ABFM ITE Exam v2 |2026/2027 Update |
Questions & Answers | Family Medicine Study
Guide |Exam study Material
2026 / 2027 Academic Year
Q:
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A 67-year-old male sees you for a Medicare annual wellness visit. He tells you that his best friend
had a stroke and he asks about his risk for stroke. He has a family history of cardiovascular disease in
his father, who had a myocardial infarction at age 65 and died from a thrombotic stroke at age 71. The
patient exercises regularly and has a BMI of 27 kg/m2. His only current medical condition is
hyperlipidemia, and his cholesterol level is at goal on rosuvastatin (Crestor), 10 mg daily. He also takes
aspirin, 81 mg daily. His blood pressure 125/78 mmHg.
Based on US Preventive Services Task Force guidelines, which one of the following would be most
appropriate at this time?
A. No additional testing for stroke risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonography
D. Magnetic resonance angiography
E. CT angiography of the carotid arteries
ANSWER: A
No additional testing for stroke risk Carotid artery disease affects extra cranial carotid arteries and
is caused by atherosclerosis.
This patient is asymptomatic and has no history of an ischemic stroke, neurology symptoms
referable to the carotid arteries such as amaurosis fugal, or TIA. He has risk factors for
cardiovascular disease (age, male sex, hyperlipidemia_, but the USPSTF recommends against
specific screening asymptomatic carotid artery stenosis (D recommendation) which a low
prevalence in the general adult population. Stroke is a leading cause of disability and death in the
US, but asymptomatic carotid artery stenosis causes a relatively small portion of strokes.
Auscultation of the carotid arteries for bruits has been found to have poor accuracy for detecting
carotid stenosis and is not a reasonable screening approach. Appropriate modalities for detecting
carotid stenosis include carotid duplex ultrasonography, magnetic resonance angiography, and
computed tomography, but there are not recommended for screening asymptomatic patients.
Q: A 28-year-old female presents for evaluation of nasal congestion, sneezing, watery eyes, and
postnasal drip. This has been an intermittent issue for her every spring and she would like to manage it
more effectively.
Which one of the following treatments has been shown to be the most effective and best tolerated
first-line therapy for this patient's condition?
A. A leukotriene receptor agonist
B. Intranasal corticosteroid monotherapy
C. Intranasal corticosteroids plus an oral antihistamine
D. Inhaled corticosteroids
E. Annual triamcinolone injections
ANSWER: B
Intranasal corticosteroid monotherapy
This patient has seasonal allergic rhinitis. A joint guideline statement from the American Academy
of Allergy, Asthma, and Immunology/American College of Allergy, Asthma and Immunology Joint
Task Force on Practice Parameters recommends that mono therapy with intranasal corticosteroids
would be prescribed initially in patients equal to or more than 12 years of age rather than combined
treatment with oral antihistamines because data has not shown an additional benefit to adding the
antihistamine. Higher patient adherence and tolerance and fewer side effects were seen with the
mono therapy regimen. High quality evidence indicates that intranasal corticosteroids were more
effective than leukotriene receptor antagonists. Inhaled corticosteroids and triamcinolone injections
are not appropriate first line options for the treatment of seasonal allergic rhinitis
Q: A 68 year old female presents with a 2 month history of watery diarrhea. She has not had any
blood or pus in her stools, and the stools are not oily. She has not had any history of fever, chills, or
weight loss, and has not traveled recently. She smokes one pack of cigarettes per day. Her
medications include ibuprofen, sertraline and pantoprazole. A CBC, metabolic panel, CRP, IgA anti
tissue transglutaminase level, total IgA level, and stool guaiac test are all normal.
Which one of the following tests would be mostly likely to yield a diagnosis?
A. C difficile toxin
B. Colonoscopy
C. Fecal calprotectin
D. A stool culture
E. Stool exam for ova and parasites
ANSWER: B
Colonoscopy
In patients with chronic nonbloody diarrhea, the differential diagnosis includes microscopic
(lymphocytic or collagenous) colitis. The mucosa appears normal on colonoscopy but a biopsy will
show lymphocytic infiltration of the epithelium. The etiology is unknown but there are several risk
factors to consider, including older age, female sex, and smoking status. Drugs with a high level of
evidence causing microscopic colitis include NSAIDs, PPIs, sertraline, acarbose, aspirin, and
ticlopidine. C. diff should be suspected in individuals who have taken antibiotics in the past 3
months. Fecal calprotectin is elevated in inflammatory diarrhea such as Crohn's disease or
ulcerative colitis. A stool culture would be indicated if there is a suspicion of an infectious bacterial
diarrhea such as Shigella or Salmonella, but these bacteria tend to cause bloody diarrhea. Checking
for a parasitic infection should be considered for patients with a history of recent travel or exposure
to unpurified water.
Q: A 23 year old male with opioid use disorder requests buprenorphine therapy. He is still
actively using immediate release oxycodone and he took a dose 2 hours ago.
This patient should begin buprenorphine induction
A. Now
B. In 2 hours
C. 8-12 hours after his last opioid use
D. 24 hours after his last opioid use
E. 1 week after his last opioid use
ANSWER: C
8-12 hours after his last opioid use
Buprenorphine is a partial opioid agonist. In order to reduce the risk of precipitated withdrawal,
buprenorphine induction should begin once the patient is exhibiting signs of mild to moderate
withdrawal, usually 8-12 hours after the last opioid use. Waiting until a patient goes through a full
withdrawal increases the chances that the patient will revert back to using opioids.
Q: A 45 year old left hand dominant female presents to your office with a lump on her hand. She
first noticed the lump 2 weeks ago and thinks it has gotten bigger. She does not recall any injury.
She has not had any numbness, weakness, or tingling. She has minimal discomfort when she
presses on the lump, and it does not affect her activity. On examination her left wrist is
neurovascularly intact.
Which one of the following management options would you recommend?
A. Re-examination if she develops numbness, weakness, or increased pain
B. Immobilization of the wrist for 6 weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the lesion with a corticosteroid
E. Referral for excision of the lesion
ANSWER: A. Re-examination if she develops numbness, weakness or increased pain
This patient has a ganglion cyst, which is common and resolves spontaneously in 50% of cases, and
watchful waiting would be most appropriate at this time. Treatment is indicated if the cyst is
causing significant symptoms such as pain, numbness, or weakness, or for cosmetic symptoms.
Aspiration of the lesion is the initial treatment, although recurrence may occur in 85% of cases.
Immobilizing the wrist with a splint or brace is sometimes helpful in the short term if the patient is
bothered by the symptoms, but immobilization does not provide lasting relief and could cause
muscle atrophy. Corticosteroid injections have not shown any benefit. Referral for excision is
appropriate if there has been no improvement. Patients should be advised that there is a 10%-15%
recurrence rate even after excision.
Q: A 57 year old female with diabetes mellitus comes to your office for a routine follow up. Her
current medications include metformin 1000 mg twice daily. She tells you that she does not exercise
regularly and finds it difficult to follow a healthy diet. HbA1c today is 7.5%. She does not want to
add medications at this time, but she does want to het her HbA1c below 7%, which is the goal that
was previously discussed.
Which one of the following would be the most effective way to improve glucose control for this
patient.
A. Discuss the components of a healthy diabetic diet and encourage her to follow it more closely.
B. Discuss the importance of regular exercise and encourage her to exercise 30-45 minutes daily.
C. Recommend that she check her glucose level 1-3 times daily to help determine what adjustments
need to be made.
D. Start her on an additional medication
E. Refer her to a diabetes educator for medical nutrition therapy.
ANSWER: E. Refer her to a diabetes educator for medical nutrition therapy
Counseling by a diabetic educator or a team of educators for medical nutrition therapy lowers
HbA1c by 0.2-0.8 percentage points in patients with type 2 diabetes. While a healthy diabetic diet
and regular exercise is important, simply reminding the patient of that fact is not likely to be as
successful as comprehensive diabetic education. According to the Society of General Internal
Medicine in the Choosing Wisely campaign, patients with type 2 diabetes who are not on insulin
therapy should not check their blood glucose level daily. An additional medication will likely
decrease HbA1c, but this patient has expressed a desire to avoid additional medication, is near goal,
and is not currently managing her diabetes with adequate lifestyle changes, so it would be
appropriate to respect her wishes and pursue proven interventions that do not require medication.
Q: During a newborn examination the patient's mother asks what she can do to decrease the
risk of food allergies in her newborn son. She tells you that there is no family history of atopic
dermatitis or asthma but she has a cousin with a peanut allergy. The remainder of the examination
is unremarkable.
You tell her that food allergy risk can be reduced by
A. breastfeeding for at least 1 year
B. Using soy based formula instead of cow's milk based formula
C. introducing peanut-containing food when solids are started
D. Avoiding all house pets
E. Avoiding a day care setting
ANSWER: C. Introducing peanut containing food when solids are started
Food allergy affects 4-6% of children in the US. IgE-mediated food allergy is the best understood,
and symptoms can range from rhinorrhea to anaphylaxis. The two most common allergens are cow's
milk and peanuts. The onset of symptoms is usually within 2 hours of exposure and they resolve
within several hours. The National Institute of Allergy and Infectious Diseases in 2017
recommended that healthy infants without known food allergy or who have mild to moderate
eczema may be introduced to peanut-containing foods with other solid foods. If the parents are
concerned about a reaction, introduction of peanut-containing foods may be done in the physician's
office. Infants with severe eczema, egg allergy, or both should undergo peanut-specific IgE or skin
prick testing. While breastfeeding may decrease atopic disease, there is insufficient evidence that it
reduces the likelihood of food allergy, and using a soy based formula will not prevent food allergy. If
there is a dog in the home there is less risk of allergy to eggs. Children who are exposed to farm
animals or who attend day care are less likely to develop atopic disease.
Q: Which one of the following antihypertensive medications is LEAST likely to exacerbate
erectile dysfunction?
A. Clonidine (Catapres)
B. Doxazosin (Cardura)
C. Hydrochlorothiazine
D. Losartan (Cozaar)
E. Metoprolol
ANSWER: D. Losartan
Angiotensin receptor blockers (ARBs) such as losartan are least likely to cause or exacerbate erectile
dysfunction. ARBs may have a favorable effect on erectile dysfunction by inhibiting vasoconstriction
activity of angiotensin. Clonidine, alpha blockers, hydrochlorothiazide, and beta-blockers are more
likely to negatively affect erectile function.
Malignant bowel obstruction is a common issues with GI cancers. Corticosteroids can help alleviate
these symptoms, which is the focus in end of life care. Corticosteroids have numerous beneficial
Q: You are providing end of life care for a 53 year old female with end stage colon cancer. Her
family reports that she is having significant abdominal pain, nausea, and vomiting, and she is not
able to tolerate oral intake. You suspect a malignant bowel obstruction.
Which one of the following interventions would be most likely to significantly improve her
symptoms?
A. Medical cannabis
B. Dexamethasone
C. Morphine
D. Octreotide (Sandostatin)
E. Polyethylene glycol (Miralax)
ANSWER: B. Dexamethasone
effects in these situations, such as central antiemetic, anti-inflammatory, anti-secretory, and
analgesic effects. Intravenous dexamethasone is generally recommended at a dosage of 4 mg 3-4
times daily for malignant bowel obstruction because it has more greater anti-inflammatory effects
than methylprednisolone. Although octreotide is commonly used for this purpose, there is little
evidence to support its use. Medical cannabis can be used to treat nausea and vomiting in end of life
care but is not effective for bowel obstruction. Morphine can be used to treat pain and end of life
dyspnea, but not for nausea and vomiting. The use of polyethylene glycol for a malignant
obstruction could worsen the patient's symptoms significantly.
Q: A 3 year old male has developed multiple large areas of bullous impetigo on the legs,
buttocks, and trunk after being bitten numerous times by ants.
Which one of the following would be the most appropriate treatment?
A. Topical mupirocin ointment
B. Oral azithromycin
C. Oral tetracycline
D. Oral trimethoprim/sufamethoxazole
E. Intramuscular penicillin G benzathine
ANSWER: D. Oral trimethoprim/sulfamethoxazole
Impetigo may be caused by Strep progenies or Staph aureus, but bullous impetigo is caused
exclusively by S aureus. Oral trimethoprim/sulfamethoxazole is an appropriate treatment for skin
infections caused by S. aureus, including susceptible cases of MRSA. Topical mupirocin ointment is
not practical in very widespread cases or in cases with large bullae. Neither azithromycin nor
penicillin is preferred treatment for impetigo, due to a high rate of treatment failure. Tetracycline
should be avoided in children under 8 years of age due to propensity to cause permanent staining of
the teeth.
A 60 year old male with diabetes mellitus and hypertension sees you for routine follow up. He has
no acute health concerns during today's visit. His current medications include metformin, lisinopril,
and HCTZ. He smokes cigarettes and has a 40 pack year smoking history. His vital signs and a
physical examination are normal. An in-office dipstick urinalysis reveals 1+ blood and trace protein
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