ABFM ITE 2018 Exam Questions &
Answers
1. A 68-year-old male presents to your office with a 2-day history of headache, muscle aches, and chills.
His wife adds that his temperature has been up to 104.1°F and he seems confused sometimes. His
symptoms have not improved with usual care, including ibuprofen and increased fluid intake. He and his
wife returned from a cruise 10 days ago but don't recall anyone having a similar illness on the ship. This
morning he started to cough and his wife was concerned because she saw some blood in his sputum. He
also states that he experiences intermittent shortness of breath and feels nauseated. His blood pressure
is 100/70 mm Hg, heart rate 98/min, temperature 39.4°C (102.9°F), and oxygen saturation 95% on room
air.
Which one of the following would be the preferred method to confirm your suspected diagnosis of
Legionnaires' disease?
A) Initiating azithromycin (Zithromax) to see if symptoms improve
B) A chest radiograp - ANSWERSANSWER: E
A urine test for Legionella pneumophila antigen is the preferred method to confirm Legionnaires'
disease. This test is rapid and will only detect Legionella pneumophila antigen. A sputum culture is the
gold standard for the diagnosis of Legionnaires' disease but it requires 48-72 hours. A chest radiograph
does not confirm the diagnosis but may show the extent of disease. Responding to antibiotic treatment
does not confirm a specific diagnosis.
2. Which one of the following factors related to pregnancy and delivery increases the risk of
developmental dysplasia of the hip in infants?
A) A large-for-gestational age infant
B) Twin birth
C) Breech presentation
D) Cesarean delivery
E) Premature birth - ANSWERSANSWER: C
Risk factors for developmental dysplasia of the hip in infants include a breech presentation in the third
trimester, regardless of whether the delivery was cesarean or vaginal. Other indications to evaluate an
infant for this condition include a positive family history, a history of previous clinical instability, parental
,concern, a history of improper swaddling, and a suspicious or inconclusive physical examination. Twin
birth, a large-for-gestational age infant, and prematurity are not considered risk factors.
3. A healthy 2-month-old female is brought to your office for a routine well baby examination by both of
her parents, who have no concerns. The parents refuse routine recommended vaccines for their
daughter because of their personal beliefs.
You want to incorporate patient-centeredness and are also concerned about improving the health of the
population. You decide to follow the CDC recommendations by
A) accepting their decision without further action
B) not offering vaccines at future visits to preserve a positive doctor-patient relationship
C) having the parents sign a refusal to vaccinate form
D) dismissing the family from the practice
E) pursuing a court order for vaccine administration since the child has no medical
exemptions - ANSWERSANSWER: C
Experts recommend that a refusal to vaccinate form be signed by patients or parents who refuse a
recommended vaccine. This form should document that the patient/parents were provided the vaccine
information statement (SOR C). The CDC recommends against dismissing a patient or family from a
practice if they refuse vaccination. Physicians should continue to discuss the benefits of immunizations at
subsequent visits, because some patients/parents may reconsider their decision not to vaccinate.
4. A 50-year-old male carpet layer presents with swelling of his right knee proximal to the patella. He
does not have any history of direct trauma, fever, chills, or changes in the overlying skin. On examination
the site is swollen but minimally tender, with no warmth or erythema.
Which one of the following would be most appropriate at this point?
A) Rest, ice, and compression
B) Aspiration of fluid for analysis
C) Injection of a corticosteroid
D) An oral corticosteroid taper
E) Referral to an orthopedic surgeon for resection - ANSWERSANSWER: A
Prepatellar bursitis is a common superficial bursitis caused by microtrauma from repeated kneeling and
crawling. Other terms for this include housemaid's knee, coal miner's knee, and carpet layer's knee. It is
,usually associated with minimal to no pain. This differs from inflammatory processes such as acute gouty
superficial bursitis, which presents as an acutely swollen, red, inflamed bursa and, in rare cases,
progresses to chronic tophaceous gout with minimal or no pain.
The proper management of prepatellar bursitis is conservative and includes ice, compression wraps,
padding, elevation, analgesics, and modification of activity. There is little evidence that a corticosteroid
injection is beneficial, even though it is often done. If inflammatory bursitis is suspected, a corticosteroid
injection may be helpful. Fluid aspiration is indicated if septic bursitis is suspected. Surgery can be
considered for significant enlargement of a bursa if it interferes with function.
5. An 85-year-old female with a previous history of diabetes mellitus, hypertension, dementia, and
peptic ulcer disease has been in a skilled nursing facility for 4 weeks for rehabilitation after a hip fracture
repair secondary to a fall during an ischemic stroke. She is transported to the emergency department
today when she develops confusion, shortness of breath, and diaphoresis. Her blood pressure is 172/98
mm Hg, her heart rate is 122 beats/min with an irregular rhythm, and her respiratory rate is 22/min. An
EKG demonstrates atrial fibrillation and 0.2 mV ST-segment elevation compared to previous EKGs. Her
first troponin level is elevated.
Which one of the following conditions in this patient is considered an ABSOLUTE contraindication to
fibrinolytic therapy?
A) Poorly controlled hypertension
B) Peptic ulcer disease
C) Alzheimer's dementia
D) Hip fracture repair
E) Ischemic stroke - ANSWERSANSWER: E
A history of an ischemic stroke within the past 3 months is an absolute contraindication to fibrinolytic
therapy in patients with an ST-elevation myocardial infarction (STEMI), unless the stroke is diagnosed
within 41⁄2 hours. Poorly controlled hypertension, dementia, peptic ulcer disease, and major surgery less
than 3 weeks before the STEMI are relative contraindications that should be considered on an individual
basis.
6. An otherwise healthy 57-year-old female presents with a sudden onset of hearing loss. She awoke this
morning unable to hear out of her left ear. There was no preceding illness and she currently feels well
otherwise. She does not have ear pain, headache, runny nose, congestion, or fever, and she does not
take any daily medications.
On examination you note normal vital signs and find a normal ear, with no obstructing cerumen and with
normal tympanic membrane motion on pneumatic otoscopy. You perform a Weber test by placing a
, tuning fork over her central forehead. She finds that the sound lateralizes to her right ear. The Rinne test
shows sounds are heard better with bone conduction on the left and with air conduction on the right.
You refer her to an otolaryngologist for further evaluation including audiometry. You should also consider
initiating which one of the following medications at this visit in order to optim - ANSWERSANSWER: E
This patient has sudden sensorineural hearing loss (SSNHL) of the left ear without any accompanying
features to suggest a clear underlying cause. An appropriate evaluation will fail to identify a cause in
85%-90% of cases. Idiopathic SSNHL can be diagnosed if a patient is found to have a 30-dB hearing loss
at three consecutive frequencies and an underlying condition is not identified by the history and physical
examination.
The most recent guideline from the American Academy of Otolaryngology-Head and Neck Surgery
recommends that oral corticosteroids be considered as first-line therapy for patients who do not have a
contraindication. While there is equivocal evidence of benefit, for most patients the risk of a short-term
course of corticosteroids is thought to be outweighed by the potential benefit, especially when
considering the serious consequences of long-term profound hearing loss. Because the greatest
improvement in hearing tends to occur in the first 2 weeks, corticosteroid treatment should be started
immediately. The recommended dosage is 1 mg/kg/day with a maximum dosage of 60 mg daily for 10-14
days.
Antiviral medications, antiplatelet agents, and vasodilators such as nifedipine have no evidence of
benefit. Antibiotics also have no evidence of benefit in the absence of signs of infection.
7. You are the team physician for the local high school track team. During a meet one of the athletes
inadvertently steps off the edge of the track and inverts her right foot forcefully. She is able to bear
weight but with significant pain. She reports pain across her right midfoot. An examination reveals
edema over the lateral malleolus and diffuse tenderness, but she does not have any pain with palpation
of the navicular, the base of the fifth metatarsal, or the posterior distal lateral and medial malleoli.
Which one of the following would be most appropriate at this time?
A) Radiographs of the right ankle only
B) Radiographs of the right foot only
C) Radiographs of the right foot and ankle
D) Lace-up ankle support, ice, compression, and clinical follow-up
E) Crutches and no weight bearing for 2 weeks, followed by a slow return to weight
bearing - ANSWERSANSWER: D
Answers
1. A 68-year-old male presents to your office with a 2-day history of headache, muscle aches, and chills.
His wife adds that his temperature has been up to 104.1°F and he seems confused sometimes. His
symptoms have not improved with usual care, including ibuprofen and increased fluid intake. He and his
wife returned from a cruise 10 days ago but don't recall anyone having a similar illness on the ship. This
morning he started to cough and his wife was concerned because she saw some blood in his sputum. He
also states that he experiences intermittent shortness of breath and feels nauseated. His blood pressure
is 100/70 mm Hg, heart rate 98/min, temperature 39.4°C (102.9°F), and oxygen saturation 95% on room
air.
Which one of the following would be the preferred method to confirm your suspected diagnosis of
Legionnaires' disease?
A) Initiating azithromycin (Zithromax) to see if symptoms improve
B) A chest radiograp - ANSWERSANSWER: E
A urine test for Legionella pneumophila antigen is the preferred method to confirm Legionnaires'
disease. This test is rapid and will only detect Legionella pneumophila antigen. A sputum culture is the
gold standard for the diagnosis of Legionnaires' disease but it requires 48-72 hours. A chest radiograph
does not confirm the diagnosis but may show the extent of disease. Responding to antibiotic treatment
does not confirm a specific diagnosis.
2. Which one of the following factors related to pregnancy and delivery increases the risk of
developmental dysplasia of the hip in infants?
A) A large-for-gestational age infant
B) Twin birth
C) Breech presentation
D) Cesarean delivery
E) Premature birth - ANSWERSANSWER: C
Risk factors for developmental dysplasia of the hip in infants include a breech presentation in the third
trimester, regardless of whether the delivery was cesarean or vaginal. Other indications to evaluate an
infant for this condition include a positive family history, a history of previous clinical instability, parental
,concern, a history of improper swaddling, and a suspicious or inconclusive physical examination. Twin
birth, a large-for-gestational age infant, and prematurity are not considered risk factors.
3. A healthy 2-month-old female is brought to your office for a routine well baby examination by both of
her parents, who have no concerns. The parents refuse routine recommended vaccines for their
daughter because of their personal beliefs.
You want to incorporate patient-centeredness and are also concerned about improving the health of the
population. You decide to follow the CDC recommendations by
A) accepting their decision without further action
B) not offering vaccines at future visits to preserve a positive doctor-patient relationship
C) having the parents sign a refusal to vaccinate form
D) dismissing the family from the practice
E) pursuing a court order for vaccine administration since the child has no medical
exemptions - ANSWERSANSWER: C
Experts recommend that a refusal to vaccinate form be signed by patients or parents who refuse a
recommended vaccine. This form should document that the patient/parents were provided the vaccine
information statement (SOR C). The CDC recommends against dismissing a patient or family from a
practice if they refuse vaccination. Physicians should continue to discuss the benefits of immunizations at
subsequent visits, because some patients/parents may reconsider their decision not to vaccinate.
4. A 50-year-old male carpet layer presents with swelling of his right knee proximal to the patella. He
does not have any history of direct trauma, fever, chills, or changes in the overlying skin. On examination
the site is swollen but minimally tender, with no warmth or erythema.
Which one of the following would be most appropriate at this point?
A) Rest, ice, and compression
B) Aspiration of fluid for analysis
C) Injection of a corticosteroid
D) An oral corticosteroid taper
E) Referral to an orthopedic surgeon for resection - ANSWERSANSWER: A
Prepatellar bursitis is a common superficial bursitis caused by microtrauma from repeated kneeling and
crawling. Other terms for this include housemaid's knee, coal miner's knee, and carpet layer's knee. It is
,usually associated with minimal to no pain. This differs from inflammatory processes such as acute gouty
superficial bursitis, which presents as an acutely swollen, red, inflamed bursa and, in rare cases,
progresses to chronic tophaceous gout with minimal or no pain.
The proper management of prepatellar bursitis is conservative and includes ice, compression wraps,
padding, elevation, analgesics, and modification of activity. There is little evidence that a corticosteroid
injection is beneficial, even though it is often done. If inflammatory bursitis is suspected, a corticosteroid
injection may be helpful. Fluid aspiration is indicated if septic bursitis is suspected. Surgery can be
considered for significant enlargement of a bursa if it interferes with function.
5. An 85-year-old female with a previous history of diabetes mellitus, hypertension, dementia, and
peptic ulcer disease has been in a skilled nursing facility for 4 weeks for rehabilitation after a hip fracture
repair secondary to a fall during an ischemic stroke. She is transported to the emergency department
today when she develops confusion, shortness of breath, and diaphoresis. Her blood pressure is 172/98
mm Hg, her heart rate is 122 beats/min with an irregular rhythm, and her respiratory rate is 22/min. An
EKG demonstrates atrial fibrillation and 0.2 mV ST-segment elevation compared to previous EKGs. Her
first troponin level is elevated.
Which one of the following conditions in this patient is considered an ABSOLUTE contraindication to
fibrinolytic therapy?
A) Poorly controlled hypertension
B) Peptic ulcer disease
C) Alzheimer's dementia
D) Hip fracture repair
E) Ischemic stroke - ANSWERSANSWER: E
A history of an ischemic stroke within the past 3 months is an absolute contraindication to fibrinolytic
therapy in patients with an ST-elevation myocardial infarction (STEMI), unless the stroke is diagnosed
within 41⁄2 hours. Poorly controlled hypertension, dementia, peptic ulcer disease, and major surgery less
than 3 weeks before the STEMI are relative contraindications that should be considered on an individual
basis.
6. An otherwise healthy 57-year-old female presents with a sudden onset of hearing loss. She awoke this
morning unable to hear out of her left ear. There was no preceding illness and she currently feels well
otherwise. She does not have ear pain, headache, runny nose, congestion, or fever, and she does not
take any daily medications.
On examination you note normal vital signs and find a normal ear, with no obstructing cerumen and with
normal tympanic membrane motion on pneumatic otoscopy. You perform a Weber test by placing a
, tuning fork over her central forehead. She finds that the sound lateralizes to her right ear. The Rinne test
shows sounds are heard better with bone conduction on the left and with air conduction on the right.
You refer her to an otolaryngologist for further evaluation including audiometry. You should also consider
initiating which one of the following medications at this visit in order to optim - ANSWERSANSWER: E
This patient has sudden sensorineural hearing loss (SSNHL) of the left ear without any accompanying
features to suggest a clear underlying cause. An appropriate evaluation will fail to identify a cause in
85%-90% of cases. Idiopathic SSNHL can be diagnosed if a patient is found to have a 30-dB hearing loss
at three consecutive frequencies and an underlying condition is not identified by the history and physical
examination.
The most recent guideline from the American Academy of Otolaryngology-Head and Neck Surgery
recommends that oral corticosteroids be considered as first-line therapy for patients who do not have a
contraindication. While there is equivocal evidence of benefit, for most patients the risk of a short-term
course of corticosteroids is thought to be outweighed by the potential benefit, especially when
considering the serious consequences of long-term profound hearing loss. Because the greatest
improvement in hearing tends to occur in the first 2 weeks, corticosteroid treatment should be started
immediately. The recommended dosage is 1 mg/kg/day with a maximum dosage of 60 mg daily for 10-14
days.
Antiviral medications, antiplatelet agents, and vasodilators such as nifedipine have no evidence of
benefit. Antibiotics also have no evidence of benefit in the absence of signs of infection.
7. You are the team physician for the local high school track team. During a meet one of the athletes
inadvertently steps off the edge of the track and inverts her right foot forcefully. She is able to bear
weight but with significant pain. She reports pain across her right midfoot. An examination reveals
edema over the lateral malleolus and diffuse tenderness, but she does not have any pain with palpation
of the navicular, the base of the fifth metatarsal, or the posterior distal lateral and medial malleoli.
Which one of the following would be most appropriate at this time?
A) Radiographs of the right ankle only
B) Radiographs of the right foot only
C) Radiographs of the right foot and ankle
D) Lace-up ankle support, ice, compression, and clinical follow-up
E) Crutches and no weight bearing for 2 weeks, followed by a slow return to weight
bearing - ANSWERSANSWER: D
