ABFM ITE | ABFM ITE Version 3: Updated and
Latest Questions and Correct Answers with
Rationale - American Board of Family Medicine
1. A 68-year-old male with a history of hypertension and type 2 diabetes presents for follow-
up. His blood pressure is consistently 142/88 mmHg. According to current ACC/AHA
guidelines, what is the most appropriate blood pressure goal for this patient?
A. <140/90 mmHg
B. <120/80 mmHg
C. <150/90 mmHg
D. <130/80 mmHg
Correct Answer: D
Expert Explanation: Current ACC/AHA guidelines recommend a blood pressure goal of
less than 130/80 mmHg for all adults with established hypertension. This recommendation
extends to patients with comorbid conditions such as diabetes mellitus and chronic kidney
disease. Achieving this target has been shown to significantly reduce the risk of major
adverse cardiovascular events. Clinical judgment should be used to monitor for adverse
effects like orthostatic hypotension in older adults. Shared decision-making is essential to
ensure the patient adheres to the intensified treatment regimen.
2. A 55-year-old female with a 30-pack-year smoking history currently smokes one pack per
day. She asks about lung cancer screening. Which of the following is the most appropriate
recommendation?
A. Annual chest X-ray
B. Sputum cytology every 6 months
C. CT scan every 3 years
D. Annual low-dose CT scan
Correct Answer: D
Expert Explanation: The USPSTF recommends annual screening for lung cancer with low-
dose computed tomography (LDCT) in adults aged 50 to 80 years. Eligible patients must
have a 20-pack-year smoking history and currently smoke or have quit within the past 15
years. This screening has been proven to reduce lung cancer mortality through early
detection of malignant nodules. Chest X-rays and sputum cytology are not recommended as
they do not provide a mortality benefit. Screening should be discontinued once a person
has not smoked for 15 years or develops a life-limiting condition.
,3. A 72-year-old male with HFrEF (LVEF 35%) is already taking lisinopril, carvedilol, and
spironolactone. He remains symptomatic (NYHA Class II). Which medication class should be
added next to improve mortality?
A. SGLT2 inhibitor
B. Loop diuretic
C. Calcium channel blocker
D. Digoxin
Correct Answer: A
Expert Explanation: SGLT2 inhibitors like dapagliflozin or empagliflozin are now
considered foundational therapy for Heart Failure with reduced Ejection Fraction (HFrEF).
These medications have shown a significant reduction in cardiovascular death and heart
failure hospitalizations regardless of diabetes status. Loop diuretics are used for symptom
management of fluid overload but do not provide a primary mortality benefit. Verapamil
and diltiazem should generally be avoided in HFrEF due to negative inotropic effects. This
patient is already on the other three pillars of guideline-directed medical therapy.
4. A 2-week-old neonate is brought to the clinic with a rectal temperature of 101.4°F (38.6°C).
The infant appears well and is feeding. What is the most appropriate next step in
management?
A. Recheck temperature in 4 hours
B. Prescribe oral amoxicillin and follow up tomorrow
C. Perform a rapid flu and RSV swab only
D. Full sepsis workup and hospitalization
Correct Answer: D
Expert Explanation: Any infant younger than 28 days with a fever of 38.0°C (100.4°F) or
higher requires a full sepsis workup. This workup must include blood, urine, and
cerebrospinal fluid (CSF) cultures to rule out serious bacterial infections. Due to the
immature immune system of neonates, clinical appearance can be misleadingly stable
during early sepsis. Hospitalization for parenteral antibiotics is mandatory while awaiting
culture results. Observation or outpatient management is inappropriate for this age group
regardless of the clinical appearance.
5. A 45-year-old male with no history of cardiovascular disease has a calculated 10-year
ASCVD risk of 8.5%. His LDL-C is 140 mg/dL. What is the most appropriate recommendation
regarding statin therapy?
A. No statin therapy is indicated
B. Initiate low-intensity statin
, C. Initiate high-intensity statin
D. Initiate moderate-intensity statin
Correct Answer: D
Expert Explanation: For adults aged 40-75 with a 10-year ASCVD risk between 7.5% and
20%, a moderate-intensity statin is recommended. This range is classified as ‘intermediate
risk,’ where the benefits of statin therapy usually outweigh the risks. Before starting
therapy, clinicians should engage in a risk discussion regarding lifestyle modifications and
potential side effects. High-intensity statins are generally reserved for those with a risk
>20% or clinical ASCVD. Coronary artery calcium scoring can be used if the treatment
decision remains uncertain after the risk discussion.
6. A 65-year-old man presents with a 4 cm asymptomatic abdominal mass felt on deep
palpation. An ultrasound confirms an abdominal aortic aneurysm (AAA) measuring 4.2 cm.
What is the appropriate follow-up?
A. Immediate surgical repair
B. Repeat ultrasound in 3 years
C. Repeat ultrasound in 6 to 12 months
D. Repeat ultrasound in 5 years
Correct Answer: C
Expert Explanation: For an abdominal aortic aneurysm measuring between 4.0 and 4.9
cm, ultrasound surveillance every 6 to 12 months is recommended. Surgical intervention is
typically reserved for aneurysms 5.5 cm or larger in men or those expanding rapidly.
Smaller aneurysms between 3.0 and 3.9 cm can be monitored annually. Screening is
specifically recommended for men aged 65-75 who have ever smoked. Risk factor
modification, including smoking cessation and blood pressure control, is crucial to slow
aneurysm growth.
7. A 78-year-old female with dementia and chronic insomnia is currently taking
diphenhydramine nightly. Which of the following is the most likely adverse effect she may
experience?
A. Increased risk of falls
B. Improved memory
C. Decreased intraocular pressure
D. Diarrhea
Correct Answer: A
Expert Explanation: Diphenhydramine is a first-generation antihistamine with significant
anticholinergic properties, making it high-risk for the elderly. According to the Beers
Latest Questions and Correct Answers with
Rationale - American Board of Family Medicine
1. A 68-year-old male with a history of hypertension and type 2 diabetes presents for follow-
up. His blood pressure is consistently 142/88 mmHg. According to current ACC/AHA
guidelines, what is the most appropriate blood pressure goal for this patient?
A. <140/90 mmHg
B. <120/80 mmHg
C. <150/90 mmHg
D. <130/80 mmHg
Correct Answer: D
Expert Explanation: Current ACC/AHA guidelines recommend a blood pressure goal of
less than 130/80 mmHg for all adults with established hypertension. This recommendation
extends to patients with comorbid conditions such as diabetes mellitus and chronic kidney
disease. Achieving this target has been shown to significantly reduce the risk of major
adverse cardiovascular events. Clinical judgment should be used to monitor for adverse
effects like orthostatic hypotension in older adults. Shared decision-making is essential to
ensure the patient adheres to the intensified treatment regimen.
2. A 55-year-old female with a 30-pack-year smoking history currently smokes one pack per
day. She asks about lung cancer screening. Which of the following is the most appropriate
recommendation?
A. Annual chest X-ray
B. Sputum cytology every 6 months
C. CT scan every 3 years
D. Annual low-dose CT scan
Correct Answer: D
Expert Explanation: The USPSTF recommends annual screening for lung cancer with low-
dose computed tomography (LDCT) in adults aged 50 to 80 years. Eligible patients must
have a 20-pack-year smoking history and currently smoke or have quit within the past 15
years. This screening has been proven to reduce lung cancer mortality through early
detection of malignant nodules. Chest X-rays and sputum cytology are not recommended as
they do not provide a mortality benefit. Screening should be discontinued once a person
has not smoked for 15 years or develops a life-limiting condition.
,3. A 72-year-old male with HFrEF (LVEF 35%) is already taking lisinopril, carvedilol, and
spironolactone. He remains symptomatic (NYHA Class II). Which medication class should be
added next to improve mortality?
A. SGLT2 inhibitor
B. Loop diuretic
C. Calcium channel blocker
D. Digoxin
Correct Answer: A
Expert Explanation: SGLT2 inhibitors like dapagliflozin or empagliflozin are now
considered foundational therapy for Heart Failure with reduced Ejection Fraction (HFrEF).
These medications have shown a significant reduction in cardiovascular death and heart
failure hospitalizations regardless of diabetes status. Loop diuretics are used for symptom
management of fluid overload but do not provide a primary mortality benefit. Verapamil
and diltiazem should generally be avoided in HFrEF due to negative inotropic effects. This
patient is already on the other three pillars of guideline-directed medical therapy.
4. A 2-week-old neonate is brought to the clinic with a rectal temperature of 101.4°F (38.6°C).
The infant appears well and is feeding. What is the most appropriate next step in
management?
A. Recheck temperature in 4 hours
B. Prescribe oral amoxicillin and follow up tomorrow
C. Perform a rapid flu and RSV swab only
D. Full sepsis workup and hospitalization
Correct Answer: D
Expert Explanation: Any infant younger than 28 days with a fever of 38.0°C (100.4°F) or
higher requires a full sepsis workup. This workup must include blood, urine, and
cerebrospinal fluid (CSF) cultures to rule out serious bacterial infections. Due to the
immature immune system of neonates, clinical appearance can be misleadingly stable
during early sepsis. Hospitalization for parenteral antibiotics is mandatory while awaiting
culture results. Observation or outpatient management is inappropriate for this age group
regardless of the clinical appearance.
5. A 45-year-old male with no history of cardiovascular disease has a calculated 10-year
ASCVD risk of 8.5%. His LDL-C is 140 mg/dL. What is the most appropriate recommendation
regarding statin therapy?
A. No statin therapy is indicated
B. Initiate low-intensity statin
, C. Initiate high-intensity statin
D. Initiate moderate-intensity statin
Correct Answer: D
Expert Explanation: For adults aged 40-75 with a 10-year ASCVD risk between 7.5% and
20%, a moderate-intensity statin is recommended. This range is classified as ‘intermediate
risk,’ where the benefits of statin therapy usually outweigh the risks. Before starting
therapy, clinicians should engage in a risk discussion regarding lifestyle modifications and
potential side effects. High-intensity statins are generally reserved for those with a risk
>20% or clinical ASCVD. Coronary artery calcium scoring can be used if the treatment
decision remains uncertain after the risk discussion.
6. A 65-year-old man presents with a 4 cm asymptomatic abdominal mass felt on deep
palpation. An ultrasound confirms an abdominal aortic aneurysm (AAA) measuring 4.2 cm.
What is the appropriate follow-up?
A. Immediate surgical repair
B. Repeat ultrasound in 3 years
C. Repeat ultrasound in 6 to 12 months
D. Repeat ultrasound in 5 years
Correct Answer: C
Expert Explanation: For an abdominal aortic aneurysm measuring between 4.0 and 4.9
cm, ultrasound surveillance every 6 to 12 months is recommended. Surgical intervention is
typically reserved for aneurysms 5.5 cm or larger in men or those expanding rapidly.
Smaller aneurysms between 3.0 and 3.9 cm can be monitored annually. Screening is
specifically recommended for men aged 65-75 who have ever smoked. Risk factor
modification, including smoking cessation and blood pressure control, is crucial to slow
aneurysm growth.
7. A 78-year-old female with dementia and chronic insomnia is currently taking
diphenhydramine nightly. Which of the following is the most likely adverse effect she may
experience?
A. Increased risk of falls
B. Improved memory
C. Decreased intraocular pressure
D. Diarrhea
Correct Answer: A
Expert Explanation: Diphenhydramine is a first-generation antihistamine with significant
anticholinergic properties, making it high-risk for the elderly. According to the Beers
