ABFM ITE 2025 latest| COMPLETE EXAM TEST QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES| get it right!!
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 radiograph
C - ANSWER: 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 - 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 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 history and physical examination.
ANSWERS WITH RATIONALES| get it right!!
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 radiograph
C - ANSWER: 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 - 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 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 history and physical examination.
