarios that need to be worked through by the
candidate. The clinical scenarios and related questions may embrace any of the areas listed in the Subject Outline appearing
elsewhere in this document. Candidates are provided with initial patient information and other relevant clinical material from which
to work through the case. Each segment of the question is assigned specific scoring criteria. For example, a candidate may receive
separate credit for completing an appropriate history and physical, requesting adequate additional studies to determine the
diagnosis, making the proper diagnosis, determining the appropriate treatment plan, etc. The particular scoring requirements of a
case vary based on the case presented. Sample cases are presented on the ABPM website.
SAMPLE BOARD QUALIFICATION EXAMINATION QUESTIONS
Below are sample questions of the type to be used in the qualification portion of the examination. Answers are found at the end of
the document.
1. A 45 year old male with diabetes mellitus type II presents for evaluation of a painful hammer toe of the third digit. The patient
has diminished sensation and denies a history of trauma.
Based on the accompanying radiograph, which of the following is the most appropriate diagnosis?
A.
B.
C.
D.
Avascular necrosis
Fracture
Osteochondroma
Enchondroma
2. A consultation is requested to the ICU for this 67 year-old female with diabetes mellitus type I who was admitted for diabetic
ketoacidocis. The patient was last heard from two days prior to admission and found in her apartment by her sister. No history
is available due to the patient’s inability to communicate. Her foot is pictured below.
What is the most appropriate treatment?
A.
B.
C.
D.
Initiate culture driven IV antibiotics
Apply NS wet to dry dressings until patient is alert
Incise and drain in operating room
Apply an enzymatic debriding agent to the wound bed
3. A 73 year old male has diabetes mellitus type II, congestive heart failure, renal insufficiency, peripheral vascular disease and an
open left second toe amputation. He presents to the emergency room with fever, chills, nausea and vomiting for the last 24
hours. His medications are:
Ciprofloxacin (Cipro), lispro (Humalog), metoprolol (Toprol) and warfarin (Coumadin).
Allergies: penicillin and tetanus toxoid.
Vitals: Temp: 97.4F BP 98/47 P:61 0² 93%
Which of the following advanced imaging studies would be the most appropriate?
A.
B.
C.
D.
Bone Scan
Densitometry
MRI
Computed tomography
4. A 34 year old male with a history of AIDS presents with the following unilateral lesions of the plantar aspect of his left foot. The
lesions are firm, but not hard and are vascular in appearance. They are asymptomatic; however the patient relates that they
have been slowly growing over the past year.
Which of the following conditions is most likely?
A.
B.
C.
D.
Sarcoidosis
Melanoma
Mycosis fungoides
Kaposi’s sarcoma
5. A patient who presents with pain at the first MTP joint is diagnosed with metatarsus primus elevatus
Which of the following physical exam finding is most likely present?
A.
B.
C.
D.
Hallux valgus
Hallux hammertoe
Dorsally contracted second toe
Dorsal hypertrophy, first metatarsal head
6. A patient presents with severe Achilles tendonitis. MRI findings reveal longitudinal tearing of the tendon fibers. She is not a
surgical candidate, due to peripheral vascular disease, damaged kidneys and decreased peripheral sensation secondary to
chemotherapy treatment for lymphoma.
A.
C.
B.
D.
Which of the ankle-foot orthoses shown is the most appropriate for this patient?
A.
B.
C.
D.
Option A
Option B
Option C
Option D
7. You are consulted for evaluation of a 6 month old with the left foot deformity shown, present since birth. Clinically the
condition is flexible. No other abnormalities are noted.
Which of the following is the most appropriate initial treatment for this deformity?
A.
B.
C.
D.
Counter Rotation Splint
AFO
Serial casting
Surgical correction
8. A 4 year-old male is referred for evaluation of pain on the inner aspect of the left foot and abnormal gait for the past month,
when his sister accidentally landed on his foot while playing. The condition is worsening. Musculoskeletal examination reveals
smooth, unrestricted range of motion at the ankle, STJ and MTJ bilaterally. Gait is antalgic on the left with persistent supination
of the left foot. Radiographs are shown.
Based on the suspected diagnosis, which of the following is the most appropriate treatment at this time?
A.
B.
C.
D.
Cast immobilization
NSAID therapy; PTB brace
AFO
UCBL with valgus rearfoot post
9. A 56 year-old male complains of long-term pain in his first MTP joint. Examination reveals moderately severe pain and
crepitation with dorsiflexion. He is undomiciled and uninsured. Radiographs are shown.
Which of the following shoe recommendations/modifications are most appropriate for this patient?
A.
B.
C.
D.
Heel lift
Negative heel
Less rigid-sole
Metatarsal rocker bar
10. A patient who previously underwent an Austin bunionectomy complains of dorsal pain of the right hallux. The hallux does not
purchase the ground with weight bearing. The hallux range of motion is a total of 60°.
Which of the following procedures is most appropriate for this patient?
A.
B.
C.
D.
Hallux interphalangeal arthrodesis
Keller arthroplasty
Scarf osteotomy of first metatarsal
Arthrodesis of first MTP joint
11. These are the radiographs of a 26 year-old male, in good health, who presented to the ED 30 minutes after a gunshot wound to
the right foot. A 2.0 cm. entrance wound is located on the dorsum of the first MTP joint.
Initial care for the patient should include all the following EXCEPT:
A.
B.
C.
D.
E.
Irrigation & debridement
Cast immobilization
Tetanus prophylaxis
Primary fracture fixation
Antibiotics
12. A 60 year-old female presents for biopsy of the right fourth nail. Past surgical history includes aortic valve replacement.
Medications include 5 mg of Coumadin (warfarin) daily. Her INR is 3.5 (0.9-1.2).
Which of the following is the most appropriate course of action?
A.
B.
C.
D.
Prescribe post-op antibiotics
Discontinue warfarin for 3-5 days before pre-op and start antibiotics post-op
Discontinue warfarin for 3-5 days and provide antibiotic prophylaxis pre-op
Prescribe pre-op antibiotics and perform the biopsy
13. A 34 year-old construction worker fell from a ladder at work. Muscle testing on the right reveals +2/5 strength of the peroneals,
extensor hallucis longus, extensor digitorum longus, and posterior tibial muscles. His MRI is shown.
Which of the following is most consistent with these findings?
A.
B.
C.
D.
Low back strain
Spinal stenosis
Disk herniation
Tumor
14. A 48 year-old female presents with pruritic water blisters on her right foot. She has previously tried over the counter Lotrimin
Ultra and Cortisone 10.
Which of the following oral medications would be the most effective for this patient?
A.
B.
C.
D.
Terbinafine
Acyclovir
Tetracycline
Prednisone
15. A 23 year-old male complains of long-standing heel pain combined with a history of intermittent low back and hip pain.
Radiograph is shown. Laboratory findings reveal a positive HLA-B27.
Which of the following is the most likely diagnosis?
A.
B.
C.
D.
Rheumatoid arthritis
Systemic lupus erythematosus
Ankylosing spondylitis
Gouty arthritis
16. An 81 year-old female is seen with darkening of the toes as shown, which began 1 week ago. She has Type 2 DM, loss of
protective threshold and an ABI of 0.8. She was recently diagnosed with atrial fibrillation.
Which of the following is the most likely diagnosis?
A.
B.
C.
D.
Shower emboli
Ischemic changes
Raynaud's phenomenon
Perfringens infection
17. A 49 year-old male with Type 2 DM presents with the ulceration shown, of 8 weeks duration. He denies pain, redness or
swelling. He notes clear fluid accumulating on his socks during the day, with odor. Examination reveals palpable pedal pulses
and absent protective threshold.
Which of the following is the most appropriate initial treatment for this wound?
A.
B.
C.
D.
Admit; begin IV antibiotics; schedule for surgical debridement
Debride; obtain tissue cultures; radiographs; off-load the wound
Order MRI; begin Cipro 500mg Q12; prescribe depth inlay shoes
Swab culture; order CT angiography with runoff; apply enzymatic debriding agent
18. A 54 year-old female presents with a non-healing foot ulcer. Examination reveals an ankle brachial index of 1.2 (>1) and a
TCpO2 of 45 mmHg (>55 mm Hg).
Which of the following is the most likely explanation?
A.
B.
C.
D.
Poor arterial collateralization
Medial calcific sclerosis affected the study results
Vasospastic disease
Venous congestion
19. A 68 year-old RA female with the deformities shown is scheduled for first MTP joint arthrodesis with resection of metatarsal
heads 2, 3, 4, 5.
Which of the following is the best post-op gait assistive device for partial weight bearing for this patient?
A.
B.
C.
D.
Single pronged cane
Four pronged cane
Forearm crutch
Platform crutch
20. A 32 year-old female tennis player presents for recent acute pain in the posterior right ankle during a match. MRI is shown.
Which of the following is the most likely diagnosis?
A.
B.
C.
D.
Inflamed retrocalcaneal bursa
Tumor or mass within the Achilles tendon
Avulsion fracture of the calcaneus at the Achilles tendon insertion
Partial rupture of the Achilles tendon
21. A 56 year-old male complains of long-term pain in his first MTP joint. Examination reveals moderately severe pain and
crepitation with dorsiflexion. He is undomiciled and uninsured. Radiographs are shown.
Which of the following shoe recommendations/modifications are most appropriate for this patient?
A.
B.
C.
D.
Heel lift
Negative heel
Less rigid-sole
Metatarsal rocker bar
22. A 4 year-old male is referred for evaluation of pain on the inner aspect of the left foot and abnormal gait for the past month,
when his sister accidentally landed on his foot while playing. The condition is worsening. Musculoskeletal examination reveals
smooth, unrestricted range of motion at the ankle, STJ and MTJ bilaterally. Gait is antalgic on the left with persistent
supination of the left foot. Radiographs are shown.
Based on the suspected diagnosis, which of the following is the most appropriate treatment at this time?
A.
B.
C.
D.
Cast immobilization
NSAID therapy; PTB brace
AFO
UCBL with valgus rearfoot post
23. You are consulted for evaluation of a 6 month old with the left foot deformity shown, present since birth. Clinically the
condition is flexible. No other abnormalities are noted.
Which of the following is the most appropriate initial treatment for this deformity?
A.
B.
C.
D.
Counter Rotation Splint
AFO
Serial casting
Surgical correction
24. A patient presents with severe Achilles tendonitis. MRI findings reveal longitudinal tearing of the tendon fibers. She is not a
surgical candidate, due to peripheral vascular disease, damaged kidneys and decreased peripheral sensation secondary to
chemotherapy treatment for lymphoma.
A.
C.
B.
D.
Which of the ankle-foot orthoses shown is the most appropriate for this patient?
A.
B.
C.
D.
Option A
Option B
Option C
Option D
25. A patient who presents with pain at the first MTP joint is diagnosed with metatarsus primus elevatus
Which of the following physical exam finding is most likely present?
A.
B.
C.
D.
Hallux valgus
Hallux hammertoe
Dorsally contracted second toe
Dorsal hypertrophy, first metatarsal head
Answers: 1.d, 2.c, 3.c, 4.d, 5.d, 6.a, 7.c, 8.a, 9.d, 10.d, 11.b, 12.c, 13.c, 14.a, 15.c, 16.a, 17.b, 18.b, 19.d, 20.d, 21.d, 22.a, 23.c, 24.a,
25.d
VIII.
Suggested Reading List
Suggested Readings - Biomechanics
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Coughlin M, Mann R, Saltzmann C, Forefoot-Sesamoids and Accessory Bones of the Foot, Surgery of the Foot and Ankle. 8th ed.,
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DeLisa J, Gans B, Walsh N, Foot Disorders, Physical Medicine and Rehabilitation: principles and practice. 4th ed., 2005, Lipppincott,
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Dugan S. Stress Fractures. Essentials of Physical Medicine and Rehabilitation, Second Edition, Philadelphia, PA. Saunders and
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Science.
Evans A. Current Medical Diagnosis and Treatment 2009, Muscular Dystrophies
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Kirby KA. Subtalar joint axis location and rotational equilibrium theory of foot function.
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McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, third edition, Vol. 1
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McNally, Eugene, Practical Musculoskeletal Ultrasound. Churchill Livingston. 2004.
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Adults with Charcot-Marie-Tooth Disease: A Randomized Trial. Journal of Physiotherapy. 2010:56(2):113-9.
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Sabharwal S., Kumar A., “MRI, CT, Radiograph,” Clinical Orthopedics and Related Research, Dec. 2008, p. 2910-2922
Sammarco GJ. Rehabilitation of the Foot and Ankle. C.V. Mosby Co., St. Louis, 1995.
Scherer P: Evidence-Based Orthotic Therapy. In Athletic Footwear and Orthoses in Sports Medicine, New York, 2010, Springer
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Scherer PR. Recent Advances in Orthotic Therapy. Lower Extremity Review, 2011
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Tachdjian's Pediatric Orthopedics, 4th edition, 2007
Tollafield DR and Merriam LM Clinical Skills in Treating the Foot. Churchill Livingstone, 1997
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Veves A, Giurini J, LoGerfo F, Charcot arthropathy in the diabetic foot. The Diabetic Foot. 2nd ed., 2006, Humana Press, p. 284
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International Orthopedics. 2007, February; 31(1):5-10.
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Suggested Readings – Medicine
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Banks A, Downey M, Martin D, Miller S: Management of Acute Tendon Trauma. Comprehensive Textbook of Foot Surgery 3rd ed.,
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