ABFM ITE REVIEWS 2027 ANSWERS AND
QUESTIONS SET A+
✔✔Most commonly associated with oligohydramnios - ✔✔Posterior urethral valves
Amniotic fluid volume is regulated in part by fetal swallowing, inspiration, and urination.
Some malformations of the urinary tract, including renal agenesis and persistent
obstruction from posterior urethral valves, lead to oliguria or anuria, and are associated
with marked oligohydramnios.
✔✔Treatment of cellulitis - ✔✔Purulent infections have a higher likelihood of being
caused by MRSA, so coverage with trimethoprim/sulfamethoxazole or clindamycin
(caution C diff) would be appropriate; but IV Vancomycin if hospitalised. In nonpurulent
skin infections, amoxicillin/clavulanate or cephalexin would be appropriate choices.
✔✔The mother of a newborn infant is concerned because her baby's eyes are
sometimes crossed. Assuming the intermittent eye crossing persists, which one of the
following is the most appropriate age for ophthalmologic referral? - ✔✔Proper
coordination should be achieved by age 4-6 months
✔✔Clinically diagnosable acute bacterial prostatitis, and no further testing, including
imaging, is required to establish the diagnosis. - ✔✔Culture of a midstream voided urine
may aid in identifying the pathogen, but prostate massage should be avoided because it
may increase the risk of bacteraemia.
✔✔Hospitalised patients with persistently raised blood glucose - ✔✔Insulin therapy
should be initiated, starting at a threshold of 180 mg/dL. Once insulin therapy is started,
a target glucose range of 140-180 mg/dL is recommended for the majority of
hospitalized patients, regardless of whether they have a critical illness.
✔✔This patient has findings consistent with influenza, including a rapid onset of fever,
nausea, and sore throat, and negative pulmonary findings. Influenza is considered a
clinical diagnosis and confirmation of the diagnosis with laboratory testing is not
,required. - ✔✔Treatment of influenza is recommended for individuals at a high risk of
influenza-related complications. High-risk individuals include those with chronic lung
disease; cardiovascular (excluding hypertension), renal, hepatic, haematologic, or
neurologic disease; or age >65. Children on long-term aspirin therapy, and pregnant
and postpartum women are also considered high risk.
✔✔Most common cause of hypercalcaemia - ✔✔Primary hyperparathyroidism
Other causes of hypercalcaemia include thiazide diuretics, lithium, vitamin D
intoxication, hyperthyroidism, milk alkali syndrome from excessive calcium antacid
ingestion, adrenal insufficiency, and lymphoma.
✔✔RSV bronchiolitis mainstay supportive care with adequate hydration - ✔✔Infants
with respiratory rates >60/min may have poor feeding secondary to difficulty breathing
and oral rehydration may increase the risk of aspiration. In these cases, nasogastric or
intravenous fluids should be administered.
Oxygen saturation of 90% or more on room air is sufficient for infants with bronchiolitis,
and using supplemental oxygen to maintain higher oxygen saturations only prolongs
hospitalization because of an assumed need for oxygen.
✔✔Scoliosis - ✔✔There are three major risk factors for curve progression of idiopathic
scoliosis: the magnitude of the curve at presentation, the potential for future growth, and
female sex. Of these factors, curve progression has the most impact on the need for
referral versus observation.
The Cobb angle is based on spine radiology that quantifies the magnitude of the
scoliosis curve. If the Cobb angle is >/= 20° there is a high risk that the curve will
progress and that the patient may need treatment.
✔✔Treatment for osteopaenia is indicated when the 10-year risk of a major fracture
reaches - ✔✔20%
✔✔Hyperthyroid treatment in pregnancy - ✔✔Since methimazole is associated with
birth defects when used in the first trimester, propylthiouracil is preferred.
Methimazole should be considered after the first trimester because the risk of congenital
anomalies is less than the risk of liver failure associated with propylthiouracil.
✔✔A 30-year-old male is treated with topical medications for his papulopustular rosacea
with only partial improvement. The preferred antibiotic is - ✔✔Doxycycline
✔✔Pre-op evaluation - ✔✔A healthy patient would be classified as ASA I, while a
patient with mild systemic disease would be classified as ASA II. All patients who are
,having major surgery should be offered preoperative laboratory testing, including a CBC
and renal function testing.
For patients who are ASA III or IV and have chronic liver disease or take anticoagulants,
coagulation testing should be considered.
There is no compelling evidence to support either a chest radiograph or an EKG as part
of a routine preoperative evaluation.
✔✔Most common hip disorder in adolescents (ages 8-15) - ✔✔SUFE 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.
Legg-Calve-Perthes disease (insidious) and transient synovitis (acute onset with fever)
are more common in children under age 10.
✔✔COPD GOLD - ✔✔A risk category of A (low risk, fewer symptoms) requires either a
SAMA/SABA as the initial
pharmacologic management. LABA/LAMA are indicated for patients with a GOLD
combined assessment category of B or worse. Long-acting inhaled corticosteroids are
indicated for patients with
a GOLD combined assessment category of C or worse.
✔✔ACEi and ARB as anti-hypertensives with renoprotective effects - ✔✔May tolerate a
rise of <30% in serum creatinine after initiation. Rises in serum creatinine of >30% from
baseline increase the risk of renal failure, adverse cardiac outcomes, and death.
✔✔Metatarsal stress fractures (common second and third) - ✔✔No weight bearing for a
few days, possibly using a posterior splint, transitioning to a walking boot or short leg
cast, and then a rigid-soled shoe in 4-6 weeks.
Other recommended conservative therapy includes modified rest for 6-8 weeks with
continuation of activities of daily living and limited walking. Normal activity can be
resumed after 2-3 weeks with no pain. Additionally, the use of NSAIDs, ice, and
stretching, as well as cross-training is recommended.
✔✔Uterine fibroid tumors (leiomyomas) are the most common tumors of the female
reproductive tract. - ✔✔Many fibroids are asymptomatic and are discovered incidentally,
with observation being the preferred management in this situation. The risk of malignant
leiomyosarcoma is exceedingly small (0.23% in one study) and there is a risk of side
effects or complications from other treatment modalities.
, ✔✔Diarrhea that develops in patients with ileal Crohn's disease or following ileal
resection is usually due to increased amounts of bile acid remaining in the stool. This
affects colonic secretion and motility and various protein factors in the gut, resulting in
the development of bile acid diarrhoea (BAD). - ✔✔A therapeutic trial with a bile acid
sequestrant such as cholestyramine is most often used for both the diagnosis and
treatment of BAD.
Reducing fat intake may also be beneficial.
Fiber supplementation may help to produce a more formed stool and could be used as
an adjunct treatment when appropriate.
✔✔Treatment of PTSD - ✔✔An SSRI or SNRI should be used first as monotherapy and
should be optimized before an additional agent is added.
Prazosin is an effective augmenting therapy for patients with PTSD and sleep
disturbance/nightmares.
✔✔Injections for shoulder impingement syndrome - ✔✔Subacromial injection of a
corticosteroid may provide pain relief for up to several weeks but does not alter long-
term outcomes.
✔✔Acne appearing at which one of the following ages should prompt detailed endocrine
laboratory testing for possible underlying systemic disease? - ✔✔Mid-childhood i.e. 5yo
✔✔A 5-year-old male is brought to your office after passing an intestinal worm. He lives
on a farm with cattle, pigs, and dogs. He has never travelled very far from home. He
does not have any respiratory symptoms or diarrhoea, but has experienced some
abdominal bloating. - ✔✔Ascaris lumbricoides is a large roundworm that typically infects
the ileum. Symptoms are variable but large infections can lead to intestinal obstruction.
Pinworms are much smaller and typically present with anal pruritus.
Tapeworms can be large, but are flat and segmental in appearance, and are typically
found in the stool as segments called proglottids.
Hookworms are also round, but are typically 6-12 mm in length. They are a significant
cause of anemia in children globally.
✔✔Precocious puberty in boys - ✔✔Penile enlargement before 9yo
Isolated sparse pubic and axillary hair growth and axillary odour is referred to as
premature adrenarche, and represents high levels of dehydroepiandrosterone rather
than activation of the hypothalamic-pituitary-gonadal axis that leads to puberty.
QUESTIONS SET A+
✔✔Most commonly associated with oligohydramnios - ✔✔Posterior urethral valves
Amniotic fluid volume is regulated in part by fetal swallowing, inspiration, and urination.
Some malformations of the urinary tract, including renal agenesis and persistent
obstruction from posterior urethral valves, lead to oliguria or anuria, and are associated
with marked oligohydramnios.
✔✔Treatment of cellulitis - ✔✔Purulent infections have a higher likelihood of being
caused by MRSA, so coverage with trimethoprim/sulfamethoxazole or clindamycin
(caution C diff) would be appropriate; but IV Vancomycin if hospitalised. In nonpurulent
skin infections, amoxicillin/clavulanate or cephalexin would be appropriate choices.
✔✔The mother of a newborn infant is concerned because her baby's eyes are
sometimes crossed. Assuming the intermittent eye crossing persists, which one of the
following is the most appropriate age for ophthalmologic referral? - ✔✔Proper
coordination should be achieved by age 4-6 months
✔✔Clinically diagnosable acute bacterial prostatitis, and no further testing, including
imaging, is required to establish the diagnosis. - ✔✔Culture of a midstream voided urine
may aid in identifying the pathogen, but prostate massage should be avoided because it
may increase the risk of bacteraemia.
✔✔Hospitalised patients with persistently raised blood glucose - ✔✔Insulin therapy
should be initiated, starting at a threshold of 180 mg/dL. Once insulin therapy is started,
a target glucose range of 140-180 mg/dL is recommended for the majority of
hospitalized patients, regardless of whether they have a critical illness.
✔✔This patient has findings consistent with influenza, including a rapid onset of fever,
nausea, and sore throat, and negative pulmonary findings. Influenza is considered a
clinical diagnosis and confirmation of the diagnosis with laboratory testing is not
,required. - ✔✔Treatment of influenza is recommended for individuals at a high risk of
influenza-related complications. High-risk individuals include those with chronic lung
disease; cardiovascular (excluding hypertension), renal, hepatic, haematologic, or
neurologic disease; or age >65. Children on long-term aspirin therapy, and pregnant
and postpartum women are also considered high risk.
✔✔Most common cause of hypercalcaemia - ✔✔Primary hyperparathyroidism
Other causes of hypercalcaemia include thiazide diuretics, lithium, vitamin D
intoxication, hyperthyroidism, milk alkali syndrome from excessive calcium antacid
ingestion, adrenal insufficiency, and lymphoma.
✔✔RSV bronchiolitis mainstay supportive care with adequate hydration - ✔✔Infants
with respiratory rates >60/min may have poor feeding secondary to difficulty breathing
and oral rehydration may increase the risk of aspiration. In these cases, nasogastric or
intravenous fluids should be administered.
Oxygen saturation of 90% or more on room air is sufficient for infants with bronchiolitis,
and using supplemental oxygen to maintain higher oxygen saturations only prolongs
hospitalization because of an assumed need for oxygen.
✔✔Scoliosis - ✔✔There are three major risk factors for curve progression of idiopathic
scoliosis: the magnitude of the curve at presentation, the potential for future growth, and
female sex. Of these factors, curve progression has the most impact on the need for
referral versus observation.
The Cobb angle is based on spine radiology that quantifies the magnitude of the
scoliosis curve. If the Cobb angle is >/= 20° there is a high risk that the curve will
progress and that the patient may need treatment.
✔✔Treatment for osteopaenia is indicated when the 10-year risk of a major fracture
reaches - ✔✔20%
✔✔Hyperthyroid treatment in pregnancy - ✔✔Since methimazole is associated with
birth defects when used in the first trimester, propylthiouracil is preferred.
Methimazole should be considered after the first trimester because the risk of congenital
anomalies is less than the risk of liver failure associated with propylthiouracil.
✔✔A 30-year-old male is treated with topical medications for his papulopustular rosacea
with only partial improvement. The preferred antibiotic is - ✔✔Doxycycline
✔✔Pre-op evaluation - ✔✔A healthy patient would be classified as ASA I, while a
patient with mild systemic disease would be classified as ASA II. All patients who are
,having major surgery should be offered preoperative laboratory testing, including a CBC
and renal function testing.
For patients who are ASA III or IV and have chronic liver disease or take anticoagulants,
coagulation testing should be considered.
There is no compelling evidence to support either a chest radiograph or an EKG as part
of a routine preoperative evaluation.
✔✔Most common hip disorder in adolescents (ages 8-15) - ✔✔SUFE 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.
Legg-Calve-Perthes disease (insidious) and transient synovitis (acute onset with fever)
are more common in children under age 10.
✔✔COPD GOLD - ✔✔A risk category of A (low risk, fewer symptoms) requires either a
SAMA/SABA as the initial
pharmacologic management. LABA/LAMA are indicated for patients with a GOLD
combined assessment category of B or worse. Long-acting inhaled corticosteroids are
indicated for patients with
a GOLD combined assessment category of C or worse.
✔✔ACEi and ARB as anti-hypertensives with renoprotective effects - ✔✔May tolerate a
rise of <30% in serum creatinine after initiation. Rises in serum creatinine of >30% from
baseline increase the risk of renal failure, adverse cardiac outcomes, and death.
✔✔Metatarsal stress fractures (common second and third) - ✔✔No weight bearing for a
few days, possibly using a posterior splint, transitioning to a walking boot or short leg
cast, and then a rigid-soled shoe in 4-6 weeks.
Other recommended conservative therapy includes modified rest for 6-8 weeks with
continuation of activities of daily living and limited walking. Normal activity can be
resumed after 2-3 weeks with no pain. Additionally, the use of NSAIDs, ice, and
stretching, as well as cross-training is recommended.
✔✔Uterine fibroid tumors (leiomyomas) are the most common tumors of the female
reproductive tract. - ✔✔Many fibroids are asymptomatic and are discovered incidentally,
with observation being the preferred management in this situation. The risk of malignant
leiomyosarcoma is exceedingly small (0.23% in one study) and there is a risk of side
effects or complications from other treatment modalities.
, ✔✔Diarrhea that develops in patients with ileal Crohn's disease or following ileal
resection is usually due to increased amounts of bile acid remaining in the stool. This
affects colonic secretion and motility and various protein factors in the gut, resulting in
the development of bile acid diarrhoea (BAD). - ✔✔A therapeutic trial with a bile acid
sequestrant such as cholestyramine is most often used for both the diagnosis and
treatment of BAD.
Reducing fat intake may also be beneficial.
Fiber supplementation may help to produce a more formed stool and could be used as
an adjunct treatment when appropriate.
✔✔Treatment of PTSD - ✔✔An SSRI or SNRI should be used first as monotherapy and
should be optimized before an additional agent is added.
Prazosin is an effective augmenting therapy for patients with PTSD and sleep
disturbance/nightmares.
✔✔Injections for shoulder impingement syndrome - ✔✔Subacromial injection of a
corticosteroid may provide pain relief for up to several weeks but does not alter long-
term outcomes.
✔✔Acne appearing at which one of the following ages should prompt detailed endocrine
laboratory testing for possible underlying systemic disease? - ✔✔Mid-childhood i.e. 5yo
✔✔A 5-year-old male is brought to your office after passing an intestinal worm. He lives
on a farm with cattle, pigs, and dogs. He has never travelled very far from home. He
does not have any respiratory symptoms or diarrhoea, but has experienced some
abdominal bloating. - ✔✔Ascaris lumbricoides is a large roundworm that typically infects
the ileum. Symptoms are variable but large infections can lead to intestinal obstruction.
Pinworms are much smaller and typically present with anal pruritus.
Tapeworms can be large, but are flat and segmental in appearance, and are typically
found in the stool as segments called proglottids.
Hookworms are also round, but are typically 6-12 mm in length. They are a significant
cause of anemia in children globally.
✔✔Precocious puberty in boys - ✔✔Penile enlargement before 9yo
Isolated sparse pubic and axillary hair growth and axillary odour is referred to as
premature adrenarche, and represents high levels of dehydroepiandrosterone rather
than activation of the hypothalamic-pituitary-gonadal axis that leads to puberty.
