,ABFM In-Training Exam (ITE) Practice
Questions 2026
Exam Instructions
• Total Questions:
• Time Allowed: 3 Hours
• Select the BEST answer for each question
• Each question is worth 1 point
Question 1
A 45-year-old male with a history of hypertension presents with acute onset
of severe, tearing chest pain that radiates to his back. His blood pressure is
180/100 mm Hg in the right arm and 130/80 mm Hg in the left arm. Which
is the most appropriate initial imaging study?
A. Chest radiograph
B. CT angiography of the chest
C. Transesophageal echocardiography
D. MRI of the chest
E. Electrocardiogram
Answer: B. CT angiography of the chest
Rationale: This patient has an acute aortic dissection with pulse deficit and
characteristic pain. CT angiography is the most appropriate initial imaging
,study to confirm the diagnosis and assess the extent of dissection. Chest
radiograph (A) may show a widened mediastinum but is not diagnostic.
Transesophageal echocardiography (C) is an alternative but is invasive and
operator-dependent. MRI (D) takes too long in an acute setting. ECG (E)
would not diagnose dissection.
Question 2
A 32-year-old female presents with progressive weakness in her lower
extremities over the past 3 days. She reports having a viral respiratory
infection 2 weeks ago. On examination, she has symmetric ascending
weakness, areflexia, and no sensory level. Which is the most likely
diagnosis?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Spinal cord compression
D. Transverse myelitis
E. Peripheral neuropathy
Answer: A. Guillain-Barré syndrome
Rationale: Guillain-Barré syndrome presents with acute, symmetric,
ascending weakness with areflexia following a viral infection. Multiple
sclerosis (B) is relapsing-remitting. Spinal cord compression (C) would have a
sensory level. Transverse myelitis (D) is acute but has a sensory level.
Peripheral neuropathy (E) is chronic—GBS is the diagnosis.
Question 3
A 68-year-old male with a history of type 2 diabetes presents with a non-
healing ulcer on the plantar surface of his right foot. He has diminished
, pedal pulses and a palpable dorsalis pedis pulse. Which is the most likely
diagnosis?
A. Diabetic foot ulcer
B. Venous stasis ulcer
C. Arterial insufficiency ulcer
D. Pressure ulcer
E. Malignant ulcer
Answer: A. Diabetic foot ulcer
Rationale: Diabetic foot ulcers are located on pressure points, especially the
plantar surface. Venous stasis ulcers (B) are located on the medial malleolus.
Arterial insufficiency ulcers (C) are on the toes or heel. Pressure ulcers (D) are
over bony prominences. Malignant ulcers (E) are rare—plantar location in a
diabetic patient is classic for diabetic foot ulcer.
Question 4
A 45-year-old female presents with a 3-month history of fatigue, weight
loss, and night sweats. She reports a recent exposure to tuberculosis. A
chest radiograph shows a right upper lobe infiltrate with cavitation. Which
is the most appropriate diagnostic test?
A. Sputum acid-fast bacilli smear
B. Sputum culture
C. Quantiferon-TB Gold test
D. Tuberculin skin test
E. Chest CT
Answer: A. Sputum acid-fast bacilli smear
Rationale: This patient has signs of active pulmonary tuberculosis. A sputum
AFB smear is the appropriate initial diagnostic test. Sputum culture (B) is the
Questions 2026
Exam Instructions
• Total Questions:
• Time Allowed: 3 Hours
• Select the BEST answer for each question
• Each question is worth 1 point
Question 1
A 45-year-old male with a history of hypertension presents with acute onset
of severe, tearing chest pain that radiates to his back. His blood pressure is
180/100 mm Hg in the right arm and 130/80 mm Hg in the left arm. Which
is the most appropriate initial imaging study?
A. Chest radiograph
B. CT angiography of the chest
C. Transesophageal echocardiography
D. MRI of the chest
E. Electrocardiogram
Answer: B. CT angiography of the chest
Rationale: This patient has an acute aortic dissection with pulse deficit and
characteristic pain. CT angiography is the most appropriate initial imaging
,study to confirm the diagnosis and assess the extent of dissection. Chest
radiograph (A) may show a widened mediastinum but is not diagnostic.
Transesophageal echocardiography (C) is an alternative but is invasive and
operator-dependent. MRI (D) takes too long in an acute setting. ECG (E)
would not diagnose dissection.
Question 2
A 32-year-old female presents with progressive weakness in her lower
extremities over the past 3 days. She reports having a viral respiratory
infection 2 weeks ago. On examination, she has symmetric ascending
weakness, areflexia, and no sensory level. Which is the most likely
diagnosis?
A. Guillain-Barré syndrome
B. Multiple sclerosis
C. Spinal cord compression
D. Transverse myelitis
E. Peripheral neuropathy
Answer: A. Guillain-Barré syndrome
Rationale: Guillain-Barré syndrome presents with acute, symmetric,
ascending weakness with areflexia following a viral infection. Multiple
sclerosis (B) is relapsing-remitting. Spinal cord compression (C) would have a
sensory level. Transverse myelitis (D) is acute but has a sensory level.
Peripheral neuropathy (E) is chronic—GBS is the diagnosis.
Question 3
A 68-year-old male with a history of type 2 diabetes presents with a non-
healing ulcer on the plantar surface of his right foot. He has diminished
, pedal pulses and a palpable dorsalis pedis pulse. Which is the most likely
diagnosis?
A. Diabetic foot ulcer
B. Venous stasis ulcer
C. Arterial insufficiency ulcer
D. Pressure ulcer
E. Malignant ulcer
Answer: A. Diabetic foot ulcer
Rationale: Diabetic foot ulcers are located on pressure points, especially the
plantar surface. Venous stasis ulcers (B) are located on the medial malleolus.
Arterial insufficiency ulcers (C) are on the toes or heel. Pressure ulcers (D) are
over bony prominences. Malignant ulcers (E) are rare—plantar location in a
diabetic patient is classic for diabetic foot ulcer.
Question 4
A 45-year-old female presents with a 3-month history of fatigue, weight
loss, and night sweats. She reports a recent exposure to tuberculosis. A
chest radiograph shows a right upper lobe infiltrate with cavitation. Which
is the most appropriate diagnostic test?
A. Sputum acid-fast bacilli smear
B. Sputum culture
C. Quantiferon-TB Gold test
D. Tuberculin skin test
E. Chest CT
Answer: A. Sputum acid-fast bacilli smear
Rationale: This patient has signs of active pulmonary tuberculosis. A sputum
AFB smear is the appropriate initial diagnostic test. Sputum culture (B) is the
