ABFM ITE | ABFM ITE Version 2: Updated and
Latest Questions and Correct Answers with
Rationale - American Board of Family Medicine
1. A 62-year-old male with a history of hypertension and type 2 diabetes presents for follow-
up. His blood pressure is 152/94 mmHg, and his last HbA1c was 7.4%. He is currently taking
metformin. Which of the following is the most appropriate initial antihypertensive agent for
this patient?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
Correct Answer: A
Expert Explanation: The patient’s blood pressure and diabetic status indicate a need for
an ACE inhibitor for renal protection. Guidelines recommend starting an ACE inhibitor or
ARB as first-line therapy in diabetic patients with hypertension. These medications help
reduce the progression of albuminuria and chronic kidney disease. Options like amlodipine
or thiazides are effective but do not provide the same degree of renal benefit. Close
monitoring of serum potassium and creatinine is required within two weeks of initiation.
2. A 45-year-old female presents with fatigue and cold intolerance. Laboratory results show a
TSH of 12.8 mIU/L and a low free T4. What is the most appropriate next step in management?
A. Levothyroxine treatment
B. Thyroid ultrasound
C. Liothyronine supplementation
D. Repeat labs in 6 months
Correct Answer: A
Expert Explanation: The patient’s elevated TSH and low free T4 confirm the diagnosis of
primary overt hypothyroidism. Levothyroxine is the standard of care for restoring
euthyroidism and relieving clinical symptoms. Initial weight-based dosing is typically
recommended for most healthy adults. Routine thyroid ultrasound is not indicated unless a
nodule is palpable on physical exam. Monitoring of TSH levels should occur every 6 to 8
weeks until a stable dose is reached.
,3. A 22-year-old female presents with shortness of breath and wheezing three times per
week. She wakes up at night with symptoms twice a month. What is the most appropriate
initial maintenance therapy according to GINA guidelines?
A. Albuterol as needed only
B. Oral prednisone for 5 days
C. High-dose ICS daily
D. Low-dose ICS-formoterol as needed
Correct Answer: D
Expert Explanation: Current GINA guidelines favor the use of as-needed low-dose ICS-
formoterol for mild asthma. This approach reduces the risk of severe exacerbations
compared to using a SABA alone. It provides both rapid symptom relief and anti-
inflammatory therapy simultaneously. Regular daily ICS with as-needed SABA is also an
acceptable alternative but may have lower compliance. Patients should be educated on
proper inhaler technique and trigger avoidance.
4. A 70-year-old male presents with fever, cough, and a CURB-65 score of 1. He has no
significant comorbidities and has not taken antibiotics recently. Which antibiotic is
recommended for outpatient treatment of his community-acquired pneumonia?
A. Vancomycin
B. Ciprofloxacin
C. Amoxicillin
D. Gentamicin
Correct Answer: C
Expert Explanation: For healthy outpatients with CAP and low CURB-65 scores,
amoxicillin is a preferred first-line agent. Doxycycline or a macrolide are also options
depending on local resistance patterns. Ciprofloxacin is generally avoided as it has poor
coverage against Streptococcus pneumoniae. Follow-up should occur within 48 to 72 hours
to ensure clinical improvement. Vaccination status should be reviewed once the acute
infection has resolved.
5. A 32-year-old female presents four weeks postpartum with persistent low mood and loss
of interest in her infant. She denies suicidal ideation but struggles to sleep even when the
baby sleeps. Which medication is first-line for this condition?
A. Diazepam
B. Sertraline
C. Haloperidol
D. Lithium
, Correct Answer: B
Expert Explanation: Postpartum depression is effectively treated with SSRIs such as
sertraline, which has low secretion into breast milk. Psychotherapy is also a vital non-
pharmacologic component of a comprehensive treatment plan. Diagnosis is usually
supported by a high score on the Edinburgh Postnatal Depression Scale. Benzodiazepines
like diazepam are not recommended as monotherapy for depression. Close monitoring for
safety and infant bonding is essential during the initial treatment phase.
6. A 68-year-old male with HFrEF (EF 30%) and NYHA Class II symptoms is already on lisinopril,
carvedilol, and spironolactone. Which medication should be added to further reduce the risk
of cardiovascular death and hospitalization?
A. Empagliflozin
B. Diltiazem
C. Isosorbide mononitrate
D. Aspirin 325 mg
Correct Answer: A
Expert Explanation: SGLT2 inhibitors like empagliflozin have shown significant mortality
benefits in patients with HFrEF regardless of diabetes status. This class of medication
reduces heart failure hospitalizations and improves overall quality of life. Calcium channel
blockers like diltiazem should generally be avoided in patients with reduced ejection
fractions. Patients should be monitored for volume depletion and potential urinary tract
infections. This addition represents a pillar of modern guideline-directed medical therapy
for heart failure.
7. A 38-year-old woman has suppressed TSH and elevated free T3 and T4 levels. A radioactive
iodine uptake scan shows a high, diffuse uptake throughout the thyroid gland. What is the
most likely diagnosis?
A. Graves’ disease
B. Subacute thyroiditis
C. Toxic multinodular goiter
D. Factitious thyrotoxicosis
Correct Answer: A
Expert Explanation: Graves’ disease is characterized by diffuse radioactive iodine uptake
due to stimulating TSH-receptor antibodies. In contrast, thyroiditis would show low uptake
because the gland is leaking preformed hormone rather than overproducing it. Toxic
multinodular goiter would present with a patchy or focal uptake pattern rather than
diffuse. Treatment options for Graves’ include methimazole, radioactive iodine ablation, or
thyroidectomy. Beta-blockers can be used acutely to manage palpitations and tremors.
Latest Questions and Correct Answers with
Rationale - American Board of Family Medicine
1. A 62-year-old male with a history of hypertension and type 2 diabetes presents for follow-
up. His blood pressure is 152/94 mmHg, and his last HbA1c was 7.4%. He is currently taking
metformin. Which of the following is the most appropriate initial antihypertensive agent for
this patient?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
Correct Answer: A
Expert Explanation: The patient’s blood pressure and diabetic status indicate a need for
an ACE inhibitor for renal protection. Guidelines recommend starting an ACE inhibitor or
ARB as first-line therapy in diabetic patients with hypertension. These medications help
reduce the progression of albuminuria and chronic kidney disease. Options like amlodipine
or thiazides are effective but do not provide the same degree of renal benefit. Close
monitoring of serum potassium and creatinine is required within two weeks of initiation.
2. A 45-year-old female presents with fatigue and cold intolerance. Laboratory results show a
TSH of 12.8 mIU/L and a low free T4. What is the most appropriate next step in management?
A. Levothyroxine treatment
B. Thyroid ultrasound
C. Liothyronine supplementation
D. Repeat labs in 6 months
Correct Answer: A
Expert Explanation: The patient’s elevated TSH and low free T4 confirm the diagnosis of
primary overt hypothyroidism. Levothyroxine is the standard of care for restoring
euthyroidism and relieving clinical symptoms. Initial weight-based dosing is typically
recommended for most healthy adults. Routine thyroid ultrasound is not indicated unless a
nodule is palpable on physical exam. Monitoring of TSH levels should occur every 6 to 8
weeks until a stable dose is reached.
,3. A 22-year-old female presents with shortness of breath and wheezing three times per
week. She wakes up at night with symptoms twice a month. What is the most appropriate
initial maintenance therapy according to GINA guidelines?
A. Albuterol as needed only
B. Oral prednisone for 5 days
C. High-dose ICS daily
D. Low-dose ICS-formoterol as needed
Correct Answer: D
Expert Explanation: Current GINA guidelines favor the use of as-needed low-dose ICS-
formoterol for mild asthma. This approach reduces the risk of severe exacerbations
compared to using a SABA alone. It provides both rapid symptom relief and anti-
inflammatory therapy simultaneously. Regular daily ICS with as-needed SABA is also an
acceptable alternative but may have lower compliance. Patients should be educated on
proper inhaler technique and trigger avoidance.
4. A 70-year-old male presents with fever, cough, and a CURB-65 score of 1. He has no
significant comorbidities and has not taken antibiotics recently. Which antibiotic is
recommended for outpatient treatment of his community-acquired pneumonia?
A. Vancomycin
B. Ciprofloxacin
C. Amoxicillin
D. Gentamicin
Correct Answer: C
Expert Explanation: For healthy outpatients with CAP and low CURB-65 scores,
amoxicillin is a preferred first-line agent. Doxycycline or a macrolide are also options
depending on local resistance patterns. Ciprofloxacin is generally avoided as it has poor
coverage against Streptococcus pneumoniae. Follow-up should occur within 48 to 72 hours
to ensure clinical improvement. Vaccination status should be reviewed once the acute
infection has resolved.
5. A 32-year-old female presents four weeks postpartum with persistent low mood and loss
of interest in her infant. She denies suicidal ideation but struggles to sleep even when the
baby sleeps. Which medication is first-line for this condition?
A. Diazepam
B. Sertraline
C. Haloperidol
D. Lithium
, Correct Answer: B
Expert Explanation: Postpartum depression is effectively treated with SSRIs such as
sertraline, which has low secretion into breast milk. Psychotherapy is also a vital non-
pharmacologic component of a comprehensive treatment plan. Diagnosis is usually
supported by a high score on the Edinburgh Postnatal Depression Scale. Benzodiazepines
like diazepam are not recommended as monotherapy for depression. Close monitoring for
safety and infant bonding is essential during the initial treatment phase.
6. A 68-year-old male with HFrEF (EF 30%) and NYHA Class II symptoms is already on lisinopril,
carvedilol, and spironolactone. Which medication should be added to further reduce the risk
of cardiovascular death and hospitalization?
A. Empagliflozin
B. Diltiazem
C. Isosorbide mononitrate
D. Aspirin 325 mg
Correct Answer: A
Expert Explanation: SGLT2 inhibitors like empagliflozin have shown significant mortality
benefits in patients with HFrEF regardless of diabetes status. This class of medication
reduces heart failure hospitalizations and improves overall quality of life. Calcium channel
blockers like diltiazem should generally be avoided in patients with reduced ejection
fractions. Patients should be monitored for volume depletion and potential urinary tract
infections. This addition represents a pillar of modern guideline-directed medical therapy
for heart failure.
7. A 38-year-old woman has suppressed TSH and elevated free T3 and T4 levels. A radioactive
iodine uptake scan shows a high, diffuse uptake throughout the thyroid gland. What is the
most likely diagnosis?
A. Graves’ disease
B. Subacute thyroiditis
C. Toxic multinodular goiter
D. Factitious thyrotoxicosis
Correct Answer: A
Expert Explanation: Graves’ disease is characterized by diffuse radioactive iodine uptake
due to stimulating TSH-receptor antibodies. In contrast, thyroiditis would show low uptake
because the gland is leaking preformed hormone rather than overproducing it. Toxic
multinodular goiter would present with a patchy or focal uptake pattern rather than
diffuse. Treatment options for Graves’ include methimazole, radioactive iodine ablation, or
thyroidectomy. Beta-blockers can be used acutely to manage palpitations and tremors.
