UPDATED ITE 2024 WITH 100%
ACCURATE ANSWERS
,UPDATED ITE 2024 WITH 100%
ACCURATE ANSWERS
A 41-year-old male who is a construction worker sees you because he experienced palpitations followed
by an episode of syncope after drinking four beers at a hotel bar while on vacation. He says that he was
hospitalized briefly, and an electric shock was administered in the emergency department after
medications were given. On discharge he was told that he had a brief episode of atrial fibrillation but
that an echocardiogram was normal. He was advised to follow up promptly with his personal physician.
An EKG performed in your office is shown below. Which one of the following would you recommend for
this patient?
A) Aspirin
B) Oral flecainide to be taken if a similar episode occurs in the future
C) Oral metoprolol therapy
D) Warfarin therapy
E) Catheter ablation therapy - CORRECT ANSWERSANSWER: E
This EKG shows a short P-R interval with a slurred upstroke in the QRS complex in the precordial leads.
These findings are classic for Wolff-Parkinson-White (WPW) syndrome. In symptomatic patients with
sustained ventricular tachycardias, especially with the more dangerous paroxysmal atrial fibrillation,
catheter ablation is the preferred therapy. Up to 95% success has been reported.
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no additional
chronic medical problems and is otherwise asymptomatic. An examination is significant for a blood
pressure of 162/95 mm Hg but is otherwise unremarkable.
Laboratory work shows that his BMP is within normal limits.
According to the American College of Cardiology/American Heart Association 2017 guidelines, which
one of the following would be the most appropriate medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
,C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily - CORRECT ANSWERSANSWER: C
This patient has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Association 2017 guidelines, antihypertensive treatment should be initiated.
For the general non-African-American population, monotherapy with an ACE inhibitor, an angiotensin
receptor blocker, a calcium channel blocker, or a thiazide diuretic would be appropriate for initial
management. It is also appropriate to initiate combination antihypertensive therapy as an initial
management strategy, although patients should not take an ACE inhibitor and an angiotensin receptor
blocker simultaneously. Studies have shown that blood pressure control is achieved faster with the
initiation of combination therapy compared to monotherapy, without an increase in morbidity.
Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. Alpha blockers,
vasodilators, beta-blockers, and potassium-sparing diuretics are not recommended as initial choices for
the treatment of hypertension.
A 36-year-old female presents for evaluation of elevated blood pressure. She is asymptomatic and does
not take any medications. On examination her blood pressure is 160/96 mm Hg and her BMI is 26
kg/m2. Fasting laboratory studies include the following:
Sodium 142.
Potassium 3.0.
Creatinine 0.76.
Glucose 97.
Which one of the following additional laboratory evaluations should be performed to assess her blood
pressure?
A) A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA)
B) A serum aldosterone/renin ratio
C) A serum cortisol level
D) A serum cystatin C level - CORRECT ANSWERSANSWER: B
Primary hyperaldosteronism should be suspected as a cause for hypertension if a patient has a
spontaneously low potassium level or persistent hypertension despite the use of three or more
antihypertensive medications, including a diuretic. This can be evaluated by checking a serum renin
, activity level and a serum aldosterone concentration and determining the aldosterone/renin ratio.
Primary hyperaldosteronism typically presents with a very low serum renin activity level and an elevated
serum aldosterone concentration.
A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA) would be used to evaluate for a
neuroendocrine tumor, which can present as chronic flushing and diarrhea. Cortisol levels can be
checked if Cushing syndrome is suspected. Hypertension can be present in Cushing syndrome, but it is
typically associated with other signs such as obesity and an elevated blood glucose level due to insulin
resistance. Cystatin C is a marker of renal function and measurement would not be indicated given this
patient's normal creatinine level.
A 26-year-old male diagnosed with coccidioidomycosis (valley fever) develops a rash on the extensor
surfaces of his lower legs consisting of painful, subcutaneous, nonulcerated, erythematous nodules. This
rash is consistent with which one of the following?
A) Erythema ab igne
B) Erythema infectiosum
C) Erythema migrans
D) Erythema multiforme
E) Erythema nodosum - CORRECT ANSWERSANSWER: E
Erythema nodosum, a panniculitis that typically affects the subcutaneous fat on the anterior surface of
the lower legs, is associated with coccidioidomycosis (valley fever) and can suggest the diagnosis. It is a
manifestation of the patient's immune response and often indicates a good prognosis. In addition to
coccidioidomycosis, it can also be associated with streptococcal infections as well as tuberculosis.
Erythema ab igne is a cutaneous rash caused by prolonged heat exposure (such as a heating pad)
presenting as an otherwise asymptomatic, red, reticulated pattern on the skin. Erythema infectiosum is
associated with parvovirus B19 infection and is usually seen in young children. It manifests as an
erythematous rash of the face (slapped cheek appearance), arms, and legs. Erythema migrans is an
expanding, erythematous, annular rash with or without central clearing and is often associated with tick
exposure (Lyme disease). Erythema multiforme consists of raised, annular, target-like lesions with
central erythema and is usually associated with herpes simplex virus type 1.
A 50-year-old male presents with chronic abdominal pain. A workup leads you to suspect peptic ulcer
disease, and you refer him for endoscopy, which shows a small duodenal ulcer. The endoscopist also
notes some small esophageal varices without red wale signs.
ACCURATE ANSWERS
,UPDATED ITE 2024 WITH 100%
ACCURATE ANSWERS
A 41-year-old male who is a construction worker sees you because he experienced palpitations followed
by an episode of syncope after drinking four beers at a hotel bar while on vacation. He says that he was
hospitalized briefly, and an electric shock was administered in the emergency department after
medications were given. On discharge he was told that he had a brief episode of atrial fibrillation but
that an echocardiogram was normal. He was advised to follow up promptly with his personal physician.
An EKG performed in your office is shown below. Which one of the following would you recommend for
this patient?
A) Aspirin
B) Oral flecainide to be taken if a similar episode occurs in the future
C) Oral metoprolol therapy
D) Warfarin therapy
E) Catheter ablation therapy - CORRECT ANSWERSANSWER: E
This EKG shows a short P-R interval with a slurred upstroke in the QRS complex in the precordial leads.
These findings are classic for Wolff-Parkinson-White (WPW) syndrome. In symptomatic patients with
sustained ventricular tachycardias, especially with the more dangerous paroxysmal atrial fibrillation,
catheter ablation is the preferred therapy. Up to 95% success has been reported.
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no additional
chronic medical problems and is otherwise asymptomatic. An examination is significant for a blood
pressure of 162/95 mm Hg but is otherwise unremarkable.
Laboratory work shows that his BMP is within normal limits.
According to the American College of Cardiology/American Heart Association 2017 guidelines, which
one of the following would be the most appropriate medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
,C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily - CORRECT ANSWERSANSWER: C
This patient has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Association 2017 guidelines, antihypertensive treatment should be initiated.
For the general non-African-American population, monotherapy with an ACE inhibitor, an angiotensin
receptor blocker, a calcium channel blocker, or a thiazide diuretic would be appropriate for initial
management. It is also appropriate to initiate combination antihypertensive therapy as an initial
management strategy, although patients should not take an ACE inhibitor and an angiotensin receptor
blocker simultaneously. Studies have shown that blood pressure control is achieved faster with the
initiation of combination therapy compared to monotherapy, without an increase in morbidity.
Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. Alpha blockers,
vasodilators, beta-blockers, and potassium-sparing diuretics are not recommended as initial choices for
the treatment of hypertension.
A 36-year-old female presents for evaluation of elevated blood pressure. She is asymptomatic and does
not take any medications. On examination her blood pressure is 160/96 mm Hg and her BMI is 26
kg/m2. Fasting laboratory studies include the following:
Sodium 142.
Potassium 3.0.
Creatinine 0.76.
Glucose 97.
Which one of the following additional laboratory evaluations should be performed to assess her blood
pressure?
A) A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA)
B) A serum aldosterone/renin ratio
C) A serum cortisol level
D) A serum cystatin C level - CORRECT ANSWERSANSWER: B
Primary hyperaldosteronism should be suspected as a cause for hypertension if a patient has a
spontaneously low potassium level or persistent hypertension despite the use of three or more
antihypertensive medications, including a diuretic. This can be evaluated by checking a serum renin
, activity level and a serum aldosterone concentration and determining the aldosterone/renin ratio.
Primary hyperaldosteronism typically presents with a very low serum renin activity level and an elevated
serum aldosterone concentration.
A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA) would be used to evaluate for a
neuroendocrine tumor, which can present as chronic flushing and diarrhea. Cortisol levels can be
checked if Cushing syndrome is suspected. Hypertension can be present in Cushing syndrome, but it is
typically associated with other signs such as obesity and an elevated blood glucose level due to insulin
resistance. Cystatin C is a marker of renal function and measurement would not be indicated given this
patient's normal creatinine level.
A 26-year-old male diagnosed with coccidioidomycosis (valley fever) develops a rash on the extensor
surfaces of his lower legs consisting of painful, subcutaneous, nonulcerated, erythematous nodules. This
rash is consistent with which one of the following?
A) Erythema ab igne
B) Erythema infectiosum
C) Erythema migrans
D) Erythema multiforme
E) Erythema nodosum - CORRECT ANSWERSANSWER: E
Erythema nodosum, a panniculitis that typically affects the subcutaneous fat on the anterior surface of
the lower legs, is associated with coccidioidomycosis (valley fever) and can suggest the diagnosis. It is a
manifestation of the patient's immune response and often indicates a good prognosis. In addition to
coccidioidomycosis, it can also be associated with streptococcal infections as well as tuberculosis.
Erythema ab igne is a cutaneous rash caused by prolonged heat exposure (such as a heating pad)
presenting as an otherwise asymptomatic, red, reticulated pattern on the skin. Erythema infectiosum is
associated with parvovirus B19 infection and is usually seen in young children. It manifests as an
erythematous rash of the face (slapped cheek appearance), arms, and legs. Erythema migrans is an
expanding, erythematous, annular rash with or without central clearing and is often associated with tick
exposure (Lyme disease). Erythema multiforme consists of raised, annular, target-like lesions with
central erythema and is usually associated with herpes simplex virus type 1.
A 50-year-old male presents with chronic abdominal pain. A workup leads you to suspect peptic ulcer
disease, and you refer him for endoscopy, which shows a small duodenal ulcer. The endoscopist also
notes some small esophageal varices without red wale signs.
