ABFM\ American Board of Family Medicine Ite Study
Exam | Questions And Correct Answers Already
Graded A+ | Latest 2026\2027 Guide
Which one of the following patient factors would be most likely to contraindicate use of a
thiazide diuretic such as chlorthalidone?
A) Chronic gout
B) An ejection fraction of 45%
C) Hypothyroidism
D) Stage 3b chronic kidney disease
E) A history of a rash when taking trimethoprim/sulfamethoxazole (Bactrim) in childhood
-CORRECT ANSWER-A
According to American College of Cardiology/American Heart Association guidelines,
first-line agents
for antihypertensive drug therapy include thiazide diuretics, calcium channel blockers,
ACE inhibitors, or
angiotensin receptor blockers. In the largest head-to-head comparison of first-step drug
therapy for
hypertension, the thiazide-type diuretic chlorthalidone was superior to the calcium
channel blocker
amlodipine and the ACE inhibitor lisinopril in preventing heart failure. Thiazides increase
serum uric acid
and the risk of gouty attacks, so they should be used with caution in patients with a
history of gout. The
presence of a reduced ejection fraction or chronic kidney disease does not preclude the
use of a thiazide
diuretic, although progressive kidney disease or concomitant use of loop diuretics does
increase the risk
of electrolyte abnormalities. Furthermore, thiazide diuretics are ineffective in patients
with severe renal
disease (stage 4 or stage 5). Hypothyroidism is not a contraindication to the use of
thiazide diuretics. The
potential for cross reactivity between antibiotic sulfonamides and non-antibiotic
sulfonamides is extremely
low and may be nonexistent.
A family in your practice includes an 11-year-old female and a 17-year-old male who are
both
healthy. They are seen separately with and without their parents and have no evidence
,of genital
warts or other lesions. The 11-year-old is not sexually active but the 17-year-old has
given and
received oral sex from a previous girlfriend. He says he is not sexually active at this
time.
Neither of these patients has received HPV vaccine in the past.
Which one of the following should you recommend regarding HPV vaccination?
A) No HPV vaccine for either sibling
B) A two-dose HPV vaccine series for both siblings
C) A three-dose HPV vaccine series for both siblings
D) A two-dose HPV vaccine series for the 11-year-old and a three-dose HPV vaccine
series
for the 17-year-old
E) A three-dose HPV vaccine series for the 11-year-old and a two-dose HPV vaccine
series
for the 17-year-old
-CORRECT ANSWER-D
The recommended HPV vaccine series includes two or three doses depending on the
age of initiation. Two
doses of HPV vaccine are recommended for children and adolescents who start the
series before 15 years
of age. The second dose should be administered 6-12 months after the initial dose. If
the patient is 15 years
or older at vaccine initiation, then a three-dose series would be indicated at 0, 1-2, and
6 months. In this
case, neither child has received HPV vaccine previously, so the 11-year-old needs a
two-dose HPV vaccine
series and the 17-year-old needs three doses. Although the optimal timing for HPV
vaccination is before
the initiation of sexual activity, it can still provide protection if administered after a patient
has become
sexually active. It is unlikely that this 17-year-old patient was exposed to all HPV
serotypes and therefore
could still receive significant benefit. There is no need to limit the administration of HPV
vaccine based
on testing for sexually transmitted infections.
Which one of the following medications should be considered for patients taking more
than 50
morphine milligram equivalents (MMEs) daily for chronic pain?
A) Clonazepam (Klonopin)
B) Clonidine (Catapres)
,C) Methadone
D) Naloxone
E) Naltrexone (Vivitrol)
-CORRECT ANSWER-D
All patients taking more than 50 morphine milligram equivalents (MMEs) daily of
chronically prescribed
opioids should also be prescribed naloxone in case of overdose. Naloxone is an opioid
antagonist that
displaces opioids from their receptors and reverses the effects. Benzodiazepines such
as clonazepam
increase the risk of overdose. Clonidine has been used to treat symptoms of opiate
withdrawal. Methadone
is a full opioid agonist used in opioid use disorder or to treat chronic pain. Naltrexone is
an opioid
antagonist that must be refrigerated and administered by trained medical staff.
Long-term oxygen therapy is recommended for patients with COPD who have a resting
oxygen
saturation at or below a threshold of
A) 88%
B) 89%
C) 90%
D) 93%
E) 95%
-CORRECT ANSWER-A
Patients with moderate to severe COPD should be evaluated periodically for hypoxemia
to determine the
need for long-term oxygen therapy. In a Cochrane review of six randomized, controlled
trials, oxygen
therapy improved survival in select patients with COPD and severe resting hypoxemia
(a resting arterial
partial pressure of oxygen <55 mm Hg or an oxygen saturation 88%).
A healthy 29-year-old female sees you for a health maintenance visit. You recommend
influenza vaccine but she declines because she has angioedema with ingestion of any
eggs or egg products.
She has an epinephrine auto-injector (EpiPen) and last used it approximately 9 months
ago when
she accidentally ingested a small amount of egg. She has not seen her allergist in more
than 3
years but is planning to call soon for an appointment.
, Based on CDC guidelines, which one of the following would you recommend for this
patient
regarding influenza vaccination?
A) No influenza vaccination regardless of vaccine form
B) Vaccination only with inactivated influenza vaccine
C) Vaccination with any licensed form of influenza vaccine
D) Referral to an allergist for specific allergen testing prior to vaccination
-CORRECT ANSWER-C
It is important to provide influenza vaccine to as many individuals as possible. Patients
with an egg allergy
can receive any form of the influenza vaccine. Patients who have an angioedema
reaction to egg products
should receive the vaccine in an office setting. Testing for specific responses to egg
allergens is not
recommended prior to giving the vaccine.
A 67-year-old female with a history of type 2 diabetes, hypertension, osteoarthritis, and
hyperlipidemia sees you for follow-up of laboratory results after hepatic steatosis and
mild
splenomegaly were noted on abdominal ultrasonography performed during a recent
emergency
department visit for right upper quadrant pain. She is currently asymptomatic. Her vital
signs
include a blood pressure of 128/72 mm Hg and a BMI of 34 kg/m2. An examination is
significant only for trace bilateral lower extremity edema. A cardiovascular examination
is
otherwise normal and neurologic and abdominal examinations are normal.
Laboratory Findings
Platelets 112,000/mm3 (N 150,000-450,000)
Creatinine 0.8 mg/dL (N 0.6-1.2)
Hemoglobin A1c 6.6%
AST 68 U/L (N 8-48)
ALT 55 U/L (N 7-55)
Albumin 3.2 g/dL (N 3.5-5.0)
Bilirubin 0.5 mg/dL (N 0.1-1.2)
INR 1.0 (N <1.2)
Which one of the following medications should be AVOIDED in this patient to reduce the
likelihood of complications of her medical condition?
A) Acetaminophen
B) Atorvastatin (Lipitor)
C) Ibuprofen
Exam | Questions And Correct Answers Already
Graded A+ | Latest 2026\2027 Guide
Which one of the following patient factors would be most likely to contraindicate use of a
thiazide diuretic such as chlorthalidone?
A) Chronic gout
B) An ejection fraction of 45%
C) Hypothyroidism
D) Stage 3b chronic kidney disease
E) A history of a rash when taking trimethoprim/sulfamethoxazole (Bactrim) in childhood
-CORRECT ANSWER-A
According to American College of Cardiology/American Heart Association guidelines,
first-line agents
for antihypertensive drug therapy include thiazide diuretics, calcium channel blockers,
ACE inhibitors, or
angiotensin receptor blockers. In the largest head-to-head comparison of first-step drug
therapy for
hypertension, the thiazide-type diuretic chlorthalidone was superior to the calcium
channel blocker
amlodipine and the ACE inhibitor lisinopril in preventing heart failure. Thiazides increase
serum uric acid
and the risk of gouty attacks, so they should be used with caution in patients with a
history of gout. The
presence of a reduced ejection fraction or chronic kidney disease does not preclude the
use of a thiazide
diuretic, although progressive kidney disease or concomitant use of loop diuretics does
increase the risk
of electrolyte abnormalities. Furthermore, thiazide diuretics are ineffective in patients
with severe renal
disease (stage 4 or stage 5). Hypothyroidism is not a contraindication to the use of
thiazide diuretics. The
potential for cross reactivity between antibiotic sulfonamides and non-antibiotic
sulfonamides is extremely
low and may be nonexistent.
A family in your practice includes an 11-year-old female and a 17-year-old male who are
both
healthy. They are seen separately with and without their parents and have no evidence
,of genital
warts or other lesions. The 11-year-old is not sexually active but the 17-year-old has
given and
received oral sex from a previous girlfriend. He says he is not sexually active at this
time.
Neither of these patients has received HPV vaccine in the past.
Which one of the following should you recommend regarding HPV vaccination?
A) No HPV vaccine for either sibling
B) A two-dose HPV vaccine series for both siblings
C) A three-dose HPV vaccine series for both siblings
D) A two-dose HPV vaccine series for the 11-year-old and a three-dose HPV vaccine
series
for the 17-year-old
E) A three-dose HPV vaccine series for the 11-year-old and a two-dose HPV vaccine
series
for the 17-year-old
-CORRECT ANSWER-D
The recommended HPV vaccine series includes two or three doses depending on the
age of initiation. Two
doses of HPV vaccine are recommended for children and adolescents who start the
series before 15 years
of age. The second dose should be administered 6-12 months after the initial dose. If
the patient is 15 years
or older at vaccine initiation, then a three-dose series would be indicated at 0, 1-2, and
6 months. In this
case, neither child has received HPV vaccine previously, so the 11-year-old needs a
two-dose HPV vaccine
series and the 17-year-old needs three doses. Although the optimal timing for HPV
vaccination is before
the initiation of sexual activity, it can still provide protection if administered after a patient
has become
sexually active. It is unlikely that this 17-year-old patient was exposed to all HPV
serotypes and therefore
could still receive significant benefit. There is no need to limit the administration of HPV
vaccine based
on testing for sexually transmitted infections.
Which one of the following medications should be considered for patients taking more
than 50
morphine milligram equivalents (MMEs) daily for chronic pain?
A) Clonazepam (Klonopin)
B) Clonidine (Catapres)
,C) Methadone
D) Naloxone
E) Naltrexone (Vivitrol)
-CORRECT ANSWER-D
All patients taking more than 50 morphine milligram equivalents (MMEs) daily of
chronically prescribed
opioids should also be prescribed naloxone in case of overdose. Naloxone is an opioid
antagonist that
displaces opioids from their receptors and reverses the effects. Benzodiazepines such
as clonazepam
increase the risk of overdose. Clonidine has been used to treat symptoms of opiate
withdrawal. Methadone
is a full opioid agonist used in opioid use disorder or to treat chronic pain. Naltrexone is
an opioid
antagonist that must be refrigerated and administered by trained medical staff.
Long-term oxygen therapy is recommended for patients with COPD who have a resting
oxygen
saturation at or below a threshold of
A) 88%
B) 89%
C) 90%
D) 93%
E) 95%
-CORRECT ANSWER-A
Patients with moderate to severe COPD should be evaluated periodically for hypoxemia
to determine the
need for long-term oxygen therapy. In a Cochrane review of six randomized, controlled
trials, oxygen
therapy improved survival in select patients with COPD and severe resting hypoxemia
(a resting arterial
partial pressure of oxygen <55 mm Hg or an oxygen saturation 88%).
A healthy 29-year-old female sees you for a health maintenance visit. You recommend
influenza vaccine but she declines because she has angioedema with ingestion of any
eggs or egg products.
She has an epinephrine auto-injector (EpiPen) and last used it approximately 9 months
ago when
she accidentally ingested a small amount of egg. She has not seen her allergist in more
than 3
years but is planning to call soon for an appointment.
, Based on CDC guidelines, which one of the following would you recommend for this
patient
regarding influenza vaccination?
A) No influenza vaccination regardless of vaccine form
B) Vaccination only with inactivated influenza vaccine
C) Vaccination with any licensed form of influenza vaccine
D) Referral to an allergist for specific allergen testing prior to vaccination
-CORRECT ANSWER-C
It is important to provide influenza vaccine to as many individuals as possible. Patients
with an egg allergy
can receive any form of the influenza vaccine. Patients who have an angioedema
reaction to egg products
should receive the vaccine in an office setting. Testing for specific responses to egg
allergens is not
recommended prior to giving the vaccine.
A 67-year-old female with a history of type 2 diabetes, hypertension, osteoarthritis, and
hyperlipidemia sees you for follow-up of laboratory results after hepatic steatosis and
mild
splenomegaly were noted on abdominal ultrasonography performed during a recent
emergency
department visit for right upper quadrant pain. She is currently asymptomatic. Her vital
signs
include a blood pressure of 128/72 mm Hg and a BMI of 34 kg/m2. An examination is
significant only for trace bilateral lower extremity edema. A cardiovascular examination
is
otherwise normal and neurologic and abdominal examinations are normal.
Laboratory Findings
Platelets 112,000/mm3 (N 150,000-450,000)
Creatinine 0.8 mg/dL (N 0.6-1.2)
Hemoglobin A1c 6.6%
AST 68 U/L (N 8-48)
ALT 55 U/L (N 7-55)
Albumin 3.2 g/dL (N 3.5-5.0)
Bilirubin 0.5 mg/dL (N 0.1-1.2)
INR 1.0 (N <1.2)
Which one of the following medications should be AVOIDED in this patient to reduce the
likelihood of complications of her medical condition?
A) Acetaminophen
B) Atorvastatin (Lipitor)
C) Ibuprofen
