ABFM ITE EXAM 300 ACTUAL QUESTIONS AND 100%
CORRECT ANSWERS WITH RATIONALE (GUARANTEED
PASS) LATEST UPDATE
This 300-question multiple-choice examination is a comprehensive
preparation resource for the American Board of Family Medicine In-Training
Examination (ABFM ITE). It covers the full spectrum of core clinical topics in
family medicine, including cardiology, pulmonology, endocrinology,
rheumatology, infectious diseases, gastroenterology, neurology, dermatology,
and women's health. Each question is designed to test clinical reasoning,
diagnostic accuracy, and evidence-based management decisions relevant to
outpatient and inpatient family practice. Detailed rationales accompany each
answer, reinforcing key pathophysiological concepts, guideline-based
treatment algorithms, and important drug interactions. This resource is ideal
for residents preparing for the ABFM ITE, board certification, or clinical
practice, with emphasis on high-yield topics frequently tested in family
medicine.
1. A 10-year-old male has an 8-mm induration 2 days after a tuberculin skin test.
He shares a bedroom with his 18-year-old brother who was recently diagnosed
with tuberculosis. There are no other historical or physical examination findings to
suggest active tuberculosis infection and a chest radiograph is normal. Which one
of the following would be most appropriate at this point?
A) Monitoring with annual tuberculin skin testing
B) Observation and repeat tuberculin skin testing in 3 weeks
C) Rifampin (Rifadin) daily for 4 months
D) Isoniazid daily for 9 months
E) Once-weekly isoniazid and rifampin for 3 months
Answer: D
Rationale: This patient's close contact with a person known to be infected with
tuberculosis places him at risk for infection. Based on CDC guidelines, an
induration of 5 mm or greater at 48-72 hours following an intradermal injection of
tuberculin is a positive test in individuals who have been in recent contact with a
person with infectious TB. With a normal chest radiograph and no evidence of
active disease, this confirms latent TB. For children age 2-11 years, treatment with
isoniazid daily for 9 months is the preferred and most efficacious treatment
regimen .
,2. A 21-year-old female is being evaluated for secondary causes of refractory
hypertension. Which one of the following would be most specific for
fibromuscular dysplasia?
A) A serum creatinine level
B) An aldosterone:renin ratio
C) 24-hour urine for metanephrines
D) Renal ultrasonography
E) Magnetic resonance angiography of the renal arteries
Answer: E
Rationale: In young adults diagnosed with hypertension, fibromuscular dysplasia
should be considered as a secondary cause. Magnetic resonance angiography of the
renal arteries is the most specific diagnostic test for fibromuscular dysplasia, as it
directly visualizes the characteristic beaded appearance of the renal arteries .
3. A 56-year-old female with type 2 diabetes is hospitalized with acute epigastric
pain, nausea, and vomiting. She reports that several of her diabetes medications
were recently changed. Findings on physical examination and laboratory studies
are consistent with acute pancreatitis. Which one of the following classes of
medications is the most likely cause?
A) Biguanides
B) GLP-1 receptor agonists
C) SGLT2 inhibitors
D) Sulfonylureas
E) Thiazolidinediones
Answer: B
Rationale: GLP-1 receptor agonists have been associated with acute pancreatitis.
These medications, which include exenatide, liraglutide, and semaglutide, carry a
warning about this risk. Other diabetes medication classes listed are not typically
associated with pancreatitis .
4. A patient at 36 weeks gestation has itchiness in palms and soles. What is the
next step?
A) Reassurance that this is normal pregnancy symptom
B) Check bile acid levels
C) Check liver function tests only
D) Prescribe topical corticosteroids
E) Schedule induction of labor
Answer: B
Rationale: Pruritus of the palms and soles in the third trimester is concerning for
intrahepatic cholestasis of pregnancy (ICP). The next step is to check serum bile
,acid levels, which is the most sensitive diagnostic test for ICP. Elevated bile acids
confirm the diagnosis and guide management, as ICP is associated with increased
fetal risks .
5. A 62-year-old female with diabetes mellitus presents to your office with left
lower quadrant pain and guarding. She has a previous history of a shellfish allergy
that caused hives and swelling. Further evaluation of this patient should include
which one of the following?
A) Ultrasonography of the abdomen
B) CT of the abdomen and pelvis with oral and intravenous (IV) contrast
C) Oral corticosteroids and antihistamines, then CT of the abdomen and pelvis
with oral and IV contrast
D) Intravenous corticosteroids and antihistamines, then CT of the abdomen and
pelvis with oral and IV contrast
E) Laparotomy
Answer: B
Rationale: In a patient with acute abdominal pain, fever, and signs of peritoneal
irritation, CT of the abdomen and pelvis with oral and IV contrast is the imaging
modality of choice. A history of contrast allergy is not an absolute
contraindication; premedication with corticosteroids and antihistamines is
recommended for patients with prior reactions. CT with contrast is necessary for
optimal evaluation of acute abdominal pathology such as diverticulitis or abscess .
6. A hemoglobin level ≤8 g/dL would be an appropriate RBC transfusion threshold
for which one of the following hospitalized patients?
A) A 19-year-old with symptomatic sickle cell pain crisis
B) A 63-year-old who is hemodynamically stable after a major trauma
C) A 79-year-old with inoperable femur and hip fractures
D) An 81-year-old who underwent cardiac bypass surgery 3 days ago
E) A 55-year-old with acute gastrointestinal bleeding and hemodynamic instability
Answer: C
Rationale: A restrictive transfusion threshold of 8 g/dL is appropriate for patients
with orthopedic injuries or those undergoing orthopedic surgery, including elderly
patients with inoperable fractures. For patients with cardiac disease, recent cardiac
surgery, or acute coronary syndrome, a higher threshold of 10 g/dL is
recommended. Hemodynamically unstable patients require individualized
transfusion decisions .
7. A 68-year-old male presents to your office with a 2-day history of headache,
muscle aches, and chills. His wife adds that his temperature has been up to 104.1°F
, and he seems confused sometimes. His symptoms have not improved with usual
care, including ibuprofen and increased fluid intake. He and his wife returned from
a cruise 10 days ago but don't recall anyone having a similar illness on the ship.
This morning he started to cough and his wife was concerned because she saw
some blood in his sputum. He also states that he experiences intermittent shortness
of breath and feels nauseated. His blood pressure is 100/70 mm Hg. What is the
most likely diagnosis?
A) Community-acquired pneumonia
B) Influenza
C) Legionnaires' disease
D) Pulmonary embolism
E) Tuberculosis
Answer: C
Rationale: This patient presents with a classic triad of fever, cough, and diarrhea,
which is characteristic of Legionnaires' disease. The recent cruise ship exposure is
a significant risk factor. Additional features include high fever, confusion,
hemoptysis, and hyponatremia (often present). Legionnaires' disease should be
suspected in any patient with severe pneumonia, particularly with gastrointestinal
symptoms and recent travel .
8. A 15-year-old female presents with a 3-month history of intermittent abdominal
pain and headaches. She does not have any associated weight loss, fever, nausea,
change in bowel habits, or other worrisome features. An examination is
unremarkable. She does report being stressed at school and has a PHQ-2 score of
4. Which one of the following would be most appropriate at this point?
A) Further evaluation for depression
B) Laboratory studies
C) Abdominal imaging
D) Citalopram (Celexa)
E) Fluoxetine (Prozac)
Answer: A
Rationale: The U.S. Preventive Services Task Force recommends depression
screening for all adolescents 12-18 years of age. This patient has a positive initial
depression screen on her PHQ-2, which merits further evaluation. Although she
has abdominal pain, the absence of worrisome features suggests that depression
may be playing a role in her somatic complaints. The evaluation should include a
full PHQ-A or discussion with a qualified clinician .
9. A 69-year-old male with type 2 diabetes mellitus, obesity, and a history of
coronary artery disease sees you for follow-up of his diabetes. His hemoglobin A1c
CORRECT ANSWERS WITH RATIONALE (GUARANTEED
PASS) LATEST UPDATE
This 300-question multiple-choice examination is a comprehensive
preparation resource for the American Board of Family Medicine In-Training
Examination (ABFM ITE). It covers the full spectrum of core clinical topics in
family medicine, including cardiology, pulmonology, endocrinology,
rheumatology, infectious diseases, gastroenterology, neurology, dermatology,
and women's health. Each question is designed to test clinical reasoning,
diagnostic accuracy, and evidence-based management decisions relevant to
outpatient and inpatient family practice. Detailed rationales accompany each
answer, reinforcing key pathophysiological concepts, guideline-based
treatment algorithms, and important drug interactions. This resource is ideal
for residents preparing for the ABFM ITE, board certification, or clinical
practice, with emphasis on high-yield topics frequently tested in family
medicine.
1. A 10-year-old male has an 8-mm induration 2 days after a tuberculin skin test.
He shares a bedroom with his 18-year-old brother who was recently diagnosed
with tuberculosis. There are no other historical or physical examination findings to
suggest active tuberculosis infection and a chest radiograph is normal. Which one
of the following would be most appropriate at this point?
A) Monitoring with annual tuberculin skin testing
B) Observation and repeat tuberculin skin testing in 3 weeks
C) Rifampin (Rifadin) daily for 4 months
D) Isoniazid daily for 9 months
E) Once-weekly isoniazid and rifampin for 3 months
Answer: D
Rationale: This patient's close contact with a person known to be infected with
tuberculosis places him at risk for infection. Based on CDC guidelines, an
induration of 5 mm or greater at 48-72 hours following an intradermal injection of
tuberculin is a positive test in individuals who have been in recent contact with a
person with infectious TB. With a normal chest radiograph and no evidence of
active disease, this confirms latent TB. For children age 2-11 years, treatment with
isoniazid daily for 9 months is the preferred and most efficacious treatment
regimen .
,2. A 21-year-old female is being evaluated for secondary causes of refractory
hypertension. Which one of the following would be most specific for
fibromuscular dysplasia?
A) A serum creatinine level
B) An aldosterone:renin ratio
C) 24-hour urine for metanephrines
D) Renal ultrasonography
E) Magnetic resonance angiography of the renal arteries
Answer: E
Rationale: In young adults diagnosed with hypertension, fibromuscular dysplasia
should be considered as a secondary cause. Magnetic resonance angiography of the
renal arteries is the most specific diagnostic test for fibromuscular dysplasia, as it
directly visualizes the characteristic beaded appearance of the renal arteries .
3. A 56-year-old female with type 2 diabetes is hospitalized with acute epigastric
pain, nausea, and vomiting. She reports that several of her diabetes medications
were recently changed. Findings on physical examination and laboratory studies
are consistent with acute pancreatitis. Which one of the following classes of
medications is the most likely cause?
A) Biguanides
B) GLP-1 receptor agonists
C) SGLT2 inhibitors
D) Sulfonylureas
E) Thiazolidinediones
Answer: B
Rationale: GLP-1 receptor agonists have been associated with acute pancreatitis.
These medications, which include exenatide, liraglutide, and semaglutide, carry a
warning about this risk. Other diabetes medication classes listed are not typically
associated with pancreatitis .
4. A patient at 36 weeks gestation has itchiness in palms and soles. What is the
next step?
A) Reassurance that this is normal pregnancy symptom
B) Check bile acid levels
C) Check liver function tests only
D) Prescribe topical corticosteroids
E) Schedule induction of labor
Answer: B
Rationale: Pruritus of the palms and soles in the third trimester is concerning for
intrahepatic cholestasis of pregnancy (ICP). The next step is to check serum bile
,acid levels, which is the most sensitive diagnostic test for ICP. Elevated bile acids
confirm the diagnosis and guide management, as ICP is associated with increased
fetal risks .
5. A 62-year-old female with diabetes mellitus presents to your office with left
lower quadrant pain and guarding. She has a previous history of a shellfish allergy
that caused hives and swelling. Further evaluation of this patient should include
which one of the following?
A) Ultrasonography of the abdomen
B) CT of the abdomen and pelvis with oral and intravenous (IV) contrast
C) Oral corticosteroids and antihistamines, then CT of the abdomen and pelvis
with oral and IV contrast
D) Intravenous corticosteroids and antihistamines, then CT of the abdomen and
pelvis with oral and IV contrast
E) Laparotomy
Answer: B
Rationale: In a patient with acute abdominal pain, fever, and signs of peritoneal
irritation, CT of the abdomen and pelvis with oral and IV contrast is the imaging
modality of choice. A history of contrast allergy is not an absolute
contraindication; premedication with corticosteroids and antihistamines is
recommended for patients with prior reactions. CT with contrast is necessary for
optimal evaluation of acute abdominal pathology such as diverticulitis or abscess .
6. A hemoglobin level ≤8 g/dL would be an appropriate RBC transfusion threshold
for which one of the following hospitalized patients?
A) A 19-year-old with symptomatic sickle cell pain crisis
B) A 63-year-old who is hemodynamically stable after a major trauma
C) A 79-year-old with inoperable femur and hip fractures
D) An 81-year-old who underwent cardiac bypass surgery 3 days ago
E) A 55-year-old with acute gastrointestinal bleeding and hemodynamic instability
Answer: C
Rationale: A restrictive transfusion threshold of 8 g/dL is appropriate for patients
with orthopedic injuries or those undergoing orthopedic surgery, including elderly
patients with inoperable fractures. For patients with cardiac disease, recent cardiac
surgery, or acute coronary syndrome, a higher threshold of 10 g/dL is
recommended. Hemodynamically unstable patients require individualized
transfusion decisions .
7. A 68-year-old male presents to your office with a 2-day history of headache,
muscle aches, and chills. His wife adds that his temperature has been up to 104.1°F
, and he seems confused sometimes. His symptoms have not improved with usual
care, including ibuprofen and increased fluid intake. He and his wife returned from
a cruise 10 days ago but don't recall anyone having a similar illness on the ship.
This morning he started to cough and his wife was concerned because she saw
some blood in his sputum. He also states that he experiences intermittent shortness
of breath and feels nauseated. His blood pressure is 100/70 mm Hg. What is the
most likely diagnosis?
A) Community-acquired pneumonia
B) Influenza
C) Legionnaires' disease
D) Pulmonary embolism
E) Tuberculosis
Answer: C
Rationale: This patient presents with a classic triad of fever, cough, and diarrhea,
which is characteristic of Legionnaires' disease. The recent cruise ship exposure is
a significant risk factor. Additional features include high fever, confusion,
hemoptysis, and hyponatremia (often present). Legionnaires' disease should be
suspected in any patient with severe pneumonia, particularly with gastrointestinal
symptoms and recent travel .
8. A 15-year-old female presents with a 3-month history of intermittent abdominal
pain and headaches. She does not have any associated weight loss, fever, nausea,
change in bowel habits, or other worrisome features. An examination is
unremarkable. She does report being stressed at school and has a PHQ-2 score of
4. Which one of the following would be most appropriate at this point?
A) Further evaluation for depression
B) Laboratory studies
C) Abdominal imaging
D) Citalopram (Celexa)
E) Fluoxetine (Prozac)
Answer: A
Rationale: The U.S. Preventive Services Task Force recommends depression
screening for all adolescents 12-18 years of age. This patient has a positive initial
depression screen on her PHQ-2, which merits further evaluation. Although she
has abdominal pain, the absence of worrisome features suggests that depression
may be playing a role in her somatic complaints. The evaluation should include a
full PHQ-A or discussion with a qualified clinician .
9. A 69-year-old male with type 2 diabetes mellitus, obesity, and a history of
coronary artery disease sees you for follow-up of his diabetes. His hemoglobin A1c
