,ABFM In-Training Exam (ITE) Practice Questions
Exam Instructions
• Total Questions: 200
• Time Allowed: 3 Hours
• Select the BEST answer for each question
• Each question is worth 1 point
SECTION 1: CARE OF ADULTS AND OLDER ADULTS
(Questions 1-25)
Question 1
A 68-year-old male presents with a 2-day history of headache, muscle
aches, and chills. His wife reports his temperature has been up to 104.1°F
and he seems confused. He returned from a cruise 10 days ago. This
morning he started to cough and his wife noticed blood in his sputum. His
blood pressure is 100/70 mm Hg, heart rate 98/min, temperature 39.4°C
(102.9°F), and oxygen saturation 95% on room air. Which one of the
following would be the preferred method to confirm your suspected
diagnosis of Legionnaires' disease?
A. Initiating azithromycin to see if symptoms improve
B. A chest radiograph
,C. A sputum culture
D. A direct fluorescent antibody stain of sputum
E. A urine test for Legionella pneumophila antigen
Answer: E. A urine test for Legionella pneumophila antigen
Rationale: A urine test for Legionella pneumophila antigen is the preferred
method to confirm Legionnaires' disease. This test is rapid and will only
detect Legionella pneumophila antigen. A sputum culture (C) is the gold
standard but requires 48-72 hours. A chest radiograph (B) does not confirm
the diagnosis but may show the extent of disease. Responding to antibiotic
treatment (A) does not confirm a specific diagnosis.
Question 2
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 72-year-old with acute gastrointestinal bleeding
Answer: C. A 79-year-old with inoperable femur and hip fractures
Rationale: A restrictive transfusion threshold of 8 g/dL is appropriate for
stable hospitalized patients, including those with orthopedic injuries. Patients
with acute coronary syndrome, severe thrombocytopenia, or symptomatic
anemia may require higher thresholds. The patient with inoperable fractures
who is hemodynamically stable would qualify for the restrictive 8 g/dL
threshold.
, Question 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 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. SGLT-2 inhibitors
D. Sulfonylureas
E. Thiazolidinediones
Answer: B. GLP-1 receptor agonists
Rationale: GLP-1 receptor agonists (e.g., semaglutide, liraglutide, exenatide)
have been associated with acute pancreatitis. Biguanides (A) are more
commonly associated with lactic acidosis, SGLT-2 inhibitors (C) with
euglycemic DKA, sulfonylureas (D) with hypoglycemia, and thiazolidinediones
(E) with fluid retention and heart failure. Pancreatitis is a known adverse
effect of GLP-1 receptor agonists.
Question 4
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. Magnetic resonance angiography of the renal arteries
Exam Instructions
• Total Questions: 200
• Time Allowed: 3 Hours
• Select the BEST answer for each question
• Each question is worth 1 point
SECTION 1: CARE OF ADULTS AND OLDER ADULTS
(Questions 1-25)
Question 1
A 68-year-old male presents with a 2-day history of headache, muscle
aches, and chills. His wife reports his temperature has been up to 104.1°F
and he seems confused. He returned from a cruise 10 days ago. This
morning he started to cough and his wife noticed blood in his sputum. His
blood pressure is 100/70 mm Hg, heart rate 98/min, temperature 39.4°C
(102.9°F), and oxygen saturation 95% on room air. Which one of the
following would be the preferred method to confirm your suspected
diagnosis of Legionnaires' disease?
A. Initiating azithromycin to see if symptoms improve
B. A chest radiograph
,C. A sputum culture
D. A direct fluorescent antibody stain of sputum
E. A urine test for Legionella pneumophila antigen
Answer: E. A urine test for Legionella pneumophila antigen
Rationale: A urine test for Legionella pneumophila antigen is the preferred
method to confirm Legionnaires' disease. This test is rapid and will only
detect Legionella pneumophila antigen. A sputum culture (C) is the gold
standard but requires 48-72 hours. A chest radiograph (B) does not confirm
the diagnosis but may show the extent of disease. Responding to antibiotic
treatment (A) does not confirm a specific diagnosis.
Question 2
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 72-year-old with acute gastrointestinal bleeding
Answer: C. A 79-year-old with inoperable femur and hip fractures
Rationale: A restrictive transfusion threshold of 8 g/dL is appropriate for
stable hospitalized patients, including those with orthopedic injuries. Patients
with acute coronary syndrome, severe thrombocytopenia, or symptomatic
anemia may require higher thresholds. The patient with inoperable fractures
who is hemodynamically stable would qualify for the restrictive 8 g/dL
threshold.
, Question 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 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. SGLT-2 inhibitors
D. Sulfonylureas
E. Thiazolidinediones
Answer: B. GLP-1 receptor agonists
Rationale: GLP-1 receptor agonists (e.g., semaglutide, liraglutide, exenatide)
have been associated with acute pancreatitis. Biguanides (A) are more
commonly associated with lactic acidosis, SGLT-2 inhibitors (C) with
euglycemic DKA, sulfonylureas (D) with hypoglycemia, and thiazolidinediones
(E) with fluid retention and heart failure. Pancreatitis is a known adverse
effect of GLP-1 receptor agonists.
Question 4
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. Magnetic resonance angiography of the renal arteries
