ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
A 45-year-old female presents to the emergency ANSWER: E
department with a 1-week history of facial swelling and
progressive dyspnea with exertion. She was diagnosed 1 Because of the prevalence of cancer in the United States, it is important for family
week ago with non-Hodgkin lymphoma but her medical physicians to recognize oncologic emergencies. This patient presents with signs
history is otherwise unremarkable. A chest radiograph is and symptoms related to superior vena cava syndrome, which is caused by
shown below. compression of the superior vena cava. This is most often caused by lung cancer or
lymphoma, but it can also be related to indwelling catheters, lymph nodes, or
After hospital admission, which one of the following would metastatic tumors. After ensuring that the patient is hospitalized and stable, the
be the most appropriate urgent next step in the initial treatment options include intravenous corticosteroids, chemotherapy,
management of this condition? radiation, and occasionally intravascular stenting.
A) Intravenous antibiotics This condition is not the result of an infection, so antibiotics would not be
B) Echocardiography appropriate. Hyperviscosity syndrome is another oncologic emergency associated
C) Plasmapheresis with leukemia, multiple myeloma, and Waldenström macroglobulinemia. It is treated
D) Bronchoscopy with chemotherapy and plasmapheresis. Echocardiography and bronchoscopy are
E) Radiation not indicated in the initial management of superior vena cava syndrome.
A 22-year-old male presents for follow-up of moderate ANSWER: B
persistent asthma. After discussing his treatment options,
you decide to use a single maintenance and reliever In the single maintenance and reliever therapy (SMART) approach for asthma
therapy (SMART) approach. control, combination therapy with an inhaled corticosteroid and a long-acting
bronchodilator is used as both controller and rescue medication. SMART is
Which one of the following daily inhaled therapies is recommended as the preferred therapeutic approach in steps 3 and 4 in the 2020
appropriate to prescribe in this setting? National Asthma Education and Prevention Program guidelines. Formoterol is the
only medication available in the United States recommended for use in SMART
A) Budesonide (Pulmicort) therapy due to its rapid onset of action. Budesonide monotherapy,
B) Budesonide/formoterol (Symbicort) fluticasone/salmeterol, fluticasone/vilanterol, and tiotropium/olodaterol are not
C) Fluticasone/salmeterol (Advair Diskus) appropriate options for SMART in asthma control.
D) Fluticasone/vilanterol (Breo Ellipta)
E) Tiotropium/olodaterol (Stiolto Respimat);
Which one of the following is an indication for long-term, ANSWER: B
rather than short-term, proton pump inhibitor therapy?
Proton pump inhibitors (PPIs) are some of the most commonly used prescription or
A) The eradication of Helicobacter pylori OTC medications. However, many patients don't have a clear indication for their
B) Gastroprotection in users of high-dose NSAIDs at high use, leading to situations in which the risks may outweigh the benefits. In 2022 the
risk for gastrointestinal bleeding AGA published 10 best practice statements to assist clinicians in addressing this
C) The prevention of rebleeding from a Mallory-Weiss tear issue. Key recommendations include regular review and documentation of the
D) The prevention of ulcers after band ligation of indication for any ongoing PPI use and to consider discontinuing PPIs for any
esophageal varices patient without a clear indication. Strategies for PPI discontinuation include tapering
E) The treatment of an NSAID-related gastric ulcer or abrupt discontinuation. Rebound acid hypersecretion can lead to a temporary
increase in symptoms in either approach. If deprescribing is attempted but not
tolerated, patients may reasonably be continued on the lowest effective dose.
Possible risks, mostly reported in retrospective studies, include an increased
incidence of chronic kidney disease, fractures, dementia, and respiratory infections,
including COVID-19.
While many patients remain on long-term PPI therapy without a clear indication,
sometimes the benefits of PPIs do clearly outweigh the risks. Examples include
Barrett esophagus, severe erosive esophagitis, eosinophilic esophagitis, and high
risk for upper GI bleeding. Risk factors for GI bleeding include prior ulcer, age >65,
high-dose NSAID use, or concurrent use of aspirin, corticosteroids, or
anticoagulants. Such patients should be advised to use PPIs indefinitely. PPIs are
recommended for short-term use for eradication of H. pylori and treatment of
NSAID-induced gastric ulcers. They may also be considered as adjunctive short-
term therapy in Mallory-Weiss tears and after sclerotherapy or band ligation
treatment of esophageal varices. None of these are indications for long-term use in
the absence of other indications.
, ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
An 85-year-old male presents for an annual Medicare ANSWER: A
examination. His wife tells you that he has been repeating
himself in conversations, buying the same item multiple Dementia is a significant condition affecting 5 million adults and that number is likely
times, and taking longer to complete routine tasks such as to expand in the future due to the increasing number of individuals over age 65. The
balancing the checkbook. He recalls 1 out of 3 items on overall prevalence of dementia is around 5%, but it is 37% in those over age 90.
the Mini-Cognitive Assessment Instrument (Mini-Cog) and Sixty percent to 80% of dementia is due to Alzheimer disease. The greatest risk
is unable to draw a clock. A depression screening is factor for dementia is older age. Strong risk factors include diabetes mellitus, midlife
negative. obesity, a family history of dementia, a personal history of cardiovascular disease,
cerebrovascular disease, use of anticholinergic medications, apolipoprotein E4
Which one of the following is the greatest risk factor for this genotype, and a low education level. Other potential risk factors that lack strong
patient's condition? evidence include atrial fibrillation, smoking, head trauma, substance abuse such as
alcohol use disorder, and medications such as benzodiazepines and proton pump
A) Advanced age inhibitors.
B) Atrial fibrillation
C) Diabetes mellitus
D) A history of head trauma
E) Smoking
Which one of the following would be the most appropriate ANSWER: C
initial pharmacotherapy for a temporomandibular disorder
in an otherwise healthy 54-year-old male? The initial first-line pharmacologic therapy for temporomandibular disorders is
naproxen. Cyclobenzaprine may also be added if there is evidence of muscle
A) Amitriptyline, 25 mg at bedtime spasm (A recommendation). If this is unsuccessful, other options include a trial of
B) Gabapentin (Neurontin), 300 mg daily amitriptyline or gabapentin. Opioid therapy is not appropriate first-line treatment for
C) Naproxen, 500 mg twice daily temporomandibular disorders. Corticosteroid injections should be avoided due to
D) Tramadol, 50 mg every 6 hours potential cartilage damage (B recommendation).
E) Corticosteroid injection into the temporomandibular joint
A 33-year-old female presents to your office concerned ANSWER: B
about feeling fatigued for the past few months. She says
that she feels cold often, has intermittent joint discomfort, Thyroiditis, a general term for inflammation of the thyroid gland, is associated with
and has gained 5 lb. She has not experienced any pain or thyroid gland dysfunction. It is classified based on clinical symptoms: painless or
problems swallowing. She gave birth to her youngest child painful, acute or subacute, and underlying etiology (medication-induced, infection,
almost 3 years ago, and she recently started an oral radiation-induced, or autoimmune). The most common forms of thyroiditis include
contraceptive. She has not had any recent illnesses. Her Hashimoto, subacute, and postpartum. Thyroiditis often results in a triphasic
family history is significant for rheumatoid arthritis. disease pattern of thyroid dysfunction: hyperthyroidism due to the release of
A physical examination reveals a mild goiter but is preformed thyroid hormone from damaged thyroid cells followed by hypothyroidism
otherwise unremarkable. Her vital signs are stable. A CBC when the thyroid stores are depleted. Eventually normal thyroid function is restored,
and comprehensive metabolic panel are normal. A TSH or the patient develops permanent hypothyroidism. This patient presents with
level is 6.48 U/mL (N 0.4-4.5) and a thyroid peroxidase symptoms commonly seen in thyroid disease. Further testing reveals elevated TSH
antibody level is 378 IU/mL (N <34). A free T4 level is and thyroid peroxidase (TPO) levels. Elevated TPO levels are found in 95% of
normal. patients with Hashimoto thyroiditis. In addition, this patient's family history includes
rheumatoid arthritis, another autoimmune disease, making Hashimoto thyroiditis the
Which one of the following is the most likely diagnosis for most likely diagnosis. Treatment is lifelong thyroid hormone therapy.
this patient? Several medications are linked to thyroiditis, including lithium, amiodarone,
interferon-alfa, interleukin-2, immune checkpoint inhibitors, and tyrosine kinase
A) Drug-induced thyroiditis inhibitors. However, there is no proven link between oral contraceptives and
B) Hashimoto thyroiditis Hashimoto thyroiditis. Postpartum thyroiditis occurs within 1 year of delivery,
C) Postpartum thyroiditis miscarriage, or medical abortion, not 2-3 years. Subacute thyroiditis is self-limited
D) Subacute thyroiditis and often occurs after upper respiratory infections, causing thyroid pain and
dysphagia due to inflammatory destruction of thyroid follicles.
A first-time mother brings her 12-month-old to your office ANSWER: D
for a well child check. She and the child's father are both
your patients as well. Routine anemia screening shows Postpartum depression is common and patients who have given birth should be
microcytic anemia with elevated RDW. You ask the parent screened for a minimum of 1 year. A mother who knows what to feed an infant may
about the child's diet. She looks down at the floor, have trouble executing it because of severe postpartum depression, leading to poor
exhibiting poor eye contact and a flat affect, and responds infant feeding practices. In this case, the provider will be more likely to successfully
that she does not shop or cook often. She says the child is treat the child's anemia by treating the mother's postpartum depression.
happy when eating just applesauce and milk. She says While mothers with depression often need encouragement and support, false
she's been unmotivated and crying frequently. reassurance is paternalistic and potentially harmful. Education of the mother is
sometimes useful, but studies have demonstrated that the more likely barrier to
In addition to checking the child's lead level and starting implementing her knowledge is not a need for education on infant nutrition, but
iron supplementation, which would be the most important rather severe depression or other psychosocial barriers. It is ideal to involve all
next step? caretakers in efforts to support a child's health, but a number of steps need to be
taken prior to calling the father, including screening for domestic violence, checking
A) Providing reassurance and validation for the mother on HIPAA consents, and asking about custody. Referring the mother to a
B) Educating the mother about nutrition and the psychiatrist may ultimately be helpful but puts unnecessary barriers in place for the
importance of iron-rich foods for the child testing and treatment of postpartum depression.
C) Notifying the child's father
D) Evaluating and treating the mother for postpartum
depression
E) Referring the mother to a psychiatrist
, ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
A 52-year-old male presents to your office for a routine ANSWER: A
annual health maintenance examination. He has a past
medical history of hypertension and well-controlled type 2 Although testicular cancer is the most common solid cancer in men ages 15-34,
diabetes with a hemoglobin A1c of 6.6%. He is also a with effective treatment and an overall survival rate of 97%, the U.S. Preventive
chronic tobacco smoker. He requests screening for Services Task Force recommends against screening for testicular cancer in
testicular cancer because his close friend recently died asymptomatic adolescent or adult males (D recommendation).
from the disease. Other than colon cancer in his adoptive A detailed history and physical examination should be obtained in symptomatic
father, there is no known family history of cancer. patients, followed by scrotal ultrasonography if there are positive findings on history
and physical examination. Tumor markers and CT of the abdomen and pelvis are
Which one of the following is indicated for testicular cancer required for staging, treatment recommendations, and surveillance, but not for
screening for this patient? screening purposes.
A) No screening
B) An α-fetoprotein level
C) Scrotal ultrasonography now
D) Scrotal ultrasonography at age 55
E) CT of the abdomen and pelvis at age 55
An 82-year-old female in your palliative care service who ANSWER: D
has stage 4 breast cancer is experiencing frequent
episodes of delirium. Her pain is well controlled on long- The first step in managing delirium in end-of-life care is to assess for any reversible
acting oral opioid therapy. Additionally, no other reversible or treatable causes, including uncontrolled pain, constipation, urinary retention,
causes of delirium are noted. Her delirium is not infections (e.g., urinary tract infections), and medication side effects. Antipsychotic
responding to conservative measures, and her family asks medications, such as haloperidol and risperidone, are recommended if conservative
if there are any medications that can effectively manage measures fail to control the symptoms of delirium. Benzodiazepines should be used
her symptoms. with caution as they can worsen delirium, especially in older patients. Melatonin is
not indicated in the management of delirium.
Which one of the following should you recommend?
A) Alprazolam (Xanax)
B) Diazepam (Valium)
C) Melatonin
D) Risperidone (Risperdal)
A Black female presents with multiple insect bites on her ANSWER: E
arms and legs. This patient is at risk for developing which
one of the following conditions? Patients with dark skin are at greater risk for postinflammatory hyperpigmentation, a
reactive hypermelanosis. These are irregular hyperpigmented macules or patches
A) Acanthosis nigricans that can occur after endogenous inflammation (e.g., acne vulgaris, pseudofolliculitis
B) Acne keloidalis nuchae barbae, atopic dermatitis, lichen planus, psoriasis, contact dermatitis) and external
C) Dermatosis papulosa nigra injuries (e.g., insect bites, chemical peels, cryotherapy, laser surgery). This
D) Melasma condition can occur at any age and is particularly noticeable in Fitzpatrick skin
E) Postinflammatory hyperpigmentation phototypes III, IV, V, and VI. Fitzpatrick skin phototype is used to classify the skin
color spectrum and is based on an individual's propensity for sunburn
(photodermatitis). It is not a surrogate marker for race or ethnicity. Broad-spectrum,
water-based sunscreen with SPF 30 should be used to prevent postinflammatory
hyperpigmentation (SOR C). Sunscreen that blocks visible light such as iron oxide
is also useful.
Acanthosis nigricans, acne keloidalis nuchae, dermatosis papulosa nigra, and
melasma are conditions that are also more common in skin of color. However, they
are not related to external injuries such as insect bites. Acanthosis nigricans are
usually on the posterior neck, axillae, and groin. These are velvety, irregularly
defined, hyperpigmented patches. Acne keloidalis nuchae occur in the nuchal and
occipital scalp. These are keloid-like papules, plaques, and cicatricial alopecia.
Dermatosis papulosa nigra is usually on the face and neck. They are
hyperpigmented, filiform, or sessile papules. Melasma are gray-brown patches that
usually occur on the face.
, ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
You are co-managing a 59-year-old female with stage 3b ANSWER: D
chronic kidney disease (CKD) and secondary
hyperparathyroidism resulting in osteoporosis. Due to Routine laboratory monitoring is required for patients with chronic kidney disease-
transportation issues, she has been unable to see her bone mineral disorder (CKD-BMD) or secondary hyperparathyroidism due to renal
specialist and requests that you take over her laboratory disease. This patient has secondary hyperparathyroidism due to CKD, which
surveillance for CKD-bone mineral disorder. interferes with normal calcium, phosphorus, and vitamin D regulation. Parathyroid
hormone (PTH) stimulates bone resorption and increases serum calcium and
In addition to serum calcium, parathyroid hormone, vitamin phosphorus levels, and an elevated PTH level can result in significant
D, and creatinine levels and the estimated glomerular hypercalcemia and hyperphosphatemia. Controlling these levels through diet and
filtration rate, which one of the following laboratory values medication reduces fracture risk and mortality. Monitoring calcitonin, magnesium,
should be routinely monitored? and TSH levels on a routine basis is not useful for the management of CKD-BMD.
PTH-related peptide is useful in diagnosing humoral hypercalcemia of malignancy
A) Calcitonin but does not play a role in CKD-BMD monitoring.
B) Magnesium
C) Parathyroid hormone-related peptide
D) Phosphorus
E) TSH
A 42-year-old premenopausal female presents to your ANSWER: B
office with new-onset bilateral nipple discharge for the past
4 weeks. She describes the discharge as green and Of this patient's medications, escitalopram is most likely to induce galactorrhea.
nonbloody. She has a past medical history of diabetes SSRIs are responsible for 95% of medication-induced galactorrhea cases. The
mellitus, dyslipidemia, hypertension, and depression. Her etiology of an elevated prolactin level <100 ng/mL is commonly medication,
current medications include the following: systemic pathology, or a microadenoma. Macroadenomas are associated with
higher prolactin levels (>250 ng/mL). A normal physical examination, negative hCG
Atorvastatin (Lipitor) level, and unremarkable TSH level, BUN level, creatinine level, and liver function
Escitalopram (Lexapro) tests further support a medication-induced etiology for this patient's galactorrhea.
Hydrochlorothiazide Antihypertensives such as calcium channel blockers and methyldopa may cause
Lisinopril (Zestril) galactorrhea, while diuretics such as hydrochlorothiazide and ACE inhibitors such
Metformin as lisinopril are not known offenders. Neither atorvastatin nor metformin are
common etiologies for medication-induced hyperprolactinemia, although
Her vital signs are unremarkable. A physical examination is atorvastatin can cause gynecomastia.
significant for nonbloody green fluid expressed from the
nipples. A TSH level, comprehensive metabolic panel, and
CBC are all within normal range, and a serum hCG test is
negative. A prolactin level is elevated at 85 ng/mL (N <30
in nonpregnant premenopausal females).
Which one of her medications is most likely to cause
galactorrhea?
A) Atorvastatin
B) Escitalopram
C) Hydrochlorothiazide
D) Lisinopril
E) Metformin
A 73-year-old female with a history of obesity, essential ANSWER: B
hypertension, hyperlipidemia, and well-controlled type 2
diabetes presents to the emergency department (ED) with Based on a large, randomized, multicenter trial with 17,187 participants, the
severe, crushing chest pain. She has a blood pressure of administration of aspirin for suspected acute myocardial infarction (MI) saves one
115/64 mm Hg, a pulse rate of 90 beats/min, a respiratory life for every 24 patients. Supplemental oxygen appears to have no benefit in
rate of 15/min, a temperature of 37.2°C (99.0°F), and an patients with an oxygen saturation >94%. Excessive oxygen can be toxic to
oxygen saturation of 95% on room air. A point-of-care endothelial cells and may decrease coronary blood flow and increase systemic
troponin level is 1.0 ng/mL (N <0.04) and an EKG is vascular resistance. ß-blockers given immediately after MI do not decrease
normal, and you diagnose a non-ST-elevation myocardial mortality, likely due to increased cardiogenic shock, although ß-blockers
infarction. administered in the subacute period following the event do have benefit. Morphine
does not appear to have benefit and may increase mortality. The use of nitroglycerin
Which one of the following interventions in the ED has the does not lower the risk of mortality.
greatest benefit with regard to decreasing mortality in this
patient?
A) Supplemental oxygen
B) Aspirin
C) Metoprolol
D) Morphine
E) Nitroglycerin
A 45-year-old female presents to the emergency ANSWER: E
department with a 1-week history of facial swelling and
progressive dyspnea with exertion. She was diagnosed 1 Because of the prevalence of cancer in the United States, it is important for family
week ago with non-Hodgkin lymphoma but her medical physicians to recognize oncologic emergencies. This patient presents with signs
history is otherwise unremarkable. A chest radiograph is and symptoms related to superior vena cava syndrome, which is caused by
shown below. compression of the superior vena cava. This is most often caused by lung cancer or
lymphoma, but it can also be related to indwelling catheters, lymph nodes, or
After hospital admission, which one of the following would metastatic tumors. After ensuring that the patient is hospitalized and stable, the
be the most appropriate urgent next step in the initial treatment options include intravenous corticosteroids, chemotherapy,
management of this condition? radiation, and occasionally intravascular stenting.
A) Intravenous antibiotics This condition is not the result of an infection, so antibiotics would not be
B) Echocardiography appropriate. Hyperviscosity syndrome is another oncologic emergency associated
C) Plasmapheresis with leukemia, multiple myeloma, and Waldenström macroglobulinemia. It is treated
D) Bronchoscopy with chemotherapy and plasmapheresis. Echocardiography and bronchoscopy are
E) Radiation not indicated in the initial management of superior vena cava syndrome.
A 22-year-old male presents for follow-up of moderate ANSWER: B
persistent asthma. After discussing his treatment options,
you decide to use a single maintenance and reliever In the single maintenance and reliever therapy (SMART) approach for asthma
therapy (SMART) approach. control, combination therapy with an inhaled corticosteroid and a long-acting
bronchodilator is used as both controller and rescue medication. SMART is
Which one of the following daily inhaled therapies is recommended as the preferred therapeutic approach in steps 3 and 4 in the 2020
appropriate to prescribe in this setting? National Asthma Education and Prevention Program guidelines. Formoterol is the
only medication available in the United States recommended for use in SMART
A) Budesonide (Pulmicort) therapy due to its rapid onset of action. Budesonide monotherapy,
B) Budesonide/formoterol (Symbicort) fluticasone/salmeterol, fluticasone/vilanterol, and tiotropium/olodaterol are not
C) Fluticasone/salmeterol (Advair Diskus) appropriate options for SMART in asthma control.
D) Fluticasone/vilanterol (Breo Ellipta)
E) Tiotropium/olodaterol (Stiolto Respimat);
Which one of the following is an indication for long-term, ANSWER: B
rather than short-term, proton pump inhibitor therapy?
Proton pump inhibitors (PPIs) are some of the most commonly used prescription or
A) The eradication of Helicobacter pylori OTC medications. However, many patients don't have a clear indication for their
B) Gastroprotection in users of high-dose NSAIDs at high use, leading to situations in which the risks may outweigh the benefits. In 2022 the
risk for gastrointestinal bleeding AGA published 10 best practice statements to assist clinicians in addressing this
C) The prevention of rebleeding from a Mallory-Weiss tear issue. Key recommendations include regular review and documentation of the
D) The prevention of ulcers after band ligation of indication for any ongoing PPI use and to consider discontinuing PPIs for any
esophageal varices patient without a clear indication. Strategies for PPI discontinuation include tapering
E) The treatment of an NSAID-related gastric ulcer or abrupt discontinuation. Rebound acid hypersecretion can lead to a temporary
increase in symptoms in either approach. If deprescribing is attempted but not
tolerated, patients may reasonably be continued on the lowest effective dose.
Possible risks, mostly reported in retrospective studies, include an increased
incidence of chronic kidney disease, fractures, dementia, and respiratory infections,
including COVID-19.
While many patients remain on long-term PPI therapy without a clear indication,
sometimes the benefits of PPIs do clearly outweigh the risks. Examples include
Barrett esophagus, severe erosive esophagitis, eosinophilic esophagitis, and high
risk for upper GI bleeding. Risk factors for GI bleeding include prior ulcer, age >65,
high-dose NSAID use, or concurrent use of aspirin, corticosteroids, or
anticoagulants. Such patients should be advised to use PPIs indefinitely. PPIs are
recommended for short-term use for eradication of H. pylori and treatment of
NSAID-induced gastric ulcers. They may also be considered as adjunctive short-
term therapy in Mallory-Weiss tears and after sclerotherapy or band ligation
treatment of esophageal varices. None of these are indications for long-term use in
the absence of other indications.
, ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
An 85-year-old male presents for an annual Medicare ANSWER: A
examination. His wife tells you that he has been repeating
himself in conversations, buying the same item multiple Dementia is a significant condition affecting 5 million adults and that number is likely
times, and taking longer to complete routine tasks such as to expand in the future due to the increasing number of individuals over age 65. The
balancing the checkbook. He recalls 1 out of 3 items on overall prevalence of dementia is around 5%, but it is 37% in those over age 90.
the Mini-Cognitive Assessment Instrument (Mini-Cog) and Sixty percent to 80% of dementia is due to Alzheimer disease. The greatest risk
is unable to draw a clock. A depression screening is factor for dementia is older age. Strong risk factors include diabetes mellitus, midlife
negative. obesity, a family history of dementia, a personal history of cardiovascular disease,
cerebrovascular disease, use of anticholinergic medications, apolipoprotein E4
Which one of the following is the greatest risk factor for this genotype, and a low education level. Other potential risk factors that lack strong
patient's condition? evidence include atrial fibrillation, smoking, head trauma, substance abuse such as
alcohol use disorder, and medications such as benzodiazepines and proton pump
A) Advanced age inhibitors.
B) Atrial fibrillation
C) Diabetes mellitus
D) A history of head trauma
E) Smoking
Which one of the following would be the most appropriate ANSWER: C
initial pharmacotherapy for a temporomandibular disorder
in an otherwise healthy 54-year-old male? The initial first-line pharmacologic therapy for temporomandibular disorders is
naproxen. Cyclobenzaprine may also be added if there is evidence of muscle
A) Amitriptyline, 25 mg at bedtime spasm (A recommendation). If this is unsuccessful, other options include a trial of
B) Gabapentin (Neurontin), 300 mg daily amitriptyline or gabapentin. Opioid therapy is not appropriate first-line treatment for
C) Naproxen, 500 mg twice daily temporomandibular disorders. Corticosteroid injections should be avoided due to
D) Tramadol, 50 mg every 6 hours potential cartilage damage (B recommendation).
E) Corticosteroid injection into the temporomandibular joint
A 33-year-old female presents to your office concerned ANSWER: B
about feeling fatigued for the past few months. She says
that she feels cold often, has intermittent joint discomfort, Thyroiditis, a general term for inflammation of the thyroid gland, is associated with
and has gained 5 lb. She has not experienced any pain or thyroid gland dysfunction. It is classified based on clinical symptoms: painless or
problems swallowing. She gave birth to her youngest child painful, acute or subacute, and underlying etiology (medication-induced, infection,
almost 3 years ago, and she recently started an oral radiation-induced, or autoimmune). The most common forms of thyroiditis include
contraceptive. She has not had any recent illnesses. Her Hashimoto, subacute, and postpartum. Thyroiditis often results in a triphasic
family history is significant for rheumatoid arthritis. disease pattern of thyroid dysfunction: hyperthyroidism due to the release of
A physical examination reveals a mild goiter but is preformed thyroid hormone from damaged thyroid cells followed by hypothyroidism
otherwise unremarkable. Her vital signs are stable. A CBC when the thyroid stores are depleted. Eventually normal thyroid function is restored,
and comprehensive metabolic panel are normal. A TSH or the patient develops permanent hypothyroidism. This patient presents with
level is 6.48 U/mL (N 0.4-4.5) and a thyroid peroxidase symptoms commonly seen in thyroid disease. Further testing reveals elevated TSH
antibody level is 378 IU/mL (N <34). A free T4 level is and thyroid peroxidase (TPO) levels. Elevated TPO levels are found in 95% of
normal. patients with Hashimoto thyroiditis. In addition, this patient's family history includes
rheumatoid arthritis, another autoimmune disease, making Hashimoto thyroiditis the
Which one of the following is the most likely diagnosis for most likely diagnosis. Treatment is lifelong thyroid hormone therapy.
this patient? Several medications are linked to thyroiditis, including lithium, amiodarone,
interferon-alfa, interleukin-2, immune checkpoint inhibitors, and tyrosine kinase
A) Drug-induced thyroiditis inhibitors. However, there is no proven link between oral contraceptives and
B) Hashimoto thyroiditis Hashimoto thyroiditis. Postpartum thyroiditis occurs within 1 year of delivery,
C) Postpartum thyroiditis miscarriage, or medical abortion, not 2-3 years. Subacute thyroiditis is self-limited
D) Subacute thyroiditis and often occurs after upper respiratory infections, causing thyroid pain and
dysphagia due to inflammatory destruction of thyroid follicles.
A first-time mother brings her 12-month-old to your office ANSWER: D
for a well child check. She and the child's father are both
your patients as well. Routine anemia screening shows Postpartum depression is common and patients who have given birth should be
microcytic anemia with elevated RDW. You ask the parent screened for a minimum of 1 year. A mother who knows what to feed an infant may
about the child's diet. She looks down at the floor, have trouble executing it because of severe postpartum depression, leading to poor
exhibiting poor eye contact and a flat affect, and responds infant feeding practices. In this case, the provider will be more likely to successfully
that she does not shop or cook often. She says the child is treat the child's anemia by treating the mother's postpartum depression.
happy when eating just applesauce and milk. She says While mothers with depression often need encouragement and support, false
she's been unmotivated and crying frequently. reassurance is paternalistic and potentially harmful. Education of the mother is
sometimes useful, but studies have demonstrated that the more likely barrier to
In addition to checking the child's lead level and starting implementing her knowledge is not a need for education on infant nutrition, but
iron supplementation, which would be the most important rather severe depression or other psychosocial barriers. It is ideal to involve all
next step? caretakers in efforts to support a child's health, but a number of steps need to be
taken prior to calling the father, including screening for domestic violence, checking
A) Providing reassurance and validation for the mother on HIPAA consents, and asking about custody. Referring the mother to a
B) Educating the mother about nutrition and the psychiatrist may ultimately be helpful but puts unnecessary barriers in place for the
importance of iron-rich foods for the child testing and treatment of postpartum depression.
C) Notifying the child's father
D) Evaluating and treating the mother for postpartum
depression
E) Referring the mother to a psychiatrist
, ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
A 52-year-old male presents to your office for a routine ANSWER: A
annual health maintenance examination. He has a past
medical history of hypertension and well-controlled type 2 Although testicular cancer is the most common solid cancer in men ages 15-34,
diabetes with a hemoglobin A1c of 6.6%. He is also a with effective treatment and an overall survival rate of 97%, the U.S. Preventive
chronic tobacco smoker. He requests screening for Services Task Force recommends against screening for testicular cancer in
testicular cancer because his close friend recently died asymptomatic adolescent or adult males (D recommendation).
from the disease. Other than colon cancer in his adoptive A detailed history and physical examination should be obtained in symptomatic
father, there is no known family history of cancer. patients, followed by scrotal ultrasonography if there are positive findings on history
and physical examination. Tumor markers and CT of the abdomen and pelvis are
Which one of the following is indicated for testicular cancer required for staging, treatment recommendations, and surveillance, but not for
screening for this patient? screening purposes.
A) No screening
B) An α-fetoprotein level
C) Scrotal ultrasonography now
D) Scrotal ultrasonography at age 55
E) CT of the abdomen and pelvis at age 55
An 82-year-old female in your palliative care service who ANSWER: D
has stage 4 breast cancer is experiencing frequent
episodes of delirium. Her pain is well controlled on long- The first step in managing delirium in end-of-life care is to assess for any reversible
acting oral opioid therapy. Additionally, no other reversible or treatable causes, including uncontrolled pain, constipation, urinary retention,
causes of delirium are noted. Her delirium is not infections (e.g., urinary tract infections), and medication side effects. Antipsychotic
responding to conservative measures, and her family asks medications, such as haloperidol and risperidone, are recommended if conservative
if there are any medications that can effectively manage measures fail to control the symptoms of delirium. Benzodiazepines should be used
her symptoms. with caution as they can worsen delirium, especially in older patients. Melatonin is
not indicated in the management of delirium.
Which one of the following should you recommend?
A) Alprazolam (Xanax)
B) Diazepam (Valium)
C) Melatonin
D) Risperidone (Risperdal)
A Black female presents with multiple insect bites on her ANSWER: E
arms and legs. This patient is at risk for developing which
one of the following conditions? Patients with dark skin are at greater risk for postinflammatory hyperpigmentation, a
reactive hypermelanosis. These are irregular hyperpigmented macules or patches
A) Acanthosis nigricans that can occur after endogenous inflammation (e.g., acne vulgaris, pseudofolliculitis
B) Acne keloidalis nuchae barbae, atopic dermatitis, lichen planus, psoriasis, contact dermatitis) and external
C) Dermatosis papulosa nigra injuries (e.g., insect bites, chemical peels, cryotherapy, laser surgery). This
D) Melasma condition can occur at any age and is particularly noticeable in Fitzpatrick skin
E) Postinflammatory hyperpigmentation phototypes III, IV, V, and VI. Fitzpatrick skin phototype is used to classify the skin
color spectrum and is based on an individual's propensity for sunburn
(photodermatitis). It is not a surrogate marker for race or ethnicity. Broad-spectrum,
water-based sunscreen with SPF 30 should be used to prevent postinflammatory
hyperpigmentation (SOR C). Sunscreen that blocks visible light such as iron oxide
is also useful.
Acanthosis nigricans, acne keloidalis nuchae, dermatosis papulosa nigra, and
melasma are conditions that are also more common in skin of color. However, they
are not related to external injuries such as insect bites. Acanthosis nigricans are
usually on the posterior neck, axillae, and groin. These are velvety, irregularly
defined, hyperpigmented patches. Acne keloidalis nuchae occur in the nuchal and
occipital scalp. These are keloid-like papules, plaques, and cicatricial alopecia.
Dermatosis papulosa nigra is usually on the face and neck. They are
hyperpigmented, filiform, or sessile papules. Melasma are gray-brown patches that
usually occur on the face.
, ABFM ITE 2026 | Family Medicine In-Training Examination | Questions and Answers
You are co-managing a 59-year-old female with stage 3b ANSWER: D
chronic kidney disease (CKD) and secondary
hyperparathyroidism resulting in osteoporosis. Due to Routine laboratory monitoring is required for patients with chronic kidney disease-
transportation issues, she has been unable to see her bone mineral disorder (CKD-BMD) or secondary hyperparathyroidism due to renal
specialist and requests that you take over her laboratory disease. This patient has secondary hyperparathyroidism due to CKD, which
surveillance for CKD-bone mineral disorder. interferes with normal calcium, phosphorus, and vitamin D regulation. Parathyroid
hormone (PTH) stimulates bone resorption and increases serum calcium and
In addition to serum calcium, parathyroid hormone, vitamin phosphorus levels, and an elevated PTH level can result in significant
D, and creatinine levels and the estimated glomerular hypercalcemia and hyperphosphatemia. Controlling these levels through diet and
filtration rate, which one of the following laboratory values medication reduces fracture risk and mortality. Monitoring calcitonin, magnesium,
should be routinely monitored? and TSH levels on a routine basis is not useful for the management of CKD-BMD.
PTH-related peptide is useful in diagnosing humoral hypercalcemia of malignancy
A) Calcitonin but does not play a role in CKD-BMD monitoring.
B) Magnesium
C) Parathyroid hormone-related peptide
D) Phosphorus
E) TSH
A 42-year-old premenopausal female presents to your ANSWER: B
office with new-onset bilateral nipple discharge for the past
4 weeks. She describes the discharge as green and Of this patient's medications, escitalopram is most likely to induce galactorrhea.
nonbloody. She has a past medical history of diabetes SSRIs are responsible for 95% of medication-induced galactorrhea cases. The
mellitus, dyslipidemia, hypertension, and depression. Her etiology of an elevated prolactin level <100 ng/mL is commonly medication,
current medications include the following: systemic pathology, or a microadenoma. Macroadenomas are associated with
higher prolactin levels (>250 ng/mL). A normal physical examination, negative hCG
Atorvastatin (Lipitor) level, and unremarkable TSH level, BUN level, creatinine level, and liver function
Escitalopram (Lexapro) tests further support a medication-induced etiology for this patient's galactorrhea.
Hydrochlorothiazide Antihypertensives such as calcium channel blockers and methyldopa may cause
Lisinopril (Zestril) galactorrhea, while diuretics such as hydrochlorothiazide and ACE inhibitors such
Metformin as lisinopril are not known offenders. Neither atorvastatin nor metformin are
common etiologies for medication-induced hyperprolactinemia, although
Her vital signs are unremarkable. A physical examination is atorvastatin can cause gynecomastia.
significant for nonbloody green fluid expressed from the
nipples. A TSH level, comprehensive metabolic panel, and
CBC are all within normal range, and a serum hCG test is
negative. A prolactin level is elevated at 85 ng/mL (N <30
in nonpregnant premenopausal females).
Which one of her medications is most likely to cause
galactorrhea?
A) Atorvastatin
B) Escitalopram
C) Hydrochlorothiazide
D) Lisinopril
E) Metformin
A 73-year-old female with a history of obesity, essential ANSWER: B
hypertension, hyperlipidemia, and well-controlled type 2
diabetes presents to the emergency department (ED) with Based on a large, randomized, multicenter trial with 17,187 participants, the
severe, crushing chest pain. She has a blood pressure of administration of aspirin for suspected acute myocardial infarction (MI) saves one
115/64 mm Hg, a pulse rate of 90 beats/min, a respiratory life for every 24 patients. Supplemental oxygen appears to have no benefit in
rate of 15/min, a temperature of 37.2°C (99.0°F), and an patients with an oxygen saturation >94%. Excessive oxygen can be toxic to
oxygen saturation of 95% on room air. A point-of-care endothelial cells and may decrease coronary blood flow and increase systemic
troponin level is 1.0 ng/mL (N <0.04) and an EKG is vascular resistance. ß-blockers given immediately after MI do not decrease
normal, and you diagnose a non-ST-elevation myocardial mortality, likely due to increased cardiogenic shock, although ß-blockers
infarction. administered in the subacute period following the event do have benefit. Morphine
does not appear to have benefit and may increase mortality. The use of nitroglycerin
Which one of the following interventions in the ED has the does not lower the risk of mortality.
greatest benefit with regard to decreasing mortality in this
patient?
A) Supplemental oxygen
B) Aspirin
C) Metoprolol
D) Morphine
E) Nitroglycerin
