ABFM ITE 2025 || A+ Practice Test: Instant Prep,
Verified Results!!
A 36-year-old female presents for evaluation of elevated blood pressure. She is asymptomatic
and does not take any medications. On examination her blood pressure is 160/96 mm Hg and
her BMI is 26 kg/m2 . Fasting laboratory studies include the following:
Sodium 142 mEq/L (N 136-145)
Potassium 3.0 mEq/L (N 3.5-5.1)
Creatinine 0.76 mg/dL (N 0.6-1.1)
Glucose 97 mg/dL
Which one of the following additional laboratory evaluations should be performed to assess
her blood pressure?
A) A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA)
B) A serum aldosterone/renin ratio
C) A serum cortisol level
D) A serum cystatin C level correct answers ANSWER: B Primary hyperaldosteronism
should be suspected as a cause for hypertension if a patient has a spontaneously low
potassium level or persistent hypertension despite the use of three or more antihypertensive
medications, including a diuretic. This can be evaluated by checking a serum renin activity
level and a serum aldosterone concentration and determining the aldosterone/renin ratio.
Primary hyperaldosteronism typically presents with a very low serum renin activity level and
an elevated serum aldosterone concentration. A 24-hour urine collection for 5-
hydroxyindoleacetic acid (5-HIAA) would be used to evaluate for a neuroendocrine tumor,
which can present as chronic flushing and diarrhea. Cortisol levels can be checked if Cushing
syndrome is suspected. Hypertension can be present in Cushing syndrome, but it is typically
associated with other signs such as obesity and an elevated blood glucose level due to insulin
resistance. Cystatin C is a marker of renal function and measurement would not be indicated
given this patient's normal creatinine level.
A 26-year-old male diagnosed with coccidioidomycosis (valley fever) develops a rash on the
extensor surfaces of his lower legs consisting of painful, subcutaneous, nonulcerated,
erythematous nodules. This rash is consistent with which one of the following?
A) Erythema ab igne
B) Erythema infectiosum
C) Erythema migrans
D) Erythema multiforme
E) Erythema nodosum correct answers ANSWER: E Erythema nodosum, a panniculitis that
typically affects the subcutaneous fat on the anterior surface of the lower legs, is associated
with coccidioidomycosis (valley fever) and can suggest the diagnosis. It is a manifestation of
the patient's immune response and often indicates a good prognosis. In addition to
coccidioidomycosis, it can also be associated with streptococcal infections as well as
tuberculosis. Erythema ab igne is a cutaneous rash caused by prolonged heat exposure (such
as a heating pad) presenting as an otherwise asymptomatic, red, reticulated pattern on the
skin. Erythema infectiosum is associated with parvovirus B19 infection and is usually seen in
young children. It manifests as an erythematous rash of the face (slapped cheek appearance),
arms, and legs. Erythema migrans is an expanding, erythematous, annular rash with or
without central clearing and is often associated with tick exposure (Lyme disease). Erythema
, multiforme consists of raised, annular, target-like lesions with central erythema and is usually
associated with herpes simplex virus type 1.
A 50-year-old male presents with chronic abdominal pain. A workup leads you to suspect
peptic ulcer disease, and you refer him for endoscopy, which shows a small duodenal ulcer.
The endoscopist also notes some small esophageal varices without red wale signs. Further
evaluation confirms that the patient has compensated cirrhosis in the setting of alcohol use
disorder. He readily accepts this diagnosis and enters an Alcoholics Anonymous program.
His ulcer symptoms resolve with antibiotic therapy for Helicobacter pylori. He says he has
abstained from alcohol for 6 weeks, and he would like to further reduce his risks from
cirrhosis. The most appropriate next step in the management of his esophageal varices would
be
A) octreotide (Sandostatin)
B) omeprazole (Prilosec)
C) propranolol
D) endoscopic variceal ligation
E) repeat endoscopy in 1-2 years correct answers ANSWER: E Primary prevention of
variceal hemorrhage is an important consideration in the management of patients with
cirrhosis. Although this patient's varices were diagnosed incidentally, patients with cirrhosis
and clinically significant portal hypertension should be screened for varices every 2-3 years
with esophagogastroduodenoscopy (EGD). EGD can be deferred in patients with platelet
counts <150,000/mm3 and transient elastography with liver stiffness <20 kPa. Once
esophageal varices are identified, the criteria for initiating prophylaxis to prevent variceal
hemorrhage is based on the risk of bleeding. Findings associated with a high risk of bleeding
include small varices in patients with decompensated cirrhosis, small varices with red wale
signs (thinning of the variceal wall), and medium to large varices. Patients with small varices
not meeting these criteria have a low risk of hemorrhage and do not require prophylaxis.
They should be rescreened with EGD every 1-2 years. For patients requiring treatment due to
high-risk features, options for primary prophylaxis of hemorrhage include nonselective -
blockers such as propranolol or endoscopic variceal ligation. Treatment decisions are based
on patient preference, other potential contraindications, and local resources. The need for
repeat endoscopy in these cases will depend on the clinical circumstances. If nonselective -
blockers are used, they should be continued indefinitely. Octreotide is only given
intravenously for acute hemorrhage. There is no evidence that omeprazole slows the
progression of esophageal varices.
An 83-year-old female with a history of Alzheimer's dementia presents with concerns about
worsening agitation in the evenings. She is accompanied by her daughter who has power of
attorney. The patient is dependent on her daughter for all instrumental activities of daily
living and requires assistance with certain core activities of daily living such as dressing and
bathing. She has no other chronic medical problems. Her daughter states that starting around
4:00 p.m., the patient becomes increasingly disoriented and agitated. There has been no
physical aggression, but the daughter asks for medical intervention to "help calm her down."
Which one of the following should you recommend initiating first for the management of this
patient's symptoms?
A) Sensory stimulation including touch and music
B) Cognitive training
C) Haloperidol
D) Quetiapine (Seroquel)
Verified Results!!
A 36-year-old female presents for evaluation of elevated blood pressure. She is asymptomatic
and does not take any medications. On examination her blood pressure is 160/96 mm Hg and
her BMI is 26 kg/m2 . Fasting laboratory studies include the following:
Sodium 142 mEq/L (N 136-145)
Potassium 3.0 mEq/L (N 3.5-5.1)
Creatinine 0.76 mg/dL (N 0.6-1.1)
Glucose 97 mg/dL
Which one of the following additional laboratory evaluations should be performed to assess
her blood pressure?
A) A 24-hour urine collection for 5-hydroxyindoleacetic acid (5-HIAA)
B) A serum aldosterone/renin ratio
C) A serum cortisol level
D) A serum cystatin C level correct answers ANSWER: B Primary hyperaldosteronism
should be suspected as a cause for hypertension if a patient has a spontaneously low
potassium level or persistent hypertension despite the use of three or more antihypertensive
medications, including a diuretic. This can be evaluated by checking a serum renin activity
level and a serum aldosterone concentration and determining the aldosterone/renin ratio.
Primary hyperaldosteronism typically presents with a very low serum renin activity level and
an elevated serum aldosterone concentration. A 24-hour urine collection for 5-
hydroxyindoleacetic acid (5-HIAA) would be used to evaluate for a neuroendocrine tumor,
which can present as chronic flushing and diarrhea. Cortisol levels can be checked if Cushing
syndrome is suspected. Hypertension can be present in Cushing syndrome, but it is typically
associated with other signs such as obesity and an elevated blood glucose level due to insulin
resistance. Cystatin C is a marker of renal function and measurement would not be indicated
given this patient's normal creatinine level.
A 26-year-old male diagnosed with coccidioidomycosis (valley fever) develops a rash on the
extensor surfaces of his lower legs consisting of painful, subcutaneous, nonulcerated,
erythematous nodules. This rash is consistent with which one of the following?
A) Erythema ab igne
B) Erythema infectiosum
C) Erythema migrans
D) Erythema multiforme
E) Erythema nodosum correct answers ANSWER: E Erythema nodosum, a panniculitis that
typically affects the subcutaneous fat on the anterior surface of the lower legs, is associated
with coccidioidomycosis (valley fever) and can suggest the diagnosis. It is a manifestation of
the patient's immune response and often indicates a good prognosis. In addition to
coccidioidomycosis, it can also be associated with streptococcal infections as well as
tuberculosis. Erythema ab igne is a cutaneous rash caused by prolonged heat exposure (such
as a heating pad) presenting as an otherwise asymptomatic, red, reticulated pattern on the
skin. Erythema infectiosum is associated with parvovirus B19 infection and is usually seen in
young children. It manifests as an erythematous rash of the face (slapped cheek appearance),
arms, and legs. Erythema migrans is an expanding, erythematous, annular rash with or
without central clearing and is often associated with tick exposure (Lyme disease). Erythema
, multiforme consists of raised, annular, target-like lesions with central erythema and is usually
associated with herpes simplex virus type 1.
A 50-year-old male presents with chronic abdominal pain. A workup leads you to suspect
peptic ulcer disease, and you refer him for endoscopy, which shows a small duodenal ulcer.
The endoscopist also notes some small esophageal varices without red wale signs. Further
evaluation confirms that the patient has compensated cirrhosis in the setting of alcohol use
disorder. He readily accepts this diagnosis and enters an Alcoholics Anonymous program.
His ulcer symptoms resolve with antibiotic therapy for Helicobacter pylori. He says he has
abstained from alcohol for 6 weeks, and he would like to further reduce his risks from
cirrhosis. The most appropriate next step in the management of his esophageal varices would
be
A) octreotide (Sandostatin)
B) omeprazole (Prilosec)
C) propranolol
D) endoscopic variceal ligation
E) repeat endoscopy in 1-2 years correct answers ANSWER: E Primary prevention of
variceal hemorrhage is an important consideration in the management of patients with
cirrhosis. Although this patient's varices were diagnosed incidentally, patients with cirrhosis
and clinically significant portal hypertension should be screened for varices every 2-3 years
with esophagogastroduodenoscopy (EGD). EGD can be deferred in patients with platelet
counts <150,000/mm3 and transient elastography with liver stiffness <20 kPa. Once
esophageal varices are identified, the criteria for initiating prophylaxis to prevent variceal
hemorrhage is based on the risk of bleeding. Findings associated with a high risk of bleeding
include small varices in patients with decompensated cirrhosis, small varices with red wale
signs (thinning of the variceal wall), and medium to large varices. Patients with small varices
not meeting these criteria have a low risk of hemorrhage and do not require prophylaxis.
They should be rescreened with EGD every 1-2 years. For patients requiring treatment due to
high-risk features, options for primary prophylaxis of hemorrhage include nonselective -
blockers such as propranolol or endoscopic variceal ligation. Treatment decisions are based
on patient preference, other potential contraindications, and local resources. The need for
repeat endoscopy in these cases will depend on the clinical circumstances. If nonselective -
blockers are used, they should be continued indefinitely. Octreotide is only given
intravenously for acute hemorrhage. There is no evidence that omeprazole slows the
progression of esophageal varices.
An 83-year-old female with a history of Alzheimer's dementia presents with concerns about
worsening agitation in the evenings. She is accompanied by her daughter who has power of
attorney. The patient is dependent on her daughter for all instrumental activities of daily
living and requires assistance with certain core activities of daily living such as dressing and
bathing. She has no other chronic medical problems. Her daughter states that starting around
4:00 p.m., the patient becomes increasingly disoriented and agitated. There has been no
physical aggression, but the daughter asks for medical intervention to "help calm her down."
Which one of the following should you recommend initiating first for the management of this
patient's symptoms?
A) Sensory stimulation including touch and music
B) Cognitive training
C) Haloperidol
D) Quetiapine (Seroquel)
