ABFM ITE | FROM QUESTION TO PERFECTION| STUDY
WITH CONFIDENCE!
Course Code:
Course Title:
Programme: ABFM ITE
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 100
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,A 67-year old male sees you for a Medicare annual wellness visit. He tells you that his best
friend had a stroke and he asks about his risk for stroke. He has a family history of
cardiovascular disease in his father, who had a myocardial infarction at age 65 and died from a
thrombotic stroke at age 71. The patient exercises regularly and has a BMI of 27 kg/m2. His
only current medical condition is hyperlipidemia, and his cholesterol level is at goal on
rosuvastatin (Crestor), 10 mg daily. He also takes aspirin, 81 mg daily. His blood pressure
125/78 mmHg.
Based on US Preventive Services Task Force guidelines, which one of the following would be
most appropriate at this time?
A. No additional testing for stroke risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonography
D. Magnetic resonance angiography
E. CT angiography of the carotid arteries Answer: ANSWER: A
No additional testing for stroke risk Carotid artery disease affects extra cranial carotid arteries
and is caused by atherosclerosis.
This patient is asymptomatic and has no history of an ischemic stroke, neurology symptoms
referable to the carotid arteries such as amaurosis fugal, or TIA. He has risk factors for
cardiovascular disease (age, male sex, hyperlipidemia_, but the USPSTF recommends against
specific screening asymptomatic carotid artery stenosis (D recommendation) which a low
prevalence in the general adult population. Stroke is a leading cause of disability and death in
the US, but asymptomatic carotid artery stenosis causes a relatively small portion of strokes.
Auscultation of the carotid arteries for bruits has been found to have poor accuracy for detecting
carotid stenosis and is not a reasonable screening approach. Appropriate modalities for detecting
carotid stenosis include carotid duplex ultrasonography, magnetic resonance angiography, and
computed tomography, but there are not recommended for screening asymptomatic patients.
A 28 year old female presents for evaluation of nasal congestion, sneezing, watery eyes, and
postnasal drip. This has been an intermittent issue for her every spring and she would like to
manage it more effectively.
Which one of the following treatments has been shown to be the most effective and best
tolerated first-line therapy for this patient's condition?
A. A leukotriene receptor agonist
B. Intranasal corticosteroid monotherapy
C. Intranasal corticosteroids plus an oral antihistamine
D. Inhaled corticosteroids
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,E. Annual triamcinolone injections Answer: ANSWER: B
Intranasal corticosteroid monotherapy
This patient has seasonal allergic rhinitis. A joint guideline statement from the American
Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma and
Immunology Joint Task Force on Practice Parameters recommends that mono therapy with
intranasal corticosteroids would be prescribed initially in patients equal to or more than 12 years
of age rather than combined treatment with oral antihistamines because data has not shown an
additional benefit to adding the antihistamine. Higher patient adherence and tolerance and fewer
side effects were seen with the mono therapy regimen. High quality evidence indicates that
intranasal corticosteroids were more effective than leukotriene receptor antagonists. Inhaled
corticosteroids and triamcinolone injections are not appropriate first line options for the
treatment of seasonal allergic rhinitis
A 68 year old female presents with a 2 month history of watery diarrhea. She has not had any
blood or pus in her stools, and the stools are not oily. She has not had any history of fever, chills,
or weight loss, and has not traveled recently. She smokes one pack of cigarettes per day. Her
medications include ibuprofen, sertraline and pantoprazole. A CBC, metabolic panel, CRP, IgA
anti tissue transglutaminase level, total IgA level, and stool guaiac test are all normal.
Which one of the following tests would be mostly likely to yield a diagnosis?
A. C difficile toxin
B. Colonoscopy
C. Fecal calprotectin
D. A stool culture
E. Stool exam for ova and parasites Answer: ANSWER: B
Colonoscopy
In patients with chronic nonbloody diarrhea, the differential diagnosis includes microscopic
(lymphocytic or collagenous) colitis. The mucosa appears normal on colonoscopy but a biopsy
will show lymphocytic infiltration of the epithelium. The etiology is unknown but there are
several risk factors to consider, including older age, female sex, and smoking status. Drugs with
a high level of evidence causing microscopic colitis include NSAIDs, PPIs, sertraline, acarbose,
aspirin, and ticlopidine. C. diff should be suspected in individuals who have taken antibiotics in
the past 3 months. Fecal calprotectin is elevated in inflammatory diarrhea such as Crohn's
disease or ulcerative colitis. A stool culture would be indicated if there is a suspicion of an
infectious bacterial diarrhea such as Shigella or Salmonella, but these bacteria tend to cause
bloody diarrhea. Checking for a parasitic infection should be considered for patients with a
history of recent travel or exposure to unpurified water.
A 23 year old male with opioid use disorder requests buprenorphine therapy. He is still actively
using immediate release oxycodone and he took a dose 2 hours ago.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, This patient should begin buprenorphine induction
A. Now
B. In 2 hours
C. 8-12 hours after his last opioid use
D. 24 hours after his last opioid use
E. 1 week after his last opioid use Answer: ANSWER: C
8-12 hours after his last opioid use
Buprenorphine is a partial opioid agonist. In order to reduce the risk of precipitated withdrawal,
buprenorphine induction should begin once the patient is exhibiting signs of mild to moderate
withdrawal, usually 8-12 hours after the last opioid use. Waiting until a patient goes through a
full withdrawal increases the chances that the patient will revert back to using opioids.
A 45 year old left hand dominant female presents to your office with a lump on her hand. She
first noticed the lump 2 weeks ago and thinks it has gotten bigger. She does not recall any injury.
She has not had any numbness, weakness, or tingling. She has minimal discomfort when she
presses on the lump, and it does not affect her activity. On examination her left wrist is
neurovascularly intact.
Which one of the following management options would you recommend?
A. Re-examination if she develops numbness, weakness, or increased pain
B. Immobilization of the wrist for 6 weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the lesion with a corticosteroid
E. Referral for excision of the lesion Answer: ANSWER: A. Re-examination if she develops
numbness, weakness or increased pain
This patient has a ganglion cyst, which is common and resolves spontaneously in 50% of cases,
and watchful waiting would be most appropriate at this time. Treatment is indicated if the cyst is
causing significant symptoms such as pain, numbness, or weakness, or for cosmetic symptoms.
Aspiration of the lesion is the initial treatment, although recurrence may occur in 85% of cases.
Immobilizing the wrist with a splint or brace is sometimes helpful in the short term if the patient
is bothered by the symptoms, but immobilization does not provide lasting relief and could cause
muscle atrophy. Corticosteroid injections have not shown any benefit. Referral for excision is
appropriate if there has been no improvement. Patients should be advised that there is a 10%-
15% recurrence rate even after excision.
A 57 year old female with diabetes mellitus comes to your office for a routine follow up. Her
current medications include metformin 1000 mg twice daily. She tells you that she does not
exercise regularly and finds it difficult to follow a healthy diet. HbA1c today is 7.5%. She does
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
WITH CONFIDENCE!
Course Code:
Course Title:
Programme: ABFM ITE
Academic Year: 2026/2027
Duration: 2 Hours
Total Marks: 100
Candidate Instructions:
1) Write your Registration Number on every answer booklet used.
2) Answer ALL questions in Section A and ANY TWO (2) questions in Section B.
3) Read each question carefully before answering.
4) Begin each question on a new page.
5) The marks for each question are indicated in brackets.
6) This paper consists of several printed pages, including this page.
7) Ensure your copy is complete before the examination begins.
8) Unauthorized materials and communication with other candidates are not permitted.
Turn Over.
APPHIA – Crafted with Care and Precision for Academic Excellence.
1
,A 67-year old male sees you for a Medicare annual wellness visit. He tells you that his best
friend had a stroke and he asks about his risk for stroke. He has a family history of
cardiovascular disease in his father, who had a myocardial infarction at age 65 and died from a
thrombotic stroke at age 71. The patient exercises regularly and has a BMI of 27 kg/m2. His
only current medical condition is hyperlipidemia, and his cholesterol level is at goal on
rosuvastatin (Crestor), 10 mg daily. He also takes aspirin, 81 mg daily. His blood pressure
125/78 mmHg.
Based on US Preventive Services Task Force guidelines, which one of the following would be
most appropriate at this time?
A. No additional testing for stroke risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonography
D. Magnetic resonance angiography
E. CT angiography of the carotid arteries Answer: ANSWER: A
No additional testing for stroke risk Carotid artery disease affects extra cranial carotid arteries
and is caused by atherosclerosis.
This patient is asymptomatic and has no history of an ischemic stroke, neurology symptoms
referable to the carotid arteries such as amaurosis fugal, or TIA. He has risk factors for
cardiovascular disease (age, male sex, hyperlipidemia_, but the USPSTF recommends against
specific screening asymptomatic carotid artery stenosis (D recommendation) which a low
prevalence in the general adult population. Stroke is a leading cause of disability and death in
the US, but asymptomatic carotid artery stenosis causes a relatively small portion of strokes.
Auscultation of the carotid arteries for bruits has been found to have poor accuracy for detecting
carotid stenosis and is not a reasonable screening approach. Appropriate modalities for detecting
carotid stenosis include carotid duplex ultrasonography, magnetic resonance angiography, and
computed tomography, but there are not recommended for screening asymptomatic patients.
A 28 year old female presents for evaluation of nasal congestion, sneezing, watery eyes, and
postnasal drip. This has been an intermittent issue for her every spring and she would like to
manage it more effectively.
Which one of the following treatments has been shown to be the most effective and best
tolerated first-line therapy for this patient's condition?
A. A leukotriene receptor agonist
B. Intranasal corticosteroid monotherapy
C. Intranasal corticosteroids plus an oral antihistamine
D. Inhaled corticosteroids
APPHIA – Crafted with Care and Precision for Academic Excellence.
2
,E. Annual triamcinolone injections Answer: ANSWER: B
Intranasal corticosteroid monotherapy
This patient has seasonal allergic rhinitis. A joint guideline statement from the American
Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma and
Immunology Joint Task Force on Practice Parameters recommends that mono therapy with
intranasal corticosteroids would be prescribed initially in patients equal to or more than 12 years
of age rather than combined treatment with oral antihistamines because data has not shown an
additional benefit to adding the antihistamine. Higher patient adherence and tolerance and fewer
side effects were seen with the mono therapy regimen. High quality evidence indicates that
intranasal corticosteroids were more effective than leukotriene receptor antagonists. Inhaled
corticosteroids and triamcinolone injections are not appropriate first line options for the
treatment of seasonal allergic rhinitis
A 68 year old female presents with a 2 month history of watery diarrhea. She has not had any
blood or pus in her stools, and the stools are not oily. She has not had any history of fever, chills,
or weight loss, and has not traveled recently. She smokes one pack of cigarettes per day. Her
medications include ibuprofen, sertraline and pantoprazole. A CBC, metabolic panel, CRP, IgA
anti tissue transglutaminase level, total IgA level, and stool guaiac test are all normal.
Which one of the following tests would be mostly likely to yield a diagnosis?
A. C difficile toxin
B. Colonoscopy
C. Fecal calprotectin
D. A stool culture
E. Stool exam for ova and parasites Answer: ANSWER: B
Colonoscopy
In patients with chronic nonbloody diarrhea, the differential diagnosis includes microscopic
(lymphocytic or collagenous) colitis. The mucosa appears normal on colonoscopy but a biopsy
will show lymphocytic infiltration of the epithelium. The etiology is unknown but there are
several risk factors to consider, including older age, female sex, and smoking status. Drugs with
a high level of evidence causing microscopic colitis include NSAIDs, PPIs, sertraline, acarbose,
aspirin, and ticlopidine. C. diff should be suspected in individuals who have taken antibiotics in
the past 3 months. Fecal calprotectin is elevated in inflammatory diarrhea such as Crohn's
disease or ulcerative colitis. A stool culture would be indicated if there is a suspicion of an
infectious bacterial diarrhea such as Shigella or Salmonella, but these bacteria tend to cause
bloody diarrhea. Checking for a parasitic infection should be considered for patients with a
history of recent travel or exposure to unpurified water.
A 23 year old male with opioid use disorder requests buprenorphine therapy. He is still actively
using immediate release oxycodone and he took a dose 2 hours ago.
APPHIA – Crafted with Care and Precision for Academic Excellence.
3
, This patient should begin buprenorphine induction
A. Now
B. In 2 hours
C. 8-12 hours after his last opioid use
D. 24 hours after his last opioid use
E. 1 week after his last opioid use Answer: ANSWER: C
8-12 hours after his last opioid use
Buprenorphine is a partial opioid agonist. In order to reduce the risk of precipitated withdrawal,
buprenorphine induction should begin once the patient is exhibiting signs of mild to moderate
withdrawal, usually 8-12 hours after the last opioid use. Waiting until a patient goes through a
full withdrawal increases the chances that the patient will revert back to using opioids.
A 45 year old left hand dominant female presents to your office with a lump on her hand. She
first noticed the lump 2 weeks ago and thinks it has gotten bigger. She does not recall any injury.
She has not had any numbness, weakness, or tingling. She has minimal discomfort when she
presses on the lump, and it does not affect her activity. On examination her left wrist is
neurovascularly intact.
Which one of the following management options would you recommend?
A. Re-examination if she develops numbness, weakness, or increased pain
B. Immobilization of the wrist for 6 weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the lesion with a corticosteroid
E. Referral for excision of the lesion Answer: ANSWER: A. Re-examination if she develops
numbness, weakness or increased pain
This patient has a ganglion cyst, which is common and resolves spontaneously in 50% of cases,
and watchful waiting would be most appropriate at this time. Treatment is indicated if the cyst is
causing significant symptoms such as pain, numbness, or weakness, or for cosmetic symptoms.
Aspiration of the lesion is the initial treatment, although recurrence may occur in 85% of cases.
Immobilizing the wrist with a splint or brace is sometimes helpful in the short term if the patient
is bothered by the symptoms, but immobilization does not provide lasting relief and could cause
muscle atrophy. Corticosteroid injections have not shown any benefit. Referral for excision is
appropriate if there has been no improvement. Patients should be advised that there is a 10%-
15% recurrence rate even after excision.
A 57 year old female with diabetes mellitus comes to your office for a routine follow up. Her
current medications include metformin 1000 mg twice daily. She tells you that she does not
exercise regularly and finds it difficult to follow a healthy diet. HbA1c today is 7.5%. She does
APPHIA – Crafted with Care and Precision for Academic Excellence.
4
