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American Board of Family Medicine In-Training Examination (ABFM ITE) Exams V1 - V4 (Latest 2026 / 2027 Updates STUDY BUNDLE PACKAGE WITH SOLUTIONS) Questions and Answers |Exam St
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American Board of Family Medicine In-Training Examination (ABFM ITE) Exams V1 - V4 (Latest 2026 / 2027 Updates STUDY BUNDLE PACKAGE WITH SOLUTIONS) 100% Ve...
rified Questions & Answers | Grade A |Exam Study Material
ABFM ITE Exam v4 |2026/2027 Update |
Questions & Answers | Family Medicine Study
Guide |Exam study Material
2026 / 2027 Academic Year
Q:
...
A 36-year-old female presents for evaluation of elevated blood pressure. She is asymptomatic
and does not take any medications. On examination her blood pressure is 160/96 mm Hg and her BMI
is 26 kg/m2 . Fasting laboratory studies include the following:
Sodium 142 mEq/L (N 136-145)
Potassium 3.0 mEq/L (N 3.5-5.1)
Creatinine 0.76 mg/dL (N 0.6-1.1)
Glucose 97 mg/dL
Which one of the following additional laboratory evaluations should be performed to assess her
blood pressure?
A) A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA)
B) A serum aldosterone/renin ratio
C) A serum cortisol level
D) A serum cystatin C level
ANSWER: B Primary hyperaldosteronism should be suspected as a cause for hypertension if a
patient has a spontaneously low potassium level or persistent hypertension despite the use of three
or more antihypertensive medications, including a diuretic. This can be evaluated by checking a
serum renin activity level and a serum aldosterone concentration and determining the
aldosterone/renin ratio. Primary hyperaldosteronism typically presents with a very low serum renin
activity level and an elevated serum aldosterone concentration. A 24-hour urine collection for 5
hydroxyindoleacetic acid (5-HIAA) would be used to evaluate for a neuroendocrine tumor, which
can present as chronic flushing and diarrhea. Cortisol levels can be checked if Cushing syndrome is
suspected. Hypertension can be present in Cushing syndrome, but it is typically associated with
other signs such as obesity and an elevated blood glucose level due to insulin resistance. Cystatin C
is a marker of renal function and measurement would not be indicated given this patient's normal
creatinine level.
Q: A 26-year-old male diagnosed with coccidioidomycosis (valley fever) develops a rash on the
extensor surfaces of his lower legs consisting of painful, subcutaneous, nonulcerated, erythematous
nodules. This rash is consistent with which one of the following?
A) Erythema ab igne
B) Erythema infectiosum
C) Erythema migrans
D) Erythema multiforme
E) Erythema nodosum
ANSWER: E Erythema nodosum, a panniculitis that typically affects the subcutaneous fat on the
anterior surface of the lower legs, is associated with coccidioidomycosis (valley fever) and can
suggest the diagnosis. It is a manifestation of the patient's immune response and often indicates a
good prognosis. In addition to coccidioidomycosis, it can also be associated with streptococcal
infections as well as tuberculosis. Erythema ab igne is a cutaneous rash caused by prolonged heat
exposure (such as a heating pad) presenting as an otherwise asymptomatic, red, reticulated pattern
on the skin. Erythema infectiosum is associated with parvovirus B19 infection and is usually seen in
young children. It manifests as an erythematous rash of the face (slapped cheek appearance), arms,
and legs. Erythema migrans is an expanding, erythematous, annular rash with or without central
clearing and is often associated with tick exposure (Lyme disease). Erythema multiforme consists of
raised, annular, target-like lesions with central erythema and is usually associated with herpes
simplex virus type 1.
Q: A 50-year-old male presents with chronic abdominal pain. A workup leads you to suspect
peptic ulcer disease, and you refer him for endoscopy, which shows a small duodenal ulcer. The
endoscopist also notes some small esophageal varices without red wale signs. Further evaluation
confirms that the patient has compensated cirrhosis in the setting of alcohol use disorder. He
readily accepts this diagnosis and enters an Alcoholics Anonymous program. His ulcer symptoms
resolve with antibiotic therapy for Helicobacter pylori. He says he has abstained from alcohol for 6
weeks, and he would like to further reduce his risks from cirrhosis. The most appropriate next step
in the management of his esophageal varices would be
A) octreotide (Sandostatin)
B) omeprazole (Prilosec)
C) propranolol
D) endoscopic variceal ligation
E) repeat endoscopy in 1-2 years
ANSWER: E Primary prevention of variceal hemorrhage is an important consideration in the
management of patients with cirrhosis. Although this patient's varices were diagnosed incidentally,
patients with cirrhosis and clinically significant portal hypertension should be screened for varices
every 2-3 years with esophagogastroduodenoscopy (EGD). EGD can be deferred in patients with
platelet counts
ABFM ITE Exam v3 |2026/2027 Update |
Questions & Answers | Family Medicine Study
Guide |Exam study Material
2026 / 2027 Academic Year
Q:
...
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no
additional chronic medical problems and is otherwise asymptomatic. An examination is significant for a
blood pressure of 162/95 mm Hg but is otherwise unremarkable.
Laboratory Findings unremarkable
Urine microalbumin negative
According to the American College of Cardiology/American Heart Association 2017 guidelines,
which one of the following would be the most appropriate medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily
ANSWER: C
This patient has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Association 2017 guidelines, antihypertensive treatment should be
initiated. For the general non-African-American population, monotherapy with an ACE inhibitor, an
angiotensin receptor blocker, a calcium channel blocker, or a thiazide diuretic would be appropriate
for initial management. It is also appropriate to initiate combination antihypertensive therapy as an
initial management strategy, although patients should not take an ACE inhibitor and an angiotensin
receptor blocker simultaneously. Studies have shown that blood pressure control is achieved faster
with the initiation of combination therapy compared to monotherapy, without an increase in
morbidity. Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. -Blockers,
vasodilators, -blockers, and potassium-sparing diuretics are not recommended as initial choices for
the treatment of hypertension.
Q: During rounds at the nursing home, you are informed that there are two residents on the
unit with laboratory-confirmed influenza. According to CDC guidelines, who should receive
chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
ANSWER: C
In long-term care facilities, an influenza outbreak is defined as two laboratory-confirmed cases of
influenza
within 72 hours in patients on the same unit. The CDC recommends chemoprophylaxis for all
asymptomatic residents of the affected unit. Any resident exhibiting symptoms of influenza should
be treated for influenza and not given chemoprophylaxis dosing. Chemoprophylaxis is not
recommended for residents of other units unless there are two laboratory-confirmed cases in those
units. Facility staff of the affected unit can be considered for chemoprophylaxis if they have not been
vaccinated or if they had a recent vaccination, but chemoprophylaxis is not recommended for all
staff in the entire facility.
Q: A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She has
had two male sex partners in the last 6 months and uses oral contraceptives and sometimes
condoms.
A physical examination reveals a temperature of 36.4°C (97.5°F) and moderate cervical motion and
uterine tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered at
the time of diagnosis and not delayed until the results of the nucleic acid amplification testing
(NAAT) for gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk
woman presenting with lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a mucopurulent discharge or
WBCs on saline microscopy. Acute phase indicators such as fever, leukocytosis, or an elevated C
reactive protein level may be helpful but are neither sensitive nor specific. A positive NAAT is not
required for diagnosis and treatment because an upper tract infection may be present, or the
causative agent may not be gonorrhea or Chlamydia. PID should be considered a polymicrobial
infection. Pelvic ultrasonography may be used if there is a concern about other pathology such as a
tubo-ovarian abscess.
Q: A 24-year-old patient wants to start the process of transitioning from female to male. He has
been working with a psychiatrist who has confirmed the diagnosis of gender dysphoria. Which one
of the following would be the best initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
ANSWER: E
For patients with gender dysphoria or gender incongruence who desire hormone treatment, the
treatment goal is to suppress endogenous sex hormone production and maintain sex hormone levels
in the normal range for their affirmed gender. For a female-to-male transgender patient this is most
easily accomplished with testosterone. When testosterone levels are maintained in the normal
genetic male range, gonadotropins and ovarian hormone production is suppressed, which
accomplishes both goals for hormonal treatment without the need for additional gonadotropin
suppression from medications such as leuprolide. Clomiphene can increase serum testosterone
levels, but only in the presence of a functioning testicle. Letrozole is an estrogen receptor antagonist,
but it would not increase serum testosterone levels. Spironolactone has androgen receptor blocking
effects and would not accomplish either of the hormone treatment goals.
Q: Based on American Cancer Society guidelines for cervical cancer screening, when should
HPV DNA co-testing first be performed along with Papanicolaou testing?
A) At the onset of sexual activity
B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening, Papanicolaou (Pap)
testing
should begin at age 21 irrespective of sexual activity and should be continued every 3 years until age
29. The preferred screening strategy beginning at age 30 is Pap testing with HPV co-testing, which
should be continued every 5 years until age 65. Cervical screening may be discontinued at that time
if the patient's last two tests have been negative and the patient was tested within the previous 5
years.
Q: Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes
ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and health
care-associated pneumonia, which is related to gastric overgrowth by gram-negative bacteria. Long
term treatment of Barrett's esophagus is an indication for chronic proton pump inhibitor (PPI) use.
PPI therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
Q: An 87-year-old female comes to your office for an annual health maintenance visit. She
appears cachectic and tells you that for the past 6 months she has had a decreased appetite and
generalized muscle weakness. The patient is alert and oriented to person and place. She has a 10%
weight loss, dry mucous membranes, and tenting of the skin on the extensor surface of her hands.
While inflating the blood pressure cuff on her right arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
E) Hyponatremia
ANSWER: B
A Trousseau sign, defined as spasmodic contraction of muscles caused by pressure on the nerves
that control them, is present in up to 94% of patients with hypocalcemia. Hypercalcemia is more
likely to present with hyperreflexia. Patients with hypokalemia, hypernatremia, or hyponatremia
may present with weakness and confusion, but tetany is not a common sign of either sodium or
potassium imbalance.
Q: 24-year old female presents to your office with a 3-month history of difficulty sleeping. She
says that she struggles to fall asleep and wakes up multiple times at night at least three times a
week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies awake
for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of the night
trying to fall back asleep. Lately she has been feeling fatigued and having difficulty
concentrating at work. You conduct a full history and physical examination and tell her to return in
2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping an
average of 5½ hours per night. Which one of the following would be the most appropriate
recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
E) Stay up for an hour if she wakes up at 3:00 a.m.
ANSWER: D
This patient presents with symptoms of chronic insomnia. Cognitive-behavioral therapy for
insomnia
(CBT-I) and brief behavioral therapy for insomnia (BBT-I) are effective nonpharmacologic
treatments for chronic insomnia. Modified CBT-I and BBT-I can be administered by a primary care
physician. The basic
principles include stimulus control (sleep hygiene) and sleep restriction. Reducing time in bed
increases sleep efficiency. In this case, 6 hours of time in bed would improve the patient's sleep
efficiency and a bedtime of 12:30 a.m. would accomplish this goal. Generally, reduced time in bed is
accomplished by postponing bedtime rather than getting up earlier. Naps generally do not improve
sleep efficiency. While getting out of bed is recommended after being in bed for 30 minutes without
falling asleep, or being awake for 30 minutes after being asleep, staying up for a prescribed period of
time is not recommended.
Q: A 45-year-old female presents to the emergency department with a 1-week history of facial
swelling and progressive dyspnea with exertion. She was diagnosed 1 week ago with non-Hodgkin's
lymphoma but her medical history is otherwise unremarkable. After hospital admission, which one
of the following would be the most appropriate next step in the management of this condition?
A) Intravenous antibiotics
B) Urgent chemotherapy and radiation
C) Urgent chemotherapy and plasmapheresis
D) Urgent echocardiography
E) Urgent bronchoscopy
ANSWER: B
Because of the prevalence of cancer in the United States, it is important for family physicians to
recognize
oncologic emergencies. This patient presents with signs and symptoms related to superior vena cava
syndrome, which is caused by compression of the superior vena cava. This is most often caused by
lung cancer or lymphoma, but it can also be related to indwelling catheters, lymph nodes, or
metastatic tumors. After ensuring that the patient is hospitalized and stable, the initial treatment
options include intravenous corticosteroids, chemotherapy, radiation, and occasionally
intravascular stenting. Antibiotics are not warranted because this condition is not the result of an
infection. Hyperviscosity syndrome is another oncologic emergency associated with leukemia,
multiple myeloma, and Waldenström's macroglobulinemia. It is treated with chemotherapy and
plasmapheresis. Echocardiography and bronchoscopy are not indicated in the initial management
of superior vena cava syndrome.
Q: A nonverbal 22-year-old male with intellectual disability is brought to your office by the staff
of the group home where he lives. They report that the patient has been functioning at his baseline
until this morning when he was found to have loud breathing. No other history is available at the
time of this visit. On examination he has a temperature of 37.3°C (99.1°F), a blood pressure of
124/82 mm Hg,
a pulse rate of 100 beats/min, and a respiratory rate of 16/min. The patient appears to be in mild
distress and a high-pitched whistling, crowing sound on inspiration is heard as you walk in the
room. Which one of the following would be the most appropriate next step for this patient?
A) Oral antibiotics
B) Oral corticosteroids
C) Nebulized albuterol
D) Nebulized epinephrine
E) Urgent evaluation in the emergency department
ANSWER: E
Stridor is a high-pitched whistling, crowing sound on inspiration. It can be caused by obstruction of
the larynx or trachea by a foreign body, vocal cord edema, a neoplasm, or a pharyngeal abscess.
Acute stridor requires urgent evaluation for obstruction. This patient may have a foreign body or
other obstruction in his airway and requires urgent assessment. Oral antibiotics, oral
corticosteroids, nebulized albuterol, or nebulized epinephrine would not be appropriate at this time.
Q: A 16-year-old female presents with chronic acne on her nose, forehead, and chin consisting
of a few comedones and a few mildly inflamed papules and pustules. She says it is minimally
improved after 12 weeks of daily adapalene 0.1% gel. There are no scars or cysts. The patient would
like to try to achieve better control. Which one of the following would you recommend at this time?
A) Continue adapalene 0.1% gel for 12 more weeks
B) Add clindamycin (Cleocin T) 1% gel for up to 12 weeks
C) Add clindamycin 1% gel for maintenance
D) Stop adapalene 0.1% gel and start clindamycin 1% gel for maintenance
E) Stop adapalene 0.1% gel and start erythromycin 2% gel for maintenance
ANSWER: B
Family physicians are often asked to manage mild to moderate acne vulgaris. Topical retinoids such
as adapalene and benzoyl peroxide are first-line therapy and a trial of therapy is typically 8-12
weeks. Topical
antibiotics may be added to topical retinoids or benzoyl peroxide to achieve better symptom control.
To decrease emerging antibiotic resistance, studies support limiting antibiotic use to 12 weeks
except in severe cases, not using antibiotics as monotherapy, and using clindamycin rather than
erythromycin. Adding
clindamycin gel rather than erythromycin gel for up to 12 weeks is recommended for this patient at
this time.
Q: A 32-year-old female who is one of your longtime patients calls you because of a 24-hour
history of painful urination with urinary frequency and urgency. She is otherwise healthy and does
not
have any fever, chills, back pain, or vaginal discharge. She uses an oral contraceptive pill and states
that her last menstrual period was normal and occurred last week. Which one of the following would
be most appropriate at this time?
A) Empiric antibiotic treatment
B) A urinalysis
C) A urine culture
D) Plain abdominal radiographs
E) Pelvic ultrasonography
ANSWER: A
This patient has symptoms of acute simple cystitis and does not have any symptoms that would
suggest a complicated urinary tract infection or vaginal infection. In these cases treatment with oral
ABFM ITE Exam v2 |2026/2027 Update |
Questions & Answers | Family Medicine Study
Guide |Exam study Material
2026 / 2027 Academic Year
Q:
...
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
ABFM ITE Exam 2026/2027 Practice Questions &
Answers | Family Medicine Study Guide |Exam
study Material
2026 / 2027 Academic Year
Q: ABX
...
ppx for ortho surgery
Answer:
Cephazolin
Q: FEV1/FVC ratio for obstructive lung disease
Answer:
walking boot or short cast -->
rigid-soled shoe in 4-6 weeks
Q: Next steps for proteinuria in children on dipstick?
Answer:
Confirm presence of proteinuria with a spot protein/creatinine ratio to r/o proteinuria
Q: How to manage a pt who is traveling to a high-risk TB area?
Answer:
TB test or interferon-gamma release assay prior to leaving the US.
If negative, repeat testing 8-10 weeks after returning.
Q: Pt developed myopathy on statins and....
Answer:
another CYP3A4 med... - Amiodarone - CCBs - some HIV meds - some anti-fungal meds
Q: When is surgical release of a dupuytren's contracture indicated?
Answer:
When the metacarpophalangeal joint is 30* or smaller or with any contracture of the PIP
Q: How to treat traveler's diarrhea?
Answer:
Azithromycin
Q: What risk factors increase risk of mortality for PNA?
Answer: - RR >30 - hypotension - confusion/disorientation - BUN >20 - >65 y/o - male sex - CHF or COPD
Q: Pityriasis rosea in pregnancy is a/w...
Answer:
increased rate of spontaneous abortion in the first 15 wks gestation
Q: What are indications for long-term PPI therapy?
Answer: - Barrett esophagus - severe erosive esophagitis - eosinophilic esophagitis - pts at high risk for GI bleeding
Q: Why do pt's with Crohn's disease develop diarrhea after ileal resection?
Answer:
D/t increased amounts of bile acid remaining in the stool. This affects colonic secretion and motility
and various protein factors in the gut --> bile acid diarrhea
Q: Pt with mild hemoptysis, next step...
Answer:
CXR - exertional dyspnea - chest pain - dizziness
Q: T/F: Obesity is a significant risk factor for esophageal adenocarcinoma?
Answer:
True
Q: What are symptoms of worsening aortic stenosis?
Answer:
Q: A1C diagnosis for T1DM?
Answer:
Need 2 A1C>6.5 in the abscence of hyperglycemia
Q: What organ system should be checked yearly for sarcoidosis?
Answer:
Occular - inflammation of eye can --> permanent impairment and is often asymptomatic
Q: Ages for HIV screening?
Answer:
15-65 y/o
Q: Blood pressure management for pt with CKD + proteinuria?
Answer:
ACE/ARB + thiazide/CCB
Q: Next step for pt with passive SI?
Answer:
Crisis planning (not a suicide prevention contract - that's not effective)
Infants consuming less than ________ mL formula/day should be supplemented with vit D.
Answer:
foot
deformities (classic rocker-bottom fot) and resultant ulcerations and infections - easily mistaken for cellulitis
What is the treatment for charcot neuroarthropathy?
Answer:
immobilization w/ total contact casting --> increases total surface area of contact to the entire lower
extremity and distributes pressure away from foot
What is the preferred treatment for preventing mountain sickness?
Acetazolamide
What is the preferred treatment for acute mountain sickness?
Dexamethasone
How long should dual antiplatelet therapy be for patients with acute coronary syndrome who are
not high risk for bleeding? who are high risk for bleeding?
Not: more than 1 year
Are: 1 year (at least)
What labs can be useful predictors of severity of pancreatitis?
Those that reflect intravascular volume depletion - hct - BUN - Cr
How to screen for DM in pts with hemoglobinopathies?
Fructosamine
What is the first step in managing delirium in end-of-life care after conservative measures have
been tried?
Antipsychotics - haloperidol - risperidone
Which diabetic meds are associated with diabetic ketoacidosis?
SGLT2 inhibitors (ex. dapagliflozin, empagliflozin)
What are risk factors for intamate partner violence? - young age - belief in strict gender roles - having new friends - low incme - unplanned pregnancy
What is a FABER test for?
Sacroiliac joint disfunction
How long do you treat provolked VTE with AC?
3 months
What has been shown to decrease hospitalizations in pts with COPD?
Written self-management plans
Normal TSH range in pregnancy is higher/lower than normal non-pregnancy range
lower
How often should a breast cancer survivor have a history and physical?
Every 3-6 months for the first 3 years.
THEN every 6-12 months for the next 2 years
THEN annually
How often should breast cancer survivors get mammograms? MRI?
mammogram: Yearly
MRI: not recommended
What are the Ottowa Knee rules? - Age >/= 55 - isolated tenderness of the patella (no other bony tenderness) - tenderness of the fibular head - unable to flex knee to 90* - unable to bear weight both immediately and in ED (4 steps, limping OK)
Tamsulosin promotes passage of ureteral stones that are ____ mm in diameter
5-10
Next step for migraine that won't respond to ibuprofen + triptan?
Anti-emetics (metaclopramide, prochloperazine, promethazine)
When to PO after pancreatitis?
As soon as pt is able to tolerate!
When is carotid stenting considered for asymptomatic patient?
>70% occlusion
what is the treatment of choice for eosinophilic eosophagitis?
steroids applied to esophagus (oral suspension or oral spray)
Which medications are a/w increased risk of osteoporosis? - antiepileptic drugs - long-term heparin - cyclosporin - tacrolimus - aromatase inhibitors - glucocorticoids
- gonadotropin-releasing hormone agonists - thiazolidinediones - excessive levothyroxine - PPIs - SSRIs - medroxyprogesterone contraceptives - methotrexate - aluminum antacids
Conditioner and head lice treatment?
Do not combine - conditioner will decrease effectiveness of permethrin
Besides permethrin, what other recommendations are made to treat lice?
wash closing and bedding with hot water or expose them to a temperature >130*F for 5 minutes
What characteristics of lung nodules are a/w malignancy? - nonsolid "ground glass" appearance - >6mm - non-calcified - size doubling between 1mo-1year - irregular/spiculated borders
How much fluid to give in shock?
at least 30cc/kg
Which vaccine is rec'd to give early for pts with HIV and CD4 >200?
Shingles vaccine
Management of a nondisplaced radial head fracture?
breif immobilization (ex. 3 days), and early range-of-motion exercises to avoid decreased ROM.
What are causes of low DLCO (difusing capacity of the lungs for carbon monoxide) with normal
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