ITE 2026 EXAM QUESTIONS &
DETAILED ANSWERS PASSED 100%
LATEST VERSION
A 70-year-old female sees you at the request of her surgeon to discuss anticoagulation
management prior to a scheduled cholecystectomy. She has a past medical history of
atrial fibrillation, stage 3a chronic kidney disease, hypertension, depression, and
cerebrovascular disease. She had an ischemic stroke 1 year ago
Her vital signs stable. A cv examination reveals an irregularly irregular rhythm.. An INR
today is 2.2. Which one of the following would be the most appropriate perioperative
anticoagulation therapy for this patient?
A) Continuing warfarin with a goal INR of 1.4-1.6 B) Discontinuing warfarin 5 days prior
to surgery and bridging with aspirin C) Discontinuing warfarin 5 days prior to surgery
and bridging with clopidogrel (Plavix) D) Discontinuing warfarin 5 days prior to surgery
and bridging with low-molecular-weight heparin
E) Discontinuing warfarin 5 days prior to surgery without bridging therapy
Discontinuing warfarin 5 days prior to surgery without bridging therapy
Continuing warfarin is not recommended prior to elective procedures or surgeries in
patients who are taking warfarin for stroke prevention secondary to atrial fibrillation. The
BRIDGE trial excluded patients who had an ischemic stroke within the previous 12
weeks but included those with more distant strokes. For such patients, cessation of
warfarin without bridging with low-molecular-weight heparin or antiplatelet agents is the
appropriate management strategy. There is no evidence that using a lower target INR is
appropriate.
A 30-year-old female with obesity and tobacco use disorder presents for evaluation of a
persistent painful lump in her axilla. After an appropriate evaluation you diagnose mild
hidradenitis suppurativa. In addition to weight loss and smoking cessation counseling,
which one of the following treatment options would be most appropriate? A) Topical
clindamycin gel (Cleocin T) B) Topical diclofenac gel C) Topical triamcinolone cream D)
Oral azithromycin (Zithromax) E) Oral meloxicam
A) Topical clindamycin gel (Cleocin T)
For patients with mild hidradenitis suppurativa, topical clindamycin is recommended as
first-line treatment and often works well as monotherapy (SOR B). Patients with
hidradenitis suppurativa who have overweight and smoke should be advised that weight
loss and smoking cessation have been shown to decrease severity of disease and
improve treatment response (SOR A). For patients with moderate disease, oral
tetracyclines in addition to topical clindamycin are recommended as first-line therapy.
Although intralesional triamcinolone may be considered for procedural management of
mild hidradenitis suppurativa, topical triamcinolone is not recommended. Other oral
,antibiotics that have shown benefit include clindamycin and rifampin, although
azithromycin is not a recommended treatment option. While NSAIDs such as topical
diclofenac and oral meloxicam may help to alleviate discomfort associated with active
lesions, they are not part of the routine management of hidradenitis suppurativa.
A 30-year-old female with a medical history of anxiety and seasonal allergies presents
for evaluation of palpitations and a racing heartbeat that has worsened over the last 3-4
days. Recently, her escitalopram (Lexapro) dosage was increased to 20 mg daily and
she started using fluticasone propionate nasal spray (Flonase) and oral cetirizine
(Zyrtec), 10 mg daily. A CBC, comprehensive metabolic panel, and TSH level are
normal. A urine pregnancy test is negative. An EKG today shows a heart rate of 85
beats/min and a QTc interval of 500 milliseconds. Which one of the following would be
the most appropriate next step? A) Reassurance only B) Discontinuing cetirizine
C) Discontinuing escitalopram D) Discontinuing fluticasone E) Echocardiography
C) Discontinuing escitalopram
This patient's EKG shows a prolonged QTc interval (>460 milliseconds for women). QT
prolongation can indicate polymorphic ventricular tachycardia characterized by
palpitations. QT prolongation can be congenital or acquired. Escitalopram and other
antidepressants are associated with QT prolongation. Any QT-prolonging medications
should be discontinued, and a subsequent EKG should be obtained once the drug
levels are expected to be minimal. Reassurance only would not be the most appropriate
next step as QT prolongation can lead to torsades de pointes, a potentially fatal
arrhythmia (SOR C). Cetirizine and fluticasone are not known to prolong the QT interval.
Echocardiography would not be the next step in management.
Which one of the following medications has been shown to increase the resolution of
metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as
nonalcoholic fatty liver disease? A) Glyburide B) Metformin C) Pioglitazone (Actos) D)
Repaglinide E) Vitamin D (cholecalciferol)
C) Pioglitazone (Actos)
Although lifestyle modification remains the first-line treatment of metabolic dysfunction-
associated steatotic liver disease (formerly known as nonalcoholic fatty liver disease),
pioglitazone increases the resolution of nonalcoholic steatohepatitis, especially in
patients with advanced fibrosis. Pioglitazone may cause weight gain and should be
avoided in patients with heart failure, and it carries a small risk for bladder cancer.
Glyburide, metformin, repaglinide, and vitamin D (cholecalciferol) do not improve
steatohepatitis or fibrosis.
A 65-year-old female is found to have a T-score of -3.3 on a DEXA scan that is
performed as part of her Welcome to Medicare evaluation. She has a 30-pack-year
smoking history but quit smoking 5 years ago. An examination reveals a thin female but
is otherwise unremarkable. A CBC, a comprehensive metabolic panel, and thyroid
studies are unremarkable. X-rays reveal evidence of an old compression fracture of the
thoracic spine. Which one of the following would be the most appropriate initial
treatment? A) Oral alendronate (Fosamax) B) Oral raloxifene (Evista) C) Subcutaneous
denosumab (Prolia) D) Subcutaneous teriparatide (Forteo) E) Intravenous zoledronic
acid (Reclast)
,D) Subcutaneous teriparatide (Forteo)
.The diagnosis of osteoporosis can be made with a prior fracture of the hip or spine, or a
T-score ≤-2.5. A FRAX score ≥3% for hip fracture or ≥20% for major osteoporotic
fracture is also diagnostic. The usual first-line treatment is an oral bisphosphonate such
as alendronate or intravenous zoledronic acid. Denosumab would be preferred if the
creatinine clearance were less than 30-35 mL/min/1.73 m². Patients such as this one
would be considered at very high fracture risk. Diagnostic criteria for this risk category
include a T-score <-3.0, a FRAX score ≥4.5% for hip fracture or ≥30% for major
osteoporotic fracture, multiple fractures, fracture within 12 months, or fracture during
treatment for osteoporosis. The initial treatment recommendation would be a
parathyroid hormone analogue such as teriparatide daily for 2 years. Raloxifene is
indicated for the prevention of vertebral fractures only. It is useful in patients with a
history of breast cancer to help decrease the risk for recurrence.
A 48-year-old female presents to the urgent care clinic approximately 1 hour after
spilling hot water on her left forearm while draining pasta. She has a past medical
history of type 2 diabetes, hypertension, and major depression. She is not allergic to
any antibiotics and is up to date on tetanus vaccination. On examination her vital signs
are normal. You determine that she has a partial-thickness (seconddegree) burn
involving approximately a 4 × 5-cm area on the posterior and lateral aspects of the left
forearm. In addition to oral medications for pain management and topical antiseptics,
you should prescribe which one of the following? A) No additional medications B)
Amoxicillin/clavulanate (Augmentin) C) Clindamycin (Cleocin) D) Levofloxacin E)
Sulfamethoxazole/trimethoprim (Bactrim)
A) No additional medications
First-degree (superficial) and second-degree (partial-thickness) burns in adults can
usually be managed in the outpatient setting. Management options include analgesia
with anti-inflammatories or opioids if necessary, and topical agents to keep the burn
area moist. Multiple agents can be used as a topical antiseptic, including silver
sulfadiazine, honey, and aloe vera. Oral antibiotics are not indicated in the initial
management unless there are obvious signs of infection.
A 63-year-old female with a pmh of hypertension, depression, fibromyalgia, and giant
cell arteritis presents with a 3-week history of progressive cough and sob. She has been
taking prednisone for the last 3 months and is tapering the dosage. Her current dosage
is 25 mg daily. Vital signs include a temperature of 38.1 °C (100.6 °F), an oxygen
saturation of 88% on room air, and a respiratory rate of 28/min. On examination, her
lungs are clear, and a chest radiograph shows bilateral perihilar interstitial pulmonary
infiltrates. You recommend hospital admission and intravenous antibiotics. Which one of
the following antibiotic combinations would be the most appropriate initial treatment? A)
Azithromycin (Zithromax) and ceftriaxone B) Levofloxacin and metronidazole C)
Piperacillin/tazobactam (Zosyn) and vancomycin D) Azithromycin, cefepime, and
vancomycin
E) Ceftriaxone, doxycycline, and sulfamethoxazole/trimethoprim
E) Ceftriaxone, doxycycline, and sulfamethoxazole/trimethoprim
, Pneumocystis jirovecii pneumonia (PJP), previously known as Pneumocystis carinii
pneumonia, is a fungus that causes severe pneumonia in immunosuppressed
individuals. It is a classic AIDS-defining illness but can also affect those on prolonged
courses of corticosteroids or other forms of immunosuppression. This patient's
presentation of notable dyspnea, hypoxia, no focal lung sounds, and bilateral interstitial
infiltrates on radiography is consistent with PJP. This patient may also have community-
acquired bacterial pneumonia. Antibiotic treatment with sulfamethoxazole/trimethoprim
for PJP along with standard antibiotics for bacterial pneumonia should be initiated while
additional tests are pending. An elevated serum lactate dehydrogenase level has a
correlation with PJP, although it has poor specificity, especially in those without HIV.
Serum β-glucan is indicative of a fungal infection and can be supportive of a diagnosis
of PJP.
A 32-year-old male comes to your office because of a gradual onset of right ankle pain.
He works in a warehouse and walks extensively during his 12-hour shifts. The pain is
located on the medial side of the ankle and worsens throughout his shift. His medical
history is notable for well-controlled hypertension and a BMI of 39 kg/m2 . On
examination the patient has difficulty performing the single-limb heel raise test. You note
a positive "too many toes" sign, as well as pes planus. You diagnose posterior tibial
tendinopathy. In addition to arch supports, which one of the following should you
recommend next? A) A stretching program B) Eccentric exercises C) Oral
corticosteroids D) Corticosteroid injection E) Percutaneous needle tenotomy
B) Eccentric exercises
Eccentric exercise is recommended over concentric exercise to treat posterior tibial
tendinopathy. Because tendinopathy is not an inflammatory process, oral corticosteroids
are not indicated. Corticosteroids injected into the tendon can provide some short-term
relief of pain but have the potential to cause tendon rupture. Needle tenotomy is not a
recommended treatment for posterior tibial tendinopathy. If the pain persists 3-6 months
after appropriate conservative management, surgical debridement of the tendon may be
considered.
A 35-year-old female presents to your clinic with a 5-day history of sinus congestion,
postnasal drainage, and a productive cough with clear sputum. She has a history of
depression, for which she takes sertraline (Zoloft), and no previous history of respiratory
symptoms or diagnoses. She smokes socially. Her vital signs include a blood pressure
of 120/70 mm Hg, a heart rate of 87 beats/min, a respiratory rate of 16/min, and an
oxygen saturation of 99% on room air. On examination the patient has clear rhinorrhea,
posterior pharynx erythema, frontal sinus tenderness to palpation, and clear lung fields.
She has recurrent coughing episodes but does not show any signs of respiratory
distress. Which one of the following would be the most appropriate treatment? A) Honey
B) Amoxicillin/clavulanate (Augmentin) C) Dextromethorphan D)
Hydrocodone/homatropine (Hycodan) E) Prednisone
A) Honey
An acute cough is a cough of <3 weeks' duration in people without asthma and no
redflag symptoms of dyspnea or hemoptysis, or systemic symptoms such as fever,
weight loss, or peripheral edema. Although there is significant use of prescribed and
DETAILED ANSWERS PASSED 100%
LATEST VERSION
A 70-year-old female sees you at the request of her surgeon to discuss anticoagulation
management prior to a scheduled cholecystectomy. She has a past medical history of
atrial fibrillation, stage 3a chronic kidney disease, hypertension, depression, and
cerebrovascular disease. She had an ischemic stroke 1 year ago
Her vital signs stable. A cv examination reveals an irregularly irregular rhythm.. An INR
today is 2.2. Which one of the following would be the most appropriate perioperative
anticoagulation therapy for this patient?
A) Continuing warfarin with a goal INR of 1.4-1.6 B) Discontinuing warfarin 5 days prior
to surgery and bridging with aspirin C) Discontinuing warfarin 5 days prior to surgery
and bridging with clopidogrel (Plavix) D) Discontinuing warfarin 5 days prior to surgery
and bridging with low-molecular-weight heparin
E) Discontinuing warfarin 5 days prior to surgery without bridging therapy
Discontinuing warfarin 5 days prior to surgery without bridging therapy
Continuing warfarin is not recommended prior to elective procedures or surgeries in
patients who are taking warfarin for stroke prevention secondary to atrial fibrillation. The
BRIDGE trial excluded patients who had an ischemic stroke within the previous 12
weeks but included those with more distant strokes. For such patients, cessation of
warfarin without bridging with low-molecular-weight heparin or antiplatelet agents is the
appropriate management strategy. There is no evidence that using a lower target INR is
appropriate.
A 30-year-old female with obesity and tobacco use disorder presents for evaluation of a
persistent painful lump in her axilla. After an appropriate evaluation you diagnose mild
hidradenitis suppurativa. In addition to weight loss and smoking cessation counseling,
which one of the following treatment options would be most appropriate? A) Topical
clindamycin gel (Cleocin T) B) Topical diclofenac gel C) Topical triamcinolone cream D)
Oral azithromycin (Zithromax) E) Oral meloxicam
A) Topical clindamycin gel (Cleocin T)
For patients with mild hidradenitis suppurativa, topical clindamycin is recommended as
first-line treatment and often works well as monotherapy (SOR B). Patients with
hidradenitis suppurativa who have overweight and smoke should be advised that weight
loss and smoking cessation have been shown to decrease severity of disease and
improve treatment response (SOR A). For patients with moderate disease, oral
tetracyclines in addition to topical clindamycin are recommended as first-line therapy.
Although intralesional triamcinolone may be considered for procedural management of
mild hidradenitis suppurativa, topical triamcinolone is not recommended. Other oral
,antibiotics that have shown benefit include clindamycin and rifampin, although
azithromycin is not a recommended treatment option. While NSAIDs such as topical
diclofenac and oral meloxicam may help to alleviate discomfort associated with active
lesions, they are not part of the routine management of hidradenitis suppurativa.
A 30-year-old female with a medical history of anxiety and seasonal allergies presents
for evaluation of palpitations and a racing heartbeat that has worsened over the last 3-4
days. Recently, her escitalopram (Lexapro) dosage was increased to 20 mg daily and
she started using fluticasone propionate nasal spray (Flonase) and oral cetirizine
(Zyrtec), 10 mg daily. A CBC, comprehensive metabolic panel, and TSH level are
normal. A urine pregnancy test is negative. An EKG today shows a heart rate of 85
beats/min and a QTc interval of 500 milliseconds. Which one of the following would be
the most appropriate next step? A) Reassurance only B) Discontinuing cetirizine
C) Discontinuing escitalopram D) Discontinuing fluticasone E) Echocardiography
C) Discontinuing escitalopram
This patient's EKG shows a prolonged QTc interval (>460 milliseconds for women). QT
prolongation can indicate polymorphic ventricular tachycardia characterized by
palpitations. QT prolongation can be congenital or acquired. Escitalopram and other
antidepressants are associated with QT prolongation. Any QT-prolonging medications
should be discontinued, and a subsequent EKG should be obtained once the drug
levels are expected to be minimal. Reassurance only would not be the most appropriate
next step as QT prolongation can lead to torsades de pointes, a potentially fatal
arrhythmia (SOR C). Cetirizine and fluticasone are not known to prolong the QT interval.
Echocardiography would not be the next step in management.
Which one of the following medications has been shown to increase the resolution of
metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as
nonalcoholic fatty liver disease? A) Glyburide B) Metformin C) Pioglitazone (Actos) D)
Repaglinide E) Vitamin D (cholecalciferol)
C) Pioglitazone (Actos)
Although lifestyle modification remains the first-line treatment of metabolic dysfunction-
associated steatotic liver disease (formerly known as nonalcoholic fatty liver disease),
pioglitazone increases the resolution of nonalcoholic steatohepatitis, especially in
patients with advanced fibrosis. Pioglitazone may cause weight gain and should be
avoided in patients with heart failure, and it carries a small risk for bladder cancer.
Glyburide, metformin, repaglinide, and vitamin D (cholecalciferol) do not improve
steatohepatitis or fibrosis.
A 65-year-old female is found to have a T-score of -3.3 on a DEXA scan that is
performed as part of her Welcome to Medicare evaluation. She has a 30-pack-year
smoking history but quit smoking 5 years ago. An examination reveals a thin female but
is otherwise unremarkable. A CBC, a comprehensive metabolic panel, and thyroid
studies are unremarkable. X-rays reveal evidence of an old compression fracture of the
thoracic spine. Which one of the following would be the most appropriate initial
treatment? A) Oral alendronate (Fosamax) B) Oral raloxifene (Evista) C) Subcutaneous
denosumab (Prolia) D) Subcutaneous teriparatide (Forteo) E) Intravenous zoledronic
acid (Reclast)
,D) Subcutaneous teriparatide (Forteo)
.The diagnosis of osteoporosis can be made with a prior fracture of the hip or spine, or a
T-score ≤-2.5. A FRAX score ≥3% for hip fracture or ≥20% for major osteoporotic
fracture is also diagnostic. The usual first-line treatment is an oral bisphosphonate such
as alendronate or intravenous zoledronic acid. Denosumab would be preferred if the
creatinine clearance were less than 30-35 mL/min/1.73 m². Patients such as this one
would be considered at very high fracture risk. Diagnostic criteria for this risk category
include a T-score <-3.0, a FRAX score ≥4.5% for hip fracture or ≥30% for major
osteoporotic fracture, multiple fractures, fracture within 12 months, or fracture during
treatment for osteoporosis. The initial treatment recommendation would be a
parathyroid hormone analogue such as teriparatide daily for 2 years. Raloxifene is
indicated for the prevention of vertebral fractures only. It is useful in patients with a
history of breast cancer to help decrease the risk for recurrence.
A 48-year-old female presents to the urgent care clinic approximately 1 hour after
spilling hot water on her left forearm while draining pasta. She has a past medical
history of type 2 diabetes, hypertension, and major depression. She is not allergic to
any antibiotics and is up to date on tetanus vaccination. On examination her vital signs
are normal. You determine that she has a partial-thickness (seconddegree) burn
involving approximately a 4 × 5-cm area on the posterior and lateral aspects of the left
forearm. In addition to oral medications for pain management and topical antiseptics,
you should prescribe which one of the following? A) No additional medications B)
Amoxicillin/clavulanate (Augmentin) C) Clindamycin (Cleocin) D) Levofloxacin E)
Sulfamethoxazole/trimethoprim (Bactrim)
A) No additional medications
First-degree (superficial) and second-degree (partial-thickness) burns in adults can
usually be managed in the outpatient setting. Management options include analgesia
with anti-inflammatories or opioids if necessary, and topical agents to keep the burn
area moist. Multiple agents can be used as a topical antiseptic, including silver
sulfadiazine, honey, and aloe vera. Oral antibiotics are not indicated in the initial
management unless there are obvious signs of infection.
A 63-year-old female with a pmh of hypertension, depression, fibromyalgia, and giant
cell arteritis presents with a 3-week history of progressive cough and sob. She has been
taking prednisone for the last 3 months and is tapering the dosage. Her current dosage
is 25 mg daily. Vital signs include a temperature of 38.1 °C (100.6 °F), an oxygen
saturation of 88% on room air, and a respiratory rate of 28/min. On examination, her
lungs are clear, and a chest radiograph shows bilateral perihilar interstitial pulmonary
infiltrates. You recommend hospital admission and intravenous antibiotics. Which one of
the following antibiotic combinations would be the most appropriate initial treatment? A)
Azithromycin (Zithromax) and ceftriaxone B) Levofloxacin and metronidazole C)
Piperacillin/tazobactam (Zosyn) and vancomycin D) Azithromycin, cefepime, and
vancomycin
E) Ceftriaxone, doxycycline, and sulfamethoxazole/trimethoprim
E) Ceftriaxone, doxycycline, and sulfamethoxazole/trimethoprim
, Pneumocystis jirovecii pneumonia (PJP), previously known as Pneumocystis carinii
pneumonia, is a fungus that causes severe pneumonia in immunosuppressed
individuals. It is a classic AIDS-defining illness but can also affect those on prolonged
courses of corticosteroids or other forms of immunosuppression. This patient's
presentation of notable dyspnea, hypoxia, no focal lung sounds, and bilateral interstitial
infiltrates on radiography is consistent with PJP. This patient may also have community-
acquired bacterial pneumonia. Antibiotic treatment with sulfamethoxazole/trimethoprim
for PJP along with standard antibiotics for bacterial pneumonia should be initiated while
additional tests are pending. An elevated serum lactate dehydrogenase level has a
correlation with PJP, although it has poor specificity, especially in those without HIV.
Serum β-glucan is indicative of a fungal infection and can be supportive of a diagnosis
of PJP.
A 32-year-old male comes to your office because of a gradual onset of right ankle pain.
He works in a warehouse and walks extensively during his 12-hour shifts. The pain is
located on the medial side of the ankle and worsens throughout his shift. His medical
history is notable for well-controlled hypertension and a BMI of 39 kg/m2 . On
examination the patient has difficulty performing the single-limb heel raise test. You note
a positive "too many toes" sign, as well as pes planus. You diagnose posterior tibial
tendinopathy. In addition to arch supports, which one of the following should you
recommend next? A) A stretching program B) Eccentric exercises C) Oral
corticosteroids D) Corticosteroid injection E) Percutaneous needle tenotomy
B) Eccentric exercises
Eccentric exercise is recommended over concentric exercise to treat posterior tibial
tendinopathy. Because tendinopathy is not an inflammatory process, oral corticosteroids
are not indicated. Corticosteroids injected into the tendon can provide some short-term
relief of pain but have the potential to cause tendon rupture. Needle tenotomy is not a
recommended treatment for posterior tibial tendinopathy. If the pain persists 3-6 months
after appropriate conservative management, surgical debridement of the tendon may be
considered.
A 35-year-old female presents to your clinic with a 5-day history of sinus congestion,
postnasal drainage, and a productive cough with clear sputum. She has a history of
depression, for which she takes sertraline (Zoloft), and no previous history of respiratory
symptoms or diagnoses. She smokes socially. Her vital signs include a blood pressure
of 120/70 mm Hg, a heart rate of 87 beats/min, a respiratory rate of 16/min, and an
oxygen saturation of 99% on room air. On examination the patient has clear rhinorrhea,
posterior pharynx erythema, frontal sinus tenderness to palpation, and clear lung fields.
She has recurrent coughing episodes but does not show any signs of respiratory
distress. Which one of the following would be the most appropriate treatment? A) Honey
B) Amoxicillin/clavulanate (Augmentin) C) Dextromethorphan D)
Hydrocodone/homatropine (Hycodan) E) Prednisone
A) Honey
An acute cough is a cough of <3 weeks' duration in people without asthma and no
redflag symptoms of dyspnea or hemoptysis, or systemic symptoms such as fever,
weight loss, or peripheral edema. Although there is significant use of prescribed and
