ABFM ITE 2018 Exam completely 100% solved correctly Grade A+ (with Explanation) 240Q
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 te
...
ABFM ITE 2018 Exam completely 100% solved correctly Grade A+ (with Explanation) 240Q
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) Legionella polymerase chain reaction (PCR) testing
D) A sputum culture for Legionella
E) Urine testing for Legionella pneumophila antigen {{Correct Ans- E
Explanation
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 {{Correct Ans- C
Explanation
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 {{Correct Ans- C
Explanation
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 {{Correct Ans- A
Explanation
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 {{Correct Ans- E
Explanation
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
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