ABFM ITE EXAM WITH 200 QUESTIONS
WITH DETAILED VERIFIED ANSWERS
(100% CORRECT ANSWERS /ALREADY
GRADED A+
1. An 87-year-old female comes to your office for an annual health maintenance
visit. She appears cachectic and tells you that for the past 6 months she has had a
decreased appetite and generalized muscle weakness. The patient is alert and
oriented to person and place. She has a 10% weight loss, dry mucous membranes,
and tenting of the skin on the extensor surface of her hands. While inflating the
blood pressure cuff on her right arm you observe carpopedal spasms. Which one of
the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
Correct Answer: B
Rationale: Carpopedal spasms observed during blood pressure cuff inflation
(Trousseau's sign) indicate hypocalcemia. The patient's cachexia, weight loss, and
muscle weakness suggest underlying malignancy, which can cause hypocalcemia
through various mechanisms including vitamin D deficiency and malnutrition.
Hypocalcemia leads to increased neuromuscular irritability, manifesting as
carpopedal spasms.
2. A 24-year-old female presents to your office with a 3-month history of difficulty
sleeping. She says that she struggles to fall asleep and wakes up multiple times at
night at least three times a week. She tries to go to bed at 10:00 p.m. and wakes up
at 6:30 a.m. to start her day. She lies awake for an hour in bed before falling asleep
1
,and spends up to 2 hours awake in the middle of the night trying to fall back
asleep. Lately she has been feeling fatigued and having difficulty concentrating at
work. You conduct a full history and physical examination and tell her to return in
2 weeks with a sleep diary. At this follow-up visit you see from her diary that she
is sleeping an average of 5 1/2 hours per night. Which one of the following would
be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
Correct Answer: D
Rationale: For sleep maintenance insomnia, sleep restriction therapy is effective.
Moving bedtime later (to 12:30 a.m.) consolidates sleep and increases sleep
efficiency. This patient spends excessive time in bed relative to actual sleep time,
perpetuating fragmentation.
3. A 45-year-old male with a 30-pack-year smoking history presents with a chronic
cough and hemoptysis. Chest radiograph shows a right hilar mass. Which one of
the following is the most common histologic type of lung cancer associated with
this presentation?
A) Adenocarcinoma
B) Squamous cell carcinoma
C) Small cell carcinoma
D) Large cell carcinoma
Correct Answer: B
Rationale: Squamous cell carcinoma is strongly associated with smoking and
typically presents as a central hilar mass with cavitation and hemoptysis.
Adenocarcinoma is more peripheral and is the most common type overall but less
associated with central hemoptysis.
2
,4. A 67-year-old male with hypertension and diabetes presents with sudden onset
of severe vertigo, dysarthria, and ataxia. He has no headache or neck pain. Which
one of the following is the most likely diagnosis?
A) Vertebrobasilar stroke
B) Cerebellar hemorrhage
C) Benign paroxysmal positional vertigo
D) Vestibular neuritis
Correct Answer: A
Rationale: Sudden onset of vertigo with brainstem signs (dysarthria, ataxia)
suggests vertebrobasilar stroke. Cerebellar hemorrhage typically presents with
headache. BPPV and vestibular neuritis are peripheral causes without brainstem
signs.
5. A 32-year-old woman presents with fatigue, palpitations, and heat intolerance.
She has a fine tremor and a diffusely enlarged, nontender thyroid gland. Which one
of the following laboratory findings would confirm the diagnosis?
A) Elevated TSH with low free T4
B) Low TSH with elevated free T4
C) Normal TSH with elevated free T4
D) Low TSH with normal free T4
Correct Answer: B
Rationale: Low TSH with elevated free T4 confirms primary hyperthyroidism
(Graves' disease). Elevated TSH with low T4 indicates hypothyroidism. Normal
TSH with elevated T4 suggests pituitary adenoma (rare).
6. A 55-year-old male with a history of alcohol use disorder presents with jaundice,
ascites, and confusion. His serum ammonia is elevated. Which one of the following
is the most appropriate initial treatment for his hepatic encephalopathy?
A) Lactulose
3
, B) Rifaximin
C) Neomycin
D) Zinc supplementation
Correct Answer: A
Rationale: Lactulose is the first-line treatment for hepatic encephalopathy. It
reduces ammonia absorption by acidifying the colon and promoting catharsis.
Rifaximin is used as an adjunct or second-line agent.
7. A 28-year-old female with a history of systemic lupus erythematosus presents
with acute onset of pleuritic chest pain and shortness of breath. ECG shows diffuse
ST-segment elevation with PR depression. Which one of the following is the most
likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Correct Answer: B
Rationale: Diffuse ST-segment elevation with PR depression is classic for
pericarditis. Lupus patients are at increased risk for pericarditis. Myocardial
infarction shows localized ST elevation; PE shows sinus tachycardia and S1Q3T3
pattern.
8. A 65-year-old female presents with progressive shortness of breath and dry
cough for 6 months. Chest radiograph shows interstitial reticular opacities and
honeycombing in the lung bases. Which one of the following is the most likely
diagnosis?
A) Idiopathic pulmonary fibrosis
B) Sarcoidosis
C) Hypersensitivity pneumonitis
4
WITH DETAILED VERIFIED ANSWERS
(100% CORRECT ANSWERS /ALREADY
GRADED A+
1. An 87-year-old female comes to your office for an annual health maintenance
visit. She appears cachectic and tells you that for the past 6 months she has had a
decreased appetite and generalized muscle weakness. The patient is alert and
oriented to person and place. She has a 10% weight loss, dry mucous membranes,
and tenting of the skin on the extensor surface of her hands. While inflating the
blood pressure cuff on her right arm you observe carpopedal spasms. Which one of
the following is the most likely electrolyte disturbance?
A) Hypercalcemia
B) Hypocalcemia
C) Hypokalemia
D) Hypernatremia
Correct Answer: B
Rationale: Carpopedal spasms observed during blood pressure cuff inflation
(Trousseau's sign) indicate hypocalcemia. The patient's cachexia, weight loss, and
muscle weakness suggest underlying malignancy, which can cause hypocalcemia
through various mechanisms including vitamin D deficiency and malnutrition.
Hypocalcemia leads to increased neuromuscular irritability, manifesting as
carpopedal spasms.
2. A 24-year-old female presents to your office with a 3-month history of difficulty
sleeping. She says that she struggles to fall asleep and wakes up multiple times at
night at least three times a week. She tries to go to bed at 10:00 p.m. and wakes up
at 6:30 a.m. to start her day. She lies awake for an hour in bed before falling asleep
1
,and spends up to 2 hours awake in the middle of the night trying to fall back
asleep. Lately she has been feeling fatigued and having difficulty concentrating at
work. You conduct a full history and physical examination and tell her to return in
2 weeks with a sleep diary. At this follow-up visit you see from her diary that she
is sleeping an average of 5 1/2 hours per night. Which one of the following would
be the most appropriate recommendation?
A) Set her alarm for 5:30 a.m.
B) Add a mid-afternoon nap
C) Move her bedtime to 9:00 p.m.
D) Move her bedtime to 12:30 a.m.
Correct Answer: D
Rationale: For sleep maintenance insomnia, sleep restriction therapy is effective.
Moving bedtime later (to 12:30 a.m.) consolidates sleep and increases sleep
efficiency. This patient spends excessive time in bed relative to actual sleep time,
perpetuating fragmentation.
3. A 45-year-old male with a 30-pack-year smoking history presents with a chronic
cough and hemoptysis. Chest radiograph shows a right hilar mass. Which one of
the following is the most common histologic type of lung cancer associated with
this presentation?
A) Adenocarcinoma
B) Squamous cell carcinoma
C) Small cell carcinoma
D) Large cell carcinoma
Correct Answer: B
Rationale: Squamous cell carcinoma is strongly associated with smoking and
typically presents as a central hilar mass with cavitation and hemoptysis.
Adenocarcinoma is more peripheral and is the most common type overall but less
associated with central hemoptysis.
2
,4. A 67-year-old male with hypertension and diabetes presents with sudden onset
of severe vertigo, dysarthria, and ataxia. He has no headache or neck pain. Which
one of the following is the most likely diagnosis?
A) Vertebrobasilar stroke
B) Cerebellar hemorrhage
C) Benign paroxysmal positional vertigo
D) Vestibular neuritis
Correct Answer: A
Rationale: Sudden onset of vertigo with brainstem signs (dysarthria, ataxia)
suggests vertebrobasilar stroke. Cerebellar hemorrhage typically presents with
headache. BPPV and vestibular neuritis are peripheral causes without brainstem
signs.
5. A 32-year-old woman presents with fatigue, palpitations, and heat intolerance.
She has a fine tremor and a diffusely enlarged, nontender thyroid gland. Which one
of the following laboratory findings would confirm the diagnosis?
A) Elevated TSH with low free T4
B) Low TSH with elevated free T4
C) Normal TSH with elevated free T4
D) Low TSH with normal free T4
Correct Answer: B
Rationale: Low TSH with elevated free T4 confirms primary hyperthyroidism
(Graves' disease). Elevated TSH with low T4 indicates hypothyroidism. Normal
TSH with elevated T4 suggests pituitary adenoma (rare).
6. A 55-year-old male with a history of alcohol use disorder presents with jaundice,
ascites, and confusion. His serum ammonia is elevated. Which one of the following
is the most appropriate initial treatment for his hepatic encephalopathy?
A) Lactulose
3
, B) Rifaximin
C) Neomycin
D) Zinc supplementation
Correct Answer: A
Rationale: Lactulose is the first-line treatment for hepatic encephalopathy. It
reduces ammonia absorption by acidifying the colon and promoting catharsis.
Rifaximin is used as an adjunct or second-line agent.
7. A 28-year-old female with a history of systemic lupus erythematosus presents
with acute onset of pleuritic chest pain and shortness of breath. ECG shows diffuse
ST-segment elevation with PR depression. Which one of the following is the most
likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pulmonary embolism
D) Aortic dissection
Correct Answer: B
Rationale: Diffuse ST-segment elevation with PR depression is classic for
pericarditis. Lupus patients are at increased risk for pericarditis. Myocardial
infarction shows localized ST elevation; PE shows sinus tachycardia and S1Q3T3
pattern.
8. A 65-year-old female presents with progressive shortness of breath and dry
cough for 6 months. Chest radiograph shows interstitial reticular opacities and
honeycombing in the lung bases. Which one of the following is the most likely
diagnosis?
A) Idiopathic pulmonary fibrosis
B) Sarcoidosis
C) Hypersensitivity pneumonitis
4
