Page 1 of 329
ABFM ITE EXAM Q. BANK (FAMILY MEDICINE IN-
TRAINING) *** QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS
|DOWNLOAD AND PASS | LATEST EXAM
UPDATE 2026/2027
A 65-year-old female sees you because of increased irritability
and confusion. She has a history of major depression, essential
hypertension, and type 2 diabetes. Her medications include
sertraline (Zoloft), 100 mg daily; lisinopril (Prinivil, Zestril), 20 mg
daily; and metformin (Glucophage), 500 mg twice daily. She
recently sustained a right distal radius fracture as a result
of a fall, and she has been taking tramadol, 50 mg, every 6 hours
for pain control.
On examination the patient has a temperature of 38.2°C
(100.8°F), a pulse rate of 96 beats/min,
a respiratory rate of 16/min, and a blood pressure of 124/78 mm
Hg. She appears confused and you note a bilateral tremor in the
upper extremities, brisk reflexes, and two beats of clonus on
,Page 2 of 329
a bilateral foot examination. The examination is otherwise
normal. A CBC, comprehensive metabolic panel, chest
radiograph, and CT of the head are all within normal limits.
Which one of the following is the most likely cause of this
patient's symptoms?
A) Acute cerebral infarction
B) Meningitis
C) Sepsis syndrome
D) Serotonin syndrome
❖ ANSWER: D
❖ Serotonin syndrome
Serotonin syndrome is a potentially life-threatening condition
caused by excessive serotonergic activity, and certain
medications are more likely to precipitate it. Early recognition of
symptoms is important, as most cases can be managed on an
outpatient basis with discontinuation of the precipitating
medication and supportive care. The Hunter Serotonin Toxicity
Criteria can be used to diagnose serotonin syndrome (SOR C).
This patient has serotonin syndrome based on her use of both
sertraline and tramadol and meeting the
,Page 3 of 329
Hunter criteria of hyperthermia, clonus, tremor, and
hyperreflexia. This patient does not have findings on the
neurologic examination that would make acute cerebral
infarction likely. Meningitis and sepsis syndrome are less likely
with a normal CBC.
A 13-year-old male is brought to your office for evaluation of
back pain. Plain radiography would be indicated at this time if
the patient has
A) pain that awakens him at night
B) pain that is localized to the midthoracic spine
C) pain that is increased with flexion
D) intermittent pain that has persisted for 2 weeks
E) a recent history of an upper respiratory infection
❖ ANSWER: A
❖ pain that awakens him at night
Guidelines from the American College of Radiology state that
imaging in children and adolescents with back pain can be
delayed unless there are abnormal neurologic findings, pain that
awakens the patient at
, Page 4 of 329
night, or pain that radiates or persists for more than 4 weeks.
Imaging would not be recommended at this
time if the patient has pain that is localized to the midthoracic
spine, pain that is increased with flexion, intermittent pain that
has persisted for 2 weeks, or a recent history of an upper
respiratory infection.
The U.S. Preventive Services Task Force recommends one-time
screening for abdominal aortic aneurysm in
A) men 55-75 years of age who have ever smoked
B) men 65-75 years of age who have ever smoked
C) men and women 65-75 years of age who have ever smoked
D) men and women 65-75 years of age who currently smoke
❖ ANSWER: B
❖ men 65-75 years of age who have ever smoked
The U.S. Preventive Services Task Force (USPSTF) concluded with
moderate certainty that there is a moderate net benefit for
screening for abdominal aortic aneurysm (AAA) in 65- to 75-
year-old men who have ever smoked (defined as >100 lifetime
cigarettes). There is insufficient evidence that screening women
ABFM ITE EXAM Q. BANK (FAMILY MEDICINE IN-
TRAINING) *** QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS
|DOWNLOAD AND PASS | LATEST EXAM
UPDATE 2026/2027
A 65-year-old female sees you because of increased irritability
and confusion. She has a history of major depression, essential
hypertension, and type 2 diabetes. Her medications include
sertraline (Zoloft), 100 mg daily; lisinopril (Prinivil, Zestril), 20 mg
daily; and metformin (Glucophage), 500 mg twice daily. She
recently sustained a right distal radius fracture as a result
of a fall, and she has been taking tramadol, 50 mg, every 6 hours
for pain control.
On examination the patient has a temperature of 38.2°C
(100.8°F), a pulse rate of 96 beats/min,
a respiratory rate of 16/min, and a blood pressure of 124/78 mm
Hg. She appears confused and you note a bilateral tremor in the
upper extremities, brisk reflexes, and two beats of clonus on
,Page 2 of 329
a bilateral foot examination. The examination is otherwise
normal. A CBC, comprehensive metabolic panel, chest
radiograph, and CT of the head are all within normal limits.
Which one of the following is the most likely cause of this
patient's symptoms?
A) Acute cerebral infarction
B) Meningitis
C) Sepsis syndrome
D) Serotonin syndrome
❖ ANSWER: D
❖ Serotonin syndrome
Serotonin syndrome is a potentially life-threatening condition
caused by excessive serotonergic activity, and certain
medications are more likely to precipitate it. Early recognition of
symptoms is important, as most cases can be managed on an
outpatient basis with discontinuation of the precipitating
medication and supportive care. The Hunter Serotonin Toxicity
Criteria can be used to diagnose serotonin syndrome (SOR C).
This patient has serotonin syndrome based on her use of both
sertraline and tramadol and meeting the
,Page 3 of 329
Hunter criteria of hyperthermia, clonus, tremor, and
hyperreflexia. This patient does not have findings on the
neurologic examination that would make acute cerebral
infarction likely. Meningitis and sepsis syndrome are less likely
with a normal CBC.
A 13-year-old male is brought to your office for evaluation of
back pain. Plain radiography would be indicated at this time if
the patient has
A) pain that awakens him at night
B) pain that is localized to the midthoracic spine
C) pain that is increased with flexion
D) intermittent pain that has persisted for 2 weeks
E) a recent history of an upper respiratory infection
❖ ANSWER: A
❖ pain that awakens him at night
Guidelines from the American College of Radiology state that
imaging in children and adolescents with back pain can be
delayed unless there are abnormal neurologic findings, pain that
awakens the patient at
, Page 4 of 329
night, or pain that radiates or persists for more than 4 weeks.
Imaging would not be recommended at this
time if the patient has pain that is localized to the midthoracic
spine, pain that is increased with flexion, intermittent pain that
has persisted for 2 weeks, or a recent history of an upper
respiratory infection.
The U.S. Preventive Services Task Force recommends one-time
screening for abdominal aortic aneurysm in
A) men 55-75 years of age who have ever smoked
B) men 65-75 years of age who have ever smoked
C) men and women 65-75 years of age who have ever smoked
D) men and women 65-75 years of age who currently smoke
❖ ANSWER: B
❖ men 65-75 years of age who have ever smoked
The U.S. Preventive Services Task Force (USPSTF) concluded with
moderate certainty that there is a moderate net benefit for
screening for abdominal aortic aneurysm (AAA) in 65- to 75-
year-old men who have ever smoked (defined as >100 lifetime
cigarettes). There is insufficient evidence that screening women
