ABFM ITE Exam v4 |2026/2027 Update | Questions and Answers | Family Medicine Study Guide |Exam study Material 2026 / 2027 Academic Year

Exam

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

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