ABFM ITE EXAM V1 (LATEST 2026/2027 UPDATE) QUESTIONS AND ANSWERS WITH
RATIONALES ALREADY GRADED A+| 100% VERIFIED SOLUTIONS………...
Core Domains
Cardiovascular Medicine
Pulmonary and Infectious Disease
Gastroenterology and Hepatology
Endocrinology and Metabolism
Neurology and Psychiatry
Musculoskeletal Medicine
Pediatrics and Adolescent Medicine
Women's Health and Obstetrics
Preventive Care and Geriatrics
Emergent and Urgent Care
Introduction
,This comprehensive examination prepares family medicine residents for the ABFM In-Training
Examination (ITE), the annual formative assessment administered by the American Board of Family
Medicine. The ITE evaluates clinical knowledge across the full spectrum of family medicine, using
multiple-choice and scenario-based questions that mirror real-world primary care decision-making.
The question bank emphasizes evidence-based guidelines, diagnostic reasoning, chronic disease
management, preventive care, and the care of special populations. Candidates must demonstrate
the clinical judgment and foundational knowledge required for independent family medicine
practice and board certification preparation.
SECTION ONE: QUESTIONS 1–45
Domain 1: Cardiovascular Medicine (Questions 1–12)
Question 1
A 62-year-old man with hypertension and type 2 diabetes presents with acute-onset substernal
chest pressure that began 45 minutes ago while raking leaves. The pain radiates to his left arm
and is associated with diaphoresis and nausea. Blood pressure is 148/92 mm Hg, heart rate 102
beats/min, and oxygen saturation 97% on room air. An ECG shows 2-mm ST-segment elevations
in leads V2–V4. Which of the following is the most appropriate next step in management?
A. Administer sublingual nitroglycerin and observe for 30 minutes
B. Obtain a chest radiograph and complete blood count
C. Immediate transfer to the emergency department for urgent reperfusion therapy
D. Start aspirin 81 mg daily and schedule a stress test for tomorrow
,🟢 C. Immediate transfer to the emergency department for urgent reperfusion therapy
🔴 RATIONALE: This patient presents with classic symptoms of an ST-elevation myocardial
infarction (STEMI) with anterior ST elevations. The most appropriate management is immediate
reperfusion therapy, either percutaneous coronary intervention (PCI) or fibrinolysis, depending
on cath lab availability. Time is muscle, and delay in reperfusion increases myocardial damage.
Nitroglycerin alone does not treat the underlying occlusion. Chest radiograph and blood count
delay definitive care. Stress testing is contraindicated in acute STEMI .
Question 2
A 55-year-old woman with a history of hypertension presents with sudden onset of severe,
tearing chest pain that radiates to her back. Blood pressure is 180/100 mm Hg in the right arm
and 130/80 mm Hg in the left arm. Heart rate is 110 beats/min. Which of the following is the
most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Stage 2 hypertension
🟢 C. Aortic dissection
, 🔴 RATIONALE: Sudden, severe, tearing chest pain radiating to the back with a significant
interarm blood pressure differential is classic for aortic dissection. Immediate imaging and blood
pressure control are critical .
Question 3
A 55-year-old man presents with chest pain radiating to the left arm, diaphoresis, and nausea.
ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🟢 C. Right coronary artery
🔴 RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior STEMI, which is typically
caused by occlusion of the right coronary artery (RCA). The RCA supplies the inferior wall of the
left ventricle and the posterior septum. Inferior MI is often associated with bradycardia and
hypotension due to vagal stimulation .
RATIONALES ALREADY GRADED A+| 100% VERIFIED SOLUTIONS………...
Core Domains
Cardiovascular Medicine
Pulmonary and Infectious Disease
Gastroenterology and Hepatology
Endocrinology and Metabolism
Neurology and Psychiatry
Musculoskeletal Medicine
Pediatrics and Adolescent Medicine
Women's Health and Obstetrics
Preventive Care and Geriatrics
Emergent and Urgent Care
Introduction
,This comprehensive examination prepares family medicine residents for the ABFM In-Training
Examination (ITE), the annual formative assessment administered by the American Board of Family
Medicine. The ITE evaluates clinical knowledge across the full spectrum of family medicine, using
multiple-choice and scenario-based questions that mirror real-world primary care decision-making.
The question bank emphasizes evidence-based guidelines, diagnostic reasoning, chronic disease
management, preventive care, and the care of special populations. Candidates must demonstrate
the clinical judgment and foundational knowledge required for independent family medicine
practice and board certification preparation.
SECTION ONE: QUESTIONS 1–45
Domain 1: Cardiovascular Medicine (Questions 1–12)
Question 1
A 62-year-old man with hypertension and type 2 diabetes presents with acute-onset substernal
chest pressure that began 45 minutes ago while raking leaves. The pain radiates to his left arm
and is associated with diaphoresis and nausea. Blood pressure is 148/92 mm Hg, heart rate 102
beats/min, and oxygen saturation 97% on room air. An ECG shows 2-mm ST-segment elevations
in leads V2–V4. Which of the following is the most appropriate next step in management?
A. Administer sublingual nitroglycerin and observe for 30 minutes
B. Obtain a chest radiograph and complete blood count
C. Immediate transfer to the emergency department for urgent reperfusion therapy
D. Start aspirin 81 mg daily and schedule a stress test for tomorrow
,🟢 C. Immediate transfer to the emergency department for urgent reperfusion therapy
🔴 RATIONALE: This patient presents with classic symptoms of an ST-elevation myocardial
infarction (STEMI) with anterior ST elevations. The most appropriate management is immediate
reperfusion therapy, either percutaneous coronary intervention (PCI) or fibrinolysis, depending
on cath lab availability. Time is muscle, and delay in reperfusion increases myocardial damage.
Nitroglycerin alone does not treat the underlying occlusion. Chest radiograph and blood count
delay definitive care. Stress testing is contraindicated in acute STEMI .
Question 2
A 55-year-old woman with a history of hypertension presents with sudden onset of severe,
tearing chest pain that radiates to her back. Blood pressure is 180/100 mm Hg in the right arm
and 130/80 mm Hg in the left arm. Heart rate is 110 beats/min. Which of the following is the
most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Stage 2 hypertension
🟢 C. Aortic dissection
, 🔴 RATIONALE: Sudden, severe, tearing chest pain radiating to the back with a significant
interarm blood pressure differential is classic for aortic dissection. Immediate imaging and blood
pressure control are critical .
Question 3
A 55-year-old man presents with chest pain radiating to the left arm, diaphoresis, and nausea.
ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
🟢 C. Right coronary artery
🔴 RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior STEMI, which is typically
caused by occlusion of the right coronary artery (RCA). The RCA supplies the inferior wall of the
left ventricle and the posterior septum. Inferior MI is often associated with bradycardia and
hypotension due to vagal stimulation .
