ABFM ITE | ABFM ITE Version 1: Updated and
Latest Questions and Correct Answers with
Rationale - American Board of Family Medicine
1. A 55-year-old male with a 25-pack-year smoking history who currently smokes asks about
lung cancer screening. According to the USPSTF, which of the following is the most
appropriate recommendation?
A. Annual chest X-ray
B. Annual low-dose computed tomography (LDCT)
C. Low-dose computed tomography (LDCT) every 3 years
D. Sputum cytology every 6 months
Correct Answer: B
Expert Explanation: The USPSTF recommends annual screening for lung cancer with low-
dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. Annual chest X-
rays have not been shown to reduce lung cancer mortality and are not recommended for
screening. Sputum cytology also lacks evidence for improving outcomes in asymptomatic
individuals. Screening should be discontinued once a person has not smoked for 15 years
or develops a health problem that substantially limits life expectancy. This evidence-based
approach aims to identify lung cancer at an earlier, more treatable stage.
2. A 48-year-old female presents for a routine wellness visit and asks when she should begin
colorectal cancer screening. What is the current recommended starting age for average-risk
individuals?
A. 40 years
B. 55 years
C. 50 years
D. 45 years
Correct Answer: D
Expert Explanation: The USPSTF updated its guidelines to recommend that colorectal
cancer screening begin at age 45 for all average-risk adults. Previously, the recommended
starting age was 50, but rising rates of early-onset colorectal cancer prompted the change.
Screening should continue through age 75 for most patients, with individualized decisions
for those aged 76 to 85. Options for screening include stool-based tests like FIT annually or
direct visualization such as colonoscopy every 10 years. Early screening is a critical
intervention to reduce morbidity and mortality from colorectal malignancies.
,3. A 68-year-old male who smoked for 20 years but quit 10 years ago presents for a physical.
Which screening ultrasound is recommended for him by the USPSTF?
A. Carotid artery ultrasound
B. Renal artery ultrasound
C. One-time abdominal aortic aneurysm (AAA) ultrasound
D. Gallbladder ultrasound
Correct Answer: C
Expert Explanation: The USPSTF recommends a one-time screening for abdominal aortic
aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
Ever smoking is defined as having smoked at least 100 cigarettes in a lifetime. There is no
recommendation for routine carotid artery screening in asymptomatic adults as the harms
often outweigh the benefits. Renal and gallbladder ultrasounds are diagnostic tools rather
than routine preventive screening measures. This screening significantly reduces AAA-
related mortality through elective repair of large aneurysms discovered early.
4. A 62-year-old female with no history of fractures has a DEXA scan showing a T-score of -2.6
at the femoral neck. What is the most appropriate diagnosis?
A. Osteoporosis
B. Normal bone density
C. Osteopenia
D. Osteomalacia
Correct Answer: A
Expert Explanation: Osteoporosis is defined by a T-score of -2.5 or lower on a DEXA scan
at the hip, femoral neck, or lumbar spine. Osteopenia is characterized by a T-score between
-1.0 and -2.5. A normal T-score is -1.0 or higher, indicating healthy bone density relative to
a young adult population. Osteomalacia refers to softening of the bones usually due to
vitamin D deficiency and is a clinical/histological diagnosis rather than a T-score
measurement. Identifying osteoporosis is vital for implementing treatment to reduce the
risk of future fragility fractures.
5. A 35-year-old pregnant woman at 12 weeks gestation tests positive for a urinary tract
infection but is asymptomatic. What is the most appropriate management?
A. Treat with appropriate antibiotics
B. Repeat the culture in 2 weeks
C. Observation only since she is asymptomatic
D. Increase fluid intake and reassess at the next visit
, Correct Answer: A
Expert Explanation: Asymptomatic bacteriuria in pregnancy must be treated because it
significantly increases the risk of progression to pyelonephritis and adverse neonatal
outcomes. In non-pregnant adults, asymptomatic bacteriuria typically does not require
treatment, but pregnancy is a major exception to this rule. Appropriate antibiotics usually
include nitrofurantoin, cephalexin, or amoxicillin-clavulanate depending on the culture
results and trimester. Observation or fluid management alone is insufficient to prevent the
potential complications of upper urinary tract infection. Screening for bacteriuria is
recommended at the first prenatal visit for all pregnant women.
6. A 12-month-old child is brought in for a well-child visit. Which of the following
developmental milestones is most expected at this age?
A. Using a spoon with little spilling
B. Jumping with both feet
C. Walking while holding onto furniture (cruising)
D. Riding a tricycle
Correct Answer: C
Expert Explanation: By 12 months, most children are cruising or beginning to take their
first independent steps. Using a spoon with minimal spilling is usually a skill developed
closer to 18-24 months of age. Jumping with both feet is a gross motor milestone typically
achieved around 2 years of age. Riding a tricycle is a complex motor skill that is generally
expected at age 3. Monitoring these milestones allows for early identification and
intervention for developmental delays.
7. A 54-year-old male with a history of hypertension and a BMI of 32 has a fasting plasma
glucose of 130 mg/dL on two separate occasions. What is the diagnosis?
A. Prediabetes
B. Type 1 Diabetes Mellitus
C. Type 2 Diabetes Mellitus
D. Impaired fasting glucose
Correct Answer: C
Expert Explanation: The diagnosis of diabetes mellitus is made if the fasting plasma
glucose is 126 mg/dL or higher on two separate tests. Prediabetes is defined by a fasting
glucose between 100 and 125 mg/dL. Type 1 diabetes is characterized by absolute insulin
deficiency and typically presents with acute symptoms or ketosis. Impaired fasting glucose
is a subcategory of prediabetes and does not meet the threshold for a diabetes diagnosis.
Early diagnosis of Type 2 Diabetes allows for prompt initiation of lifestyle changes and
metformin therapy to prevent microvascular complications.
Latest Questions and Correct Answers with
Rationale - American Board of Family Medicine
1. A 55-year-old male with a 25-pack-year smoking history who currently smokes asks about
lung cancer screening. According to the USPSTF, which of the following is the most
appropriate recommendation?
A. Annual chest X-ray
B. Annual low-dose computed tomography (LDCT)
C. Low-dose computed tomography (LDCT) every 3 years
D. Sputum cytology every 6 months
Correct Answer: B
Expert Explanation: The USPSTF recommends annual screening for lung cancer with low-
dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. Annual chest X-
rays have not been shown to reduce lung cancer mortality and are not recommended for
screening. Sputum cytology also lacks evidence for improving outcomes in asymptomatic
individuals. Screening should be discontinued once a person has not smoked for 15 years
or develops a health problem that substantially limits life expectancy. This evidence-based
approach aims to identify lung cancer at an earlier, more treatable stage.
2. A 48-year-old female presents for a routine wellness visit and asks when she should begin
colorectal cancer screening. What is the current recommended starting age for average-risk
individuals?
A. 40 years
B. 55 years
C. 50 years
D. 45 years
Correct Answer: D
Expert Explanation: The USPSTF updated its guidelines to recommend that colorectal
cancer screening begin at age 45 for all average-risk adults. Previously, the recommended
starting age was 50, but rising rates of early-onset colorectal cancer prompted the change.
Screening should continue through age 75 for most patients, with individualized decisions
for those aged 76 to 85. Options for screening include stool-based tests like FIT annually or
direct visualization such as colonoscopy every 10 years. Early screening is a critical
intervention to reduce morbidity and mortality from colorectal malignancies.
,3. A 68-year-old male who smoked for 20 years but quit 10 years ago presents for a physical.
Which screening ultrasound is recommended for him by the USPSTF?
A. Carotid artery ultrasound
B. Renal artery ultrasound
C. One-time abdominal aortic aneurysm (AAA) ultrasound
D. Gallbladder ultrasound
Correct Answer: C
Expert Explanation: The USPSTF recommends a one-time screening for abdominal aortic
aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.
Ever smoking is defined as having smoked at least 100 cigarettes in a lifetime. There is no
recommendation for routine carotid artery screening in asymptomatic adults as the harms
often outweigh the benefits. Renal and gallbladder ultrasounds are diagnostic tools rather
than routine preventive screening measures. This screening significantly reduces AAA-
related mortality through elective repair of large aneurysms discovered early.
4. A 62-year-old female with no history of fractures has a DEXA scan showing a T-score of -2.6
at the femoral neck. What is the most appropriate diagnosis?
A. Osteoporosis
B. Normal bone density
C. Osteopenia
D. Osteomalacia
Correct Answer: A
Expert Explanation: Osteoporosis is defined by a T-score of -2.5 or lower on a DEXA scan
at the hip, femoral neck, or lumbar spine. Osteopenia is characterized by a T-score between
-1.0 and -2.5. A normal T-score is -1.0 or higher, indicating healthy bone density relative to
a young adult population. Osteomalacia refers to softening of the bones usually due to
vitamin D deficiency and is a clinical/histological diagnosis rather than a T-score
measurement. Identifying osteoporosis is vital for implementing treatment to reduce the
risk of future fragility fractures.
5. A 35-year-old pregnant woman at 12 weeks gestation tests positive for a urinary tract
infection but is asymptomatic. What is the most appropriate management?
A. Treat with appropriate antibiotics
B. Repeat the culture in 2 weeks
C. Observation only since she is asymptomatic
D. Increase fluid intake and reassess at the next visit
, Correct Answer: A
Expert Explanation: Asymptomatic bacteriuria in pregnancy must be treated because it
significantly increases the risk of progression to pyelonephritis and adverse neonatal
outcomes. In non-pregnant adults, asymptomatic bacteriuria typically does not require
treatment, but pregnancy is a major exception to this rule. Appropriate antibiotics usually
include nitrofurantoin, cephalexin, or amoxicillin-clavulanate depending on the culture
results and trimester. Observation or fluid management alone is insufficient to prevent the
potential complications of upper urinary tract infection. Screening for bacteriuria is
recommended at the first prenatal visit for all pregnant women.
6. A 12-month-old child is brought in for a well-child visit. Which of the following
developmental milestones is most expected at this age?
A. Using a spoon with little spilling
B. Jumping with both feet
C. Walking while holding onto furniture (cruising)
D. Riding a tricycle
Correct Answer: C
Expert Explanation: By 12 months, most children are cruising or beginning to take their
first independent steps. Using a spoon with minimal spilling is usually a skill developed
closer to 18-24 months of age. Jumping with both feet is a gross motor milestone typically
achieved around 2 years of age. Riding a tricycle is a complex motor skill that is generally
expected at age 3. Monitoring these milestones allows for early identification and
intervention for developmental delays.
7. A 54-year-old male with a history of hypertension and a BMI of 32 has a fasting plasma
glucose of 130 mg/dL on two separate occasions. What is the diagnosis?
A. Prediabetes
B. Type 1 Diabetes Mellitus
C. Type 2 Diabetes Mellitus
D. Impaired fasting glucose
Correct Answer: C
Expert Explanation: The diagnosis of diabetes mellitus is made if the fasting plasma
glucose is 126 mg/dL or higher on two separate tests. Prediabetes is defined by a fasting
glucose between 100 and 125 mg/dL. Type 1 diabetes is characterized by absolute insulin
deficiency and typically presents with acute symptoms or ketosis. Impaired fasting glucose
is a subcategory of prediabetes and does not meet the threshold for a diabetes diagnosis.
Early diagnosis of Type 2 Diabetes allows for prompt initiation of lifestyle changes and
metformin therapy to prevent microvascular complications.
