ABFM ITE 2026 With complete solu on| Updated New
edi on
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no
addi onal chronic medical problems and is otherwise asymptoma c. An examina on is
significant for a blood pressure of 162/95 mm Hg but is otherwise unremarkable.
Laboratory Findings
Sodium 138 mEq/L (N 135-145) Potassium 3.9 mEq/L (N 3.5-5.5) Fas ngglucose 86mg/dLBUN
14 mg/dL (N 10-20) Crea nine 0.6mg/dL(N0.6-1.3) Urinemicroalbumin nega ve
According to the American College of Cardiology/American Heart Associa on 2017 guidelines,
which one of the following would be the most appropriate medica on to ini ate at this me?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three mes daily
C) Lisinopril/hydrochlorothiazide (Zestore c), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily
ANSWER: C
This pa ent has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Associa on 2017 guidelines, an hypertensive treatment should be
ini ated. For the general non-African-American popula on, monotherapy with an ACE inhibitor,
an angiotensin receptor blocker, a calcium channel blocker, or a thiazide diure c would be
appropriate for ini al management. It is also appropriate to ini ate combina on
an hypertensive therapy as an ini al management strategy, although pa ents should not take
an ACE inhibitor and an angiotensin receptor blocker simultaneously. Studies have shown that
blood pressure control is achieved faster with the ini a on of combina on therapy compared
to monotherapy, without an increase in morbidity. Lisinopril/hydrochlorothiazide would be an
appropriate choice in this pa ent. -Blockers, vasodilators, -blockers, and potassium-sparing
diure cs are not recommended as ini al choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two residents on the unit
with laboratory-confirmed influenza. According to CDC guidelines, who should receive
chemoprophylaxis for influenza?
A) Only symptoma c residents on the same unit
B) Only symptoma c residents in the en re facility
C) All asymptoma c residents on the same unit
,D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
ANSWER: C
In long-term care facili es, an influenza outbreak is defined as two laboratory-confirmed cases
of influenza within 72 hours in pa ents on the same unit. The CDC recommends
chemoprophylaxis for all asymptoma c residents of the affected unit. Any resident exhibi ng
symptoms of influenza should be treated for influenza and not given chemoprophylaxis dosing.
Chemoprophylaxis is not recommended for residents of other units unless there are two
laboratory-confirmed cases in those units. Facility staff of the affected unit can be considered
for chemoprophylaxis if they have not been vaccinated or if they had a recent vaccina on, but
chemoprophylaxis is not recommended for all staff in the en re facility.
A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She has had
two male sex partners in the last 6 months and uses oral contracep ves and some mes
condoms. A physical examina on reveals a temperature of 36.4°C (97.5°F) and moderate
cervical mo on and uterine tenderness. Urine hCG and a urinalysis are nega ve. Vaginal
microscopy shows only WBCs.
The ini a on of an bio cs for treatment of pelvic inflammatory disease in this pa ent
A) is appropriate at this me
B) requires an elevated temperature, WBC count, or C-reac ve protein level
C) should be based on the results of gonorrhea and Chlamydia tes ng
D) should be based on the results of pelvic ultrasonography
ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered
at the me of diagnosis and not delayed un l the results of the nucleic acid amplifica on tes ng
(NAAT) for gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk
woman presen ng with lower abdominal or pelvic pain, accompanied by cervical mo on,
uterine, or adnexal tenderness that can range from mild to severe. There is oHen a
mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators such as fever,
leukocytosis, or an elevated C-reac ve protein level may be helpful but are neither sensi ve nor
specific. A posi ve NAAT is not required for diagnosis and treatment because an upper tract
infec on may be present, or the causa ve agent may not be gonorrhea or Chlamydia. PID
should be considered a polymicrobial infec on. Pelvic ultrasonography may be used if there is a
concern about other pathology such as a tubo-ovarian abscess.
A 24-year-old pa ent wants to start the process of transi oning from female to male. He has
been working with a psychiatrist who has confirmed the diagnosis of gender dysphoria.
Which one of the following would be the best ini al treatment for this pa ent?
,A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
ANSWER: E
For pa ents with gender dysphoria or gender incongruence who desire hormone treatment, the
treatment goal is to suppress endogenous sex hormone produc on and maintain sex hormone
levels in the normal range for their affirmed gender. For a female-to-male transgender pa ent
this is most easily accomplished with testosterone. When testosterone levels are maintained in
the normal gene c male range, gonadotropins and ovarian hormone produc on is suppressed,
which accomplishes both goals for hormonal treatment without the need for addi onal
gonadotropin suppression from medica ons such as leuprolide.
Clomiphene can increase serum testosterone levels, but only in the presence of a func oning
tes cle. Letrozole is an estrogen receptor antagonist, but it would not increase serum
testosterone levels. Spironolactone has androgen receptor blocking effects and would not
accomplish either of the hormone treatment goals.
Based on American Cancer Society guidelines for cervical cancer screening, when should HPV
DNA co-tes ng first be performed along with Papanicolaou tes ng?
A) At the onset of sexual ac vity
B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening, Papanicolaou
(Pap) tes ng should begin at age 21 irrespec ve of sexual ac vity and should be con nued
every 3 years un l age 29. The preferred screening strategy beginning at age 30 is Pap tes ng
with HPV co-tes ng, which should be con nued every 5 years un l age 65. Cervical screening
may be discon nued at that me if the pa ent's last two tests have been nega ve and the
pa ent was tested within the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) BarreK's esophagus
B) gout
C) hypertension
, D) pneumonia
E) type 2 diabetes
ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and health
care-associated pneumonia, which is related to gastric overgrowth by gram-nega ve bacteria.
Long-term treatment of BarreK's esophagus is an indica on for chronic proton pump inhibitor
(PPI) use. PPI therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
An 87-year-old female comes to your office for an annual health maintenance visit. She appears
cachec c and tells you that for the past 6 months she has had a decreased appe te and
generalized muscle weakness. The pa ent is alert and oriented to person and place. She has a
10% weight loss, dry mucous membranes, and ten ng of the skin on the extensor surface of her
hands. While infla ng the blood pressure cuff on her right arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
E) Hyponatremia
ANSWER: B
A Trousseau sign, defined as spasmodic contrac on of muscles caused by pressure on the
nerves that control them, is present in up to 94% of pa ents with hypocalcemia. Hypercalcemia
is more likely to present with hyperreflexia. Pa ents with hypokalemia, hypernatremia, or
hyponatremia may present with weakness and confusion, but tetany is not a common sign of
either sodium or potassium imbalance.
A 24-year old female presents to your office with a 3-month history of difficulty sleeping. She
says that she struggles to fall asleep and wakes up mul ple mes at night at least three mes a
week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies
awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of
the night trying to fall back asleep. Lately she has been feeling fa gued and having difficulty
concentra ng at work. You conduct a full history and physical examina on and tell her to return
in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping
an average of 51⁄2 hours per night.
Which one of the following would be the most appropriate recommenda on?
A) Set her alarm for 5:30 a.m.
B) Add a mid-aHernoon nap
C) Move her bed me to 9:00 p.m.
edi on
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He has no
addi onal chronic medical problems and is otherwise asymptoma c. An examina on is
significant for a blood pressure of 162/95 mm Hg but is otherwise unremarkable.
Laboratory Findings
Sodium 138 mEq/L (N 135-145) Potassium 3.9 mEq/L (N 3.5-5.5) Fas ngglucose 86mg/dLBUN
14 mg/dL (N 10-20) Crea nine 0.6mg/dL(N0.6-1.3) Urinemicroalbumin nega ve
According to the American College of Cardiology/American Heart Associa on 2017 guidelines,
which one of the following would be the most appropriate medica on to ini ate at this me?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three mes daily
C) Lisinopril/hydrochlorothiazide (Zestore c), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily
ANSWER: C
This pa ent has hypertension and according to both JNC 8 and American College of
Cardiology/American Heart Associa on 2017 guidelines, an hypertensive treatment should be
ini ated. For the general non-African-American popula on, monotherapy with an ACE inhibitor,
an angiotensin receptor blocker, a calcium channel blocker, or a thiazide diure c would be
appropriate for ini al management. It is also appropriate to ini ate combina on
an hypertensive therapy as an ini al management strategy, although pa ents should not take
an ACE inhibitor and an angiotensin receptor blocker simultaneously. Studies have shown that
blood pressure control is achieved faster with the ini a on of combina on therapy compared
to monotherapy, without an increase in morbidity. Lisinopril/hydrochlorothiazide would be an
appropriate choice in this pa ent. -Blockers, vasodilators, -blockers, and potassium-sparing
diure cs are not recommended as ini al choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two residents on the unit
with laboratory-confirmed influenza. According to CDC guidelines, who should receive
chemoprophylaxis for influenza?
A) Only symptoma c residents on the same unit
B) Only symptoma c residents in the en re facility
C) All asymptoma c residents on the same unit
,D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
ANSWER: C
In long-term care facili es, an influenza outbreak is defined as two laboratory-confirmed cases
of influenza within 72 hours in pa ents on the same unit. The CDC recommends
chemoprophylaxis for all asymptoma c residents of the affected unit. Any resident exhibi ng
symptoms of influenza should be treated for influenza and not given chemoprophylaxis dosing.
Chemoprophylaxis is not recommended for residents of other units unless there are two
laboratory-confirmed cases in those units. Facility staff of the affected unit can be considered
for chemoprophylaxis if they have not been vaccinated or if they had a recent vaccina on, but
chemoprophylaxis is not recommended for all staff in the en re facility.
A 24-year-old female presents with a 2-day history of mild to moderate pelvic pain. She has had
two male sex partners in the last 6 months and uses oral contracep ves and some mes
condoms. A physical examina on reveals a temperature of 36.4°C (97.5°F) and moderate
cervical mo on and uterine tenderness. Urine hCG and a urinalysis are nega ve. Vaginal
microscopy shows only WBCs.
The ini a on of an bio cs for treatment of pelvic inflammatory disease in this pa ent
A) is appropriate at this me
B) requires an elevated temperature, WBC count, or C-reac ve protein level
C) should be based on the results of gonorrhea and Chlamydia tes ng
D) should be based on the results of pelvic ultrasonography
ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should be administered
at the me of diagnosis and not delayed un l the results of the nucleic acid amplifica on tes ng
(NAAT) for gonorrhea and Chlamydia are returned. The clinical diagnosis is based on an at-risk
woman presen ng with lower abdominal or pelvic pain, accompanied by cervical mo on,
uterine, or adnexal tenderness that can range from mild to severe. There is oHen a
mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators such as fever,
leukocytosis, or an elevated C-reac ve protein level may be helpful but are neither sensi ve nor
specific. A posi ve NAAT is not required for diagnosis and treatment because an upper tract
infec on may be present, or the causa ve agent may not be gonorrhea or Chlamydia. PID
should be considered a polymicrobial infec on. Pelvic ultrasonography may be used if there is a
concern about other pathology such as a tubo-ovarian abscess.
A 24-year-old pa ent wants to start the process of transi oning from female to male. He has
been working with a psychiatrist who has confirmed the diagnosis of gender dysphoria.
Which one of the following would be the best ini al treatment for this pa ent?
,A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
ANSWER: E
For pa ents with gender dysphoria or gender incongruence who desire hormone treatment, the
treatment goal is to suppress endogenous sex hormone produc on and maintain sex hormone
levels in the normal range for their affirmed gender. For a female-to-male transgender pa ent
this is most easily accomplished with testosterone. When testosterone levels are maintained in
the normal gene c male range, gonadotropins and ovarian hormone produc on is suppressed,
which accomplishes both goals for hormonal treatment without the need for addi onal
gonadotropin suppression from medica ons such as leuprolide.
Clomiphene can increase serum testosterone levels, but only in the presence of a func oning
tes cle. Letrozole is an estrogen receptor antagonist, but it would not increase serum
testosterone levels. Spironolactone has androgen receptor blocking effects and would not
accomplish either of the hormone treatment goals.
Based on American Cancer Society guidelines for cervical cancer screening, when should HPV
DNA co-tes ng first be performed along with Papanicolaou tes ng?
A) At the onset of sexual ac vity
B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening, Papanicolaou
(Pap) tes ng should begin at age 21 irrespec ve of sexual ac vity and should be con nued
every 3 years un l age 29. The preferred screening strategy beginning at age 30 is Pap tes ng
with HPV co-tes ng, which should be con nued every 5 years un l age 65. Cervical screening
may be discon nued at that me if the pa ent's last two tests have been nega ve and the
pa ent was tested within the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) BarreK's esophagus
B) gout
C) hypertension
, D) pneumonia
E) type 2 diabetes
ANSWER: D
Acid suppression therapy is associated with an increased risk of community-acquired and health
care-associated pneumonia, which is related to gastric overgrowth by gram-nega ve bacteria.
Long-term treatment of BarreK's esophagus is an indica on for chronic proton pump inhibitor
(PPI) use. PPI therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
An 87-year-old female comes to your office for an annual health maintenance visit. She appears
cachec c and tells you that for the past 6 months she has had a decreased appe te and
generalized muscle weakness. The pa ent is alert and oriented to person and place. She has a
10% weight loss, dry mucous membranes, and ten ng of the skin on the extensor surface of her
hands. While infla ng the blood pressure cuff on her right arm you observe carpopedal spasms.
Which one of the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
E) Hyponatremia
ANSWER: B
A Trousseau sign, defined as spasmodic contrac on of muscles caused by pressure on the
nerves that control them, is present in up to 94% of pa ents with hypocalcemia. Hypercalcemia
is more likely to present with hyperreflexia. Pa ents with hypokalemia, hypernatremia, or
hyponatremia may present with weakness and confusion, but tetany is not a common sign of
either sodium or potassium imbalance.
A 24-year old female presents to your office with a 3-month history of difficulty sleeping. She
says that she struggles to fall asleep and wakes up mul ple mes at night at least three mes a
week. She tries to go to bed at 10:00 p.m. and wakes up at 6:30 a.m. to start her day. She lies
awake for an hour in bed before falling asleep and spends up to 2 hours awake in the middle of
the night trying to fall back asleep. Lately she has been feeling fa gued and having difficulty
concentra ng at work. You conduct a full history and physical examina on and tell her to return
in 2 weeks with a sleep diary. At this follow-up visit you see from her diary that she is sleeping
an average of 51⁄2 hours per night.
Which one of the following would be the most appropriate recommenda on?
A) Set her alarm for 5:30 a.m.
B) Add a mid-aHernoon nap
C) Move her bed me to 9:00 p.m.
