ABFM ITE Exam V1 2026/2027:
Verified Q&A with Rationales
Guaranteed Pass (GRADED A+)
1. A 68-year-old male presents with a 2-day history of
high fever (104°F), confusion, cough, and hemoptysis.
He recently returned from a cruise. Which of the
following is the preferred method to confirm the
suspected diagnosis of Legionnaires' disease?
A) Initiating azithromycin to see if symptoms improve
B) A chest radiograph
C) A urine test for Legionella pneumophila antigen
D) Sputum culture for acid-fast bacilli
Correct Answer: C) A urine test for Legionella
pneumophila antigen
Rationale: The urine antigen test is the preferred, rapid
method for confirming Legionnaires' disease (specifically
serogroup 1, the most common). While sputum culture is
the gold standard, it requires 48–72 hours. A chest
radiograph supports the diagnosis of pneumonia but does
not identify the organism. Response to antibiotics is not
diagnostic .
,2. A 50-year-old carpet layer presents with swelling
over the anterior knee (proximal to the patella)
without trauma or fever. The area is minimally tender
with no warmth or erythema. What is the most
appropriate initial management?
A) Rest, ice, and compression
B) Aspiration of fluid for analysis
C) Injection of a corticosteroid
D) Referral to an orthopedic surgeon for resection
Correct Answer: A) Rest, ice, and compression
Rationale: This presentation is classic for prepatellar bursitis
(often due to microtrauma from kneeling). In the absence of
signs of infection (fever, erythema, significant warmth) or
trauma, conservative management with rest, ice, and
compression is appropriate. Aspiration is reserved for
suspected septic bursitis or persistent cases .
3. A 55-year-old female with a 30-pack-year smoking
history presents with progressive dyspnea and
peripheral edema. Exam shows JVD and 3+ pitting
edema. Echocardiogram reveals an ejection fraction of
25%. Which of the following is the most appropriate
initial pharmacologic therapy for mortality benefit?
,A) Furosemide
B) Digoxin
C) Lisinopril
D) Metoprolol succinate
Correct Answer: C) Lisinopril
Rationale: The patient has Heart Failure with reduced
Ejection Fraction (HFrEF). The cornerstone of initial therapy
for mortality benefit includes an ACE inhibitor (lisinopril) or
ARB. While furosemide is used for symptom management
(volume overload), it does not improve mortality. Beta-
blockers are indicated but are typically initiated after
stabilization. Digoxin is not first-line .
4. A 72-year-old male with hypertension and
hyperlipidemia has a blood pressure of 148/92 mmHg
on two separate visits. Home readings average 142/88
mmHg. He is already on atorvastatin and aspirin.
According to ACC/AHA guidelines, what is the most
appropriate next step?
A) Recommend lifestyle modifications only and recheck in
3 months
B) Start amlodipine 5 mg daily
, C) Start hydrochlorothiazide 12.5 mg daily
D) Start lisinopril 10 mg daily
Correct Answer: D) Start lisinopril 10 mg daily
Rationale: This patient has Stage 2 hypertension and
elevated ASCVD risk. The target is <130/80 mmHg. Initial
monotherapy options include a thiazide diuretic, ACE
inhibitor, ARB, or calcium channel blocker. Lisinopril is a
first-line agent and is particularly appropriate given his
cardiovascular risk profile .
5. A 2-month-old female is brought in for a well-child
visit. The parents refuse routine vaccinations based on
personal beliefs. You wish to follow CDC
recommendations while maintaining patient-
centeredness. What is the most appropriate action?
A) Accept the decision without further action
B) Have the parents sign a refusal to vaccinate form
C) Dismiss the family from the practice immediately
D) Pursue a court order for vaccine administration
Correct Answer: B) Have the parents sign a refusal to
vaccinate form
Verified Q&A with Rationales
Guaranteed Pass (GRADED A+)
1. A 68-year-old male presents with a 2-day history of
high fever (104°F), confusion, cough, and hemoptysis.
He recently returned from a cruise. Which of the
following is the preferred method to confirm the
suspected diagnosis of Legionnaires' disease?
A) Initiating azithromycin to see if symptoms improve
B) A chest radiograph
C) A urine test for Legionella pneumophila antigen
D) Sputum culture for acid-fast bacilli
Correct Answer: C) A urine test for Legionella
pneumophila antigen
Rationale: The urine antigen test is the preferred, rapid
method for confirming Legionnaires' disease (specifically
serogroup 1, the most common). While sputum culture is
the gold standard, it requires 48–72 hours. A chest
radiograph supports the diagnosis of pneumonia but does
not identify the organism. Response to antibiotics is not
diagnostic .
,2. A 50-year-old carpet layer presents with swelling
over the anterior knee (proximal to the patella)
without trauma or fever. The area is minimally tender
with no warmth or erythema. What is the most
appropriate initial management?
A) Rest, ice, and compression
B) Aspiration of fluid for analysis
C) Injection of a corticosteroid
D) Referral to an orthopedic surgeon for resection
Correct Answer: A) Rest, ice, and compression
Rationale: This presentation is classic for prepatellar bursitis
(often due to microtrauma from kneeling). In the absence of
signs of infection (fever, erythema, significant warmth) or
trauma, conservative management with rest, ice, and
compression is appropriate. Aspiration is reserved for
suspected septic bursitis or persistent cases .
3. A 55-year-old female with a 30-pack-year smoking
history presents with progressive dyspnea and
peripheral edema. Exam shows JVD and 3+ pitting
edema. Echocardiogram reveals an ejection fraction of
25%. Which of the following is the most appropriate
initial pharmacologic therapy for mortality benefit?
,A) Furosemide
B) Digoxin
C) Lisinopril
D) Metoprolol succinate
Correct Answer: C) Lisinopril
Rationale: The patient has Heart Failure with reduced
Ejection Fraction (HFrEF). The cornerstone of initial therapy
for mortality benefit includes an ACE inhibitor (lisinopril) or
ARB. While furosemide is used for symptom management
(volume overload), it does not improve mortality. Beta-
blockers are indicated but are typically initiated after
stabilization. Digoxin is not first-line .
4. A 72-year-old male with hypertension and
hyperlipidemia has a blood pressure of 148/92 mmHg
on two separate visits. Home readings average 142/88
mmHg. He is already on atorvastatin and aspirin.
According to ACC/AHA guidelines, what is the most
appropriate next step?
A) Recommend lifestyle modifications only and recheck in
3 months
B) Start amlodipine 5 mg daily
, C) Start hydrochlorothiazide 12.5 mg daily
D) Start lisinopril 10 mg daily
Correct Answer: D) Start lisinopril 10 mg daily
Rationale: This patient has Stage 2 hypertension and
elevated ASCVD risk. The target is <130/80 mmHg. Initial
monotherapy options include a thiazide diuretic, ACE
inhibitor, ARB, or calcium channel blocker. Lisinopril is a
first-line agent and is particularly appropriate given his
cardiovascular risk profile .
5. A 2-month-old female is brought in for a well-child
visit. The parents refuse routine vaccinations based on
personal beliefs. You wish to follow CDC
recommendations while maintaining patient-
centeredness. What is the most appropriate action?
A) Accept the decision without further action
B) Have the parents sign a refusal to vaccinate form
C) Dismiss the family from the practice immediately
D) Pursue a court order for vaccine administration
Correct Answer: B) Have the parents sign a refusal to
vaccinate form
