ABFM ITE 2025 EXAM Q & A MOST FREQUENTLY TESTED
QUESTIONS WITH EXPLANATIONS
A 68-year-old male presents with a 2-day history of headache, muscle
aches, chills, fever, confusion, cough with blood-tinged sputum, shortness
of breath, and nausea after returning from a cruise. 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 radiograph
C) Sputum Gram stain and culture
D) PCR testing of respiratory secretions for Legionella pneumophila
E) Urine test for Legionella pneumophila antigen – CORRECT ANSWER
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 ANSWER: 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 ANSWER: 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 ANSWER: 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 ANSWER: 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 optimum ANSWER: 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
QUESTIONS WITH EXPLANATIONS
A 68-year-old male presents with a 2-day history of headache, muscle
aches, chills, fever, confusion, cough with blood-tinged sputum, shortness
of breath, and nausea after returning from a cruise. 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 radiograph
C) Sputum Gram stain and culture
D) PCR testing of respiratory secretions for Legionella pneumophila
E) Urine test for Legionella pneumophila antigen – CORRECT ANSWER
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 ANSWER: 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 ANSWER: 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 ANSWER: 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 ANSWER: 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 optimum ANSWER: 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
