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ABFM ITE / with complete solution | RATED A+
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ABFM ITE / with complete solution | RATED A+
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ABFM ITE 2024 -2025 / with complete solution | RATED A+ 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 i buprofen 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 a lso 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 preferr ed method to confirm your suspected diagnosis of Legionnaires' disease? A) Initiating azithromycin (Zithromax) to see if symptoms improve B) A chest radiograp - ANSWER: E A urine test for Legionella pneumophila antigen is the preferred method to confi rm 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 diagnosi s 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, regardles s 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, w ho 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 follo w 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 fr om 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 s hould 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 imm unizations 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 trau ma, 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 repeate d 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, ana lgesics, 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 i s 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 stro ke - 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 con trolled 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 o nset 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 find s 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 - 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 histor y 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 i s 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 age nts, 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 tender ness, 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 ret urn to weight bearing - ANSWER: D The Ottawa foot and ankle rules should be used to determine the need for radiographs in foot and ankle injuries. A radiograph of the ankle is recommended if there is pain in the malleolar zone along with the inability to bear weight for at least four steps immediately after the injury and in the physician's office or emergency department (ED), or tenderness at the tip of the posterior medial or lateral malleolus. A radiograph of the foot is recommended if there is pain in the midfoot zone along with the inability to bear weight for four steps immediately after the injury and in the physician's office or ED, or tenderness at the base of the fifth metatarsal or over the navicular bone. The Ottawa foot and ankle rules are u p to 99% sensitive for detecting fractures, although they are not highly specific. In this case there are no findings that would require radiographs, so treatment for the ankle sprain would be recommended. Compression combined with lace-up ankle support or an air cast, along with cryotherapy, is recommended and can increase mobility. Early mobilization, including weight bearing as tolerated for daily activities, is associated with better long -term outcomes than prolonged rest. 8. A 65 -year-old male with ty pe 2 diabetes mellitus, hypertension, and obstructive sleep apnea sees you for follow -up. He does not use tobacco or other drugs, and his alcohol consumption consists of two drinks per day. His BMI is 31.0 kg/m2, and he just started a fitness program. The patient tells you that his brother was recently diagnosed with atrial fibrillation and he asks you if this increases his own risk. Which one of the following factors would increase the risk of atrial fibrillation in this patient? A) Alcohol use B) Treatme nt with lisinopril (Prinivil, Zestril) C) Treatment with pioglitazone (Actos) D) Use of a continuous positive airway pressure (CPAP) device E) Physical stress - ANSWER: A Alcohol consumption greater than one drink/day has been associated with atrial fibrillation. While not recommended to prevent atrial fibrillation, pioglitazone and lisinopril have both been associated with lower rates of atrial fibrillation compared to
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