FM
CARD I OLOGY / P U LMONARY / GASTROENTEROLOGY / END OCRI NE /
NEP H ROLOGY / NEU ROLOGY / I NFECTI OU S D I SEASE
2 02 02 7 EDI TI ON | VO L U M E 1 | P R AC T I C E
E X A M I N AT I O N
ABFM ITE
Practice ExamV1
180 Multiple-Choice Questions with Answers and Full
Rationales — Family Medicine In-Training Examination
Preparation
F ULL- LENGTH EXAM VI GNETTE- B ASED
STANDARD I TE DI F F I CULTY A– E F ORMAT
A single, full-length practice examination containing one hundred eighty
original vignette-style multiple-choice questions spanning the internal
medicine subspecialties most heavily represented on the American Board of
Family Medicine In-Training Examination. Each item is paired with a detailed
rationale that explains the correct answer, dissects the most tempting
distractors, and references current clinical guidelines — designed for realistic
self-assessment and targeted review.
E X A M I N AT I O N F O R M AT
180 Items · Single Best Answer · A–E
Vignette-Heavy · Standard ABFM ITE Difficulty Mix (40/40/20)
F A M I LY M E D I C I N E · I N - T R A I N I N G E X A M I N AT I O N P R E P
V O L U M E 1 · 2 0 2 0 2 7 U P D AT E
,ABFM ITE Practice Exam V1 — 2026/2027 Update Questions
Exam Instructions & Overview
This practice examination contains 180 multiple-choice questions designed to mirror the content, format,
and difficulty of the American Board of Family Medicine In-Training Examination (ABFM ITE). All questions
are original, vignette-based items authored to reflect the 2026/2027 ITE blueprint, with emphasis on
internal medicine subspecialties most heavily represented on the exam: cardiology, pulmonary medicine,
gastroenterology, endocrinology, nephrology, neurology, and infectious disease. Each item presents a
clinical scenario followed by a lead-in question and five answer options (A–E). Questions are arranged in a
single continuous exam with no section breaks, replicating the actual test-day experience.
How to use this exam. For the most realistic practice, complete all 180 questions in a single sitting without
consulting external references, then score yourself using the Answer Key and Rationales section that
follows the exam. A compact Quick-Reference Answer Grid appears on the final page for rapid scoring.
Each rationale explains why the correct answer is right and why the most tempting distractors are wrong,
with explicit reference to current guidelines (ACC/AHA, GINA, GOLD, ADA, KDIGO, AHA/ASA, CDC, IDSA,
USPSTF, and others) and landmark trials where relevant. Use these rationales as a focused review of
high-yield teaching points.
Difficulty distribution. The exam follows the standard ITE difficulty mix: approximately 40% of items are
straightforward (test recognition of classic presentations and first-line management), 40% are
intermediate (require two-step reasoning or differentiation between similar entities), and 20% are
challenging (test nuanced guideline application, interpretation of conflicting data, or management of
complex comorbidities). This distribution mirrors what residents encounter on the actual ITE.
Topic Distribution
Topic Area Number of Questions Approximate %
Cardiology 35 19.4%
Pulmonary 25 13.9%
Gastroenterology 25 13.9%
Endocrine 25 13.9%
Nephrology 20 11.1%
Neurology 25 13.9%
Infectious Disease 25 13.9%
180 MCQs with Answers & Rationales Page 1 Family Medicine In-Training Exam Prep
,ABFM ITE Practice Exam V1 — 2026/2027 Update Questions
Topic Area Number of Questions Approximate %
Total 180 100.0%
Scoring & Interpretation
Each question is worth one point; there is no penalty for guessing. After completing the exam, compare
your responses to the Quick-Reference Answer Grid on the final page. As a rough guide to ABFM ITE
performance, residents typically need to answer approximately 65–70% of items correctly to score at the
national mean; scores above 80% historically correlate with a high probability of passing the ABFM
certification examination on the first attempt. Use the detailed rationales to identify knowledge gaps and
prioritize topics for further study. Particular attention should be paid to items you answered incorrectly
even when you felt confident about your choice, as these often reflect ingrained misconceptions that will
recur on the actual exam without targeted remediation.
Disclaimer
This practice examination is an independent educational resource authored for resident and clinician
self-assessment. It is not affiliated with, endorsed by, or derived from any official American Board of Family
Medicine material. All questions, vignettes, and rationales are original work. Clinical recommendations
referenced in the rationales reflect guidelines current as of 2024–2025; readers should verify against the
most recent guideline updates before applying recommendations to patient care. This document is
intended for educational use only and does not constitute medical advice.
180 MCQs with Answers & Rationales Page 2 Family Medicine In-Training Exam Prep
, ABFM ITE Practice Exam V1 — 2026/2027 Update Questions
QUESTION 1 · Cardiology · Straightforward
A 62-year-old man with hypertension and type 2 diabetes presents to the emergency department with 40
minutes of crushing substernal chest pressure radiating to the left arm, associated with diaphoresis, nausea,
and mild dyspnea. Vitals: BP 152/92, HR 98, SpO2 97% on room air. ECG shows 2 mm ST elevations in leads II, III,
and aVF with reciprocal ST depressions in I and aVL. The patient is at a PCI-capable hospital and has no
contraindications to anticoagulation.
What is the most appropriate next step in management?
A. Administer aspirin, P2Y12 inhibitor, parenteral anticoagulant, and activate the cath lab for primary PCI
B. Administer fibrinolytic therapy within 30 minutes of arrival
C. Obtain CT chest with contrast to exclude aortic dissection
D. Wait for serial troponins before calling cardiology
E. Give morphine, sublingual nitrates, and admit for observation
QUESTION 2 · Cardiology · Intermediate
A 71-year-old woman with type 2 diabetes and chronic kidney disease presents to the emergency department
with intermittent chest pain at rest over the past 48 hours, occurring every few hours and lasting 10 to 15
minutes each time. ECG shows dynamic T-wave inversions in V2 through V4 that were not present on a prior
ECG. High-sensitivity troponin T is 0.42 ng/mL (reference less than 0.01). She is hemodynamically stable with BP
142/86 and HR 88, and has no signs of heart failure.
What is the most appropriate management strategy?
A. Immediate invasive strategy (within 2 hours)
B. Routine medical therapy followed by stress testing
C. Fibrinolytic therapy within 30 minutes
D. Early invasive strategy (within 24 hours)
E. Observe and recheck troponin in 6 hours before deciding
QUESTION 3 · Cardiology · Straightforward
A 64-year-old man with known coronary artery disease has stable exertional angina occurring two to three
times per week, each relieved by sublingual nitroglycerin within 5 minutes. Current medications: aspirin 81 mg
daily, atorvastatin 80 mg daily, metoprolol succinate 100 mg daily. Vitals: BP 124/72, HR 56, LDL 68 mg/dL. He
has no prior revascularization and reports good medication adherence. He has no chest pain at rest.
What is the most appropriate addition to reduce angina frequency?
A. Ranolazine
B. Isosorbide mononitrate
C. Clopidogrel
D. Coronary artery bypass surgery
E. Add ezetimibe to current statin
180 MCQs with Answers & Rationales Page 3 Family Medicine In-Training Exam Prep
CARD I OLOGY / P U LMONARY / GASTROENTEROLOGY / END OCRI NE /
NEP H ROLOGY / NEU ROLOGY / I NFECTI OU S D I SEASE
2 02 02 7 EDI TI ON | VO L U M E 1 | P R AC T I C E
E X A M I N AT I O N
ABFM ITE
Practice ExamV1
180 Multiple-Choice Questions with Answers and Full
Rationales — Family Medicine In-Training Examination
Preparation
F ULL- LENGTH EXAM VI GNETTE- B ASED
STANDARD I TE DI F F I CULTY A– E F ORMAT
A single, full-length practice examination containing one hundred eighty
original vignette-style multiple-choice questions spanning the internal
medicine subspecialties most heavily represented on the American Board of
Family Medicine In-Training Examination. Each item is paired with a detailed
rationale that explains the correct answer, dissects the most tempting
distractors, and references current clinical guidelines — designed for realistic
self-assessment and targeted review.
E X A M I N AT I O N F O R M AT
180 Items · Single Best Answer · A–E
Vignette-Heavy · Standard ABFM ITE Difficulty Mix (40/40/20)
F A M I LY M E D I C I N E · I N - T R A I N I N G E X A M I N AT I O N P R E P
V O L U M E 1 · 2 0 2 0 2 7 U P D AT E
,ABFM ITE Practice Exam V1 — 2026/2027 Update Questions
Exam Instructions & Overview
This practice examination contains 180 multiple-choice questions designed to mirror the content, format,
and difficulty of the American Board of Family Medicine In-Training Examination (ABFM ITE). All questions
are original, vignette-based items authored to reflect the 2026/2027 ITE blueprint, with emphasis on
internal medicine subspecialties most heavily represented on the exam: cardiology, pulmonary medicine,
gastroenterology, endocrinology, nephrology, neurology, and infectious disease. Each item presents a
clinical scenario followed by a lead-in question and five answer options (A–E). Questions are arranged in a
single continuous exam with no section breaks, replicating the actual test-day experience.
How to use this exam. For the most realistic practice, complete all 180 questions in a single sitting without
consulting external references, then score yourself using the Answer Key and Rationales section that
follows the exam. A compact Quick-Reference Answer Grid appears on the final page for rapid scoring.
Each rationale explains why the correct answer is right and why the most tempting distractors are wrong,
with explicit reference to current guidelines (ACC/AHA, GINA, GOLD, ADA, KDIGO, AHA/ASA, CDC, IDSA,
USPSTF, and others) and landmark trials where relevant. Use these rationales as a focused review of
high-yield teaching points.
Difficulty distribution. The exam follows the standard ITE difficulty mix: approximately 40% of items are
straightforward (test recognition of classic presentations and first-line management), 40% are
intermediate (require two-step reasoning or differentiation between similar entities), and 20% are
challenging (test nuanced guideline application, interpretation of conflicting data, or management of
complex comorbidities). This distribution mirrors what residents encounter on the actual ITE.
Topic Distribution
Topic Area Number of Questions Approximate %
Cardiology 35 19.4%
Pulmonary 25 13.9%
Gastroenterology 25 13.9%
Endocrine 25 13.9%
Nephrology 20 11.1%
Neurology 25 13.9%
Infectious Disease 25 13.9%
180 MCQs with Answers & Rationales Page 1 Family Medicine In-Training Exam Prep
,ABFM ITE Practice Exam V1 — 2026/2027 Update Questions
Topic Area Number of Questions Approximate %
Total 180 100.0%
Scoring & Interpretation
Each question is worth one point; there is no penalty for guessing. After completing the exam, compare
your responses to the Quick-Reference Answer Grid on the final page. As a rough guide to ABFM ITE
performance, residents typically need to answer approximately 65–70% of items correctly to score at the
national mean; scores above 80% historically correlate with a high probability of passing the ABFM
certification examination on the first attempt. Use the detailed rationales to identify knowledge gaps and
prioritize topics for further study. Particular attention should be paid to items you answered incorrectly
even when you felt confident about your choice, as these often reflect ingrained misconceptions that will
recur on the actual exam without targeted remediation.
Disclaimer
This practice examination is an independent educational resource authored for resident and clinician
self-assessment. It is not affiliated with, endorsed by, or derived from any official American Board of Family
Medicine material. All questions, vignettes, and rationales are original work. Clinical recommendations
referenced in the rationales reflect guidelines current as of 2024–2025; readers should verify against the
most recent guideline updates before applying recommendations to patient care. This document is
intended for educational use only and does not constitute medical advice.
180 MCQs with Answers & Rationales Page 2 Family Medicine In-Training Exam Prep
, ABFM ITE Practice Exam V1 — 2026/2027 Update Questions
QUESTION 1 · Cardiology · Straightforward
A 62-year-old man with hypertension and type 2 diabetes presents to the emergency department with 40
minutes of crushing substernal chest pressure radiating to the left arm, associated with diaphoresis, nausea,
and mild dyspnea. Vitals: BP 152/92, HR 98, SpO2 97% on room air. ECG shows 2 mm ST elevations in leads II, III,
and aVF with reciprocal ST depressions in I and aVL. The patient is at a PCI-capable hospital and has no
contraindications to anticoagulation.
What is the most appropriate next step in management?
A. Administer aspirin, P2Y12 inhibitor, parenteral anticoagulant, and activate the cath lab for primary PCI
B. Administer fibrinolytic therapy within 30 minutes of arrival
C. Obtain CT chest with contrast to exclude aortic dissection
D. Wait for serial troponins before calling cardiology
E. Give morphine, sublingual nitrates, and admit for observation
QUESTION 2 · Cardiology · Intermediate
A 71-year-old woman with type 2 diabetes and chronic kidney disease presents to the emergency department
with intermittent chest pain at rest over the past 48 hours, occurring every few hours and lasting 10 to 15
minutes each time. ECG shows dynamic T-wave inversions in V2 through V4 that were not present on a prior
ECG. High-sensitivity troponin T is 0.42 ng/mL (reference less than 0.01). She is hemodynamically stable with BP
142/86 and HR 88, and has no signs of heart failure.
What is the most appropriate management strategy?
A. Immediate invasive strategy (within 2 hours)
B. Routine medical therapy followed by stress testing
C. Fibrinolytic therapy within 30 minutes
D. Early invasive strategy (within 24 hours)
E. Observe and recheck troponin in 6 hours before deciding
QUESTION 3 · Cardiology · Straightforward
A 64-year-old man with known coronary artery disease has stable exertional angina occurring two to three
times per week, each relieved by sublingual nitroglycerin within 5 minutes. Current medications: aspirin 81 mg
daily, atorvastatin 80 mg daily, metoprolol succinate 100 mg daily. Vitals: BP 124/72, HR 56, LDL 68 mg/dL. He
has no prior revascularization and reports good medication adherence. He has no chest pain at rest.
What is the most appropriate addition to reduce angina frequency?
A. Ranolazine
B. Isosorbide mononitrate
C. Clopidogrel
D. Coronary artery bypass surgery
E. Add ezetimibe to current statin
180 MCQs with Answers & Rationales Page 3 Family Medicine In-Training Exam Prep
