1
ABFM ITE EXAM AND ACTUAL EXAM NEWEST 2026 TEST
BANK| AMERICAN BOARD OF FAMILY MEDICINE IN-
TRAINING EXAM PREP WITH COMPLETE 200 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+
ABFM ITE 2026 Test Bank
200 High-Yield, Difficult Questions with Rotations
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1–25)
Rotation 1.1: Hypertension Guidelines & Management
1. A 52-year-old male has repeated blood pressure readings of 138/86 mmHg.
He has no history of diabetes, chronic kidney disease, or cardiovascular disease.
According to the ACC/AHA 2017 guideline, how is his blood pressure classified?
• A) Normal
• B) Elevated
• C) Stage 1 hypertension
• D) Stage 2 hypertension
; Correct Answer : C) Stage 1 hypertension
*Rationale: ACC/AHA defines Stage 1 hypertension as SBP 130-139 or DBP 80-89
mmHg. Elevated is SBP 120-129 and DBP <80. This patient's SBP of 138 and DBP of
86 both fall within Stage 1.*
2. The same patient with Stage 1 hypertension has a 10-year ASCVD risk
calculated at 8%. What is the initial management recommendation?
• A) Initiate antihypertensive medication immediately
pg. 1
,2
• B) Initiate lifestyle modifications alone; reassess in 3-6 months
• C) Initiate lifestyle modifications and start a thiazide diuretic
• D) Refer to cardiology
; Correct Answer : B) Initiate lifestyle modifications alone; reassess in 3-6
months
*Rationale: For Stage 1 hypertension with ASCVD risk <10%, the guideline
recommends lifestyle modifications alone for the first 3-6 months. If blood
pressure is not controlled after that period, pharmacotherapy is initiated.*
3. A 68-year-old African American female with Stage 2 hypertension (148/94
mmHg) and no compelling indications is started on pharmacotherapy. Which is
the recommended first-line agent?
• A) Lisinopril
• B) Losartan
• C) Amlodipine
• D) Metoprolol
; Correct Answer : C) Amlodipine (or a thiazide diuretic)
Rationale: In the general non-Black population, first-line agents include ACE
inhibitors, ARBs, CCBs, or thiazides. In Black patients (including African
Americans), thiazide diuretics or CCBs are preferred as initial monotherapy
because ACE inhibitors and ARBs are less effective as monotherapy for
hypertension in this population.
4. A patient with hypertension also has type 2 diabetes and microalbuminuria
(urine albumin-to-creatinine ratio 150 mg/g). His blood pressure is 144/90
mmHg. Which class of medication is most strongly indicated?
• A) Beta-blocker
• B) Calcium channel blocker
pg. 2
,3
• C) ACE inhibitor or ARB
• D) Loop diuretic
; Correct Answer : C) ACE inhibitor or ARB
*Rationale: ACE inhibitors and ARBs are first-line for patients with diabetes and
albuminuria due to their reno-protective effects, slowing progression of diabetic
nephropathy. A BP target of <130/80 is recommended.*
5. A 72-year-old woman with a history of heart failure with preserved ejection
fraction (HFpEF) and hypertension has a blood pressure of 146/88 mmHg. She is
on lisinopril 20 mg daily. Which additional medication would be most
appropriate?
• A) Diltiazem
• B) Spironolactone or chlorthalidone
• C) Metoprolol succinate
• D) Clonidine
; Correct Answer : B) Spironolactone or chlorthalidone
Rationale: In HFpEF with hypertension, diuretics are useful for volume
management. Spironolactone (per TOPCAT trial) has shown benefit in HFpEF.
Chlorthalidone is effective for BP control. Beta-blockers are not first-line for HFpEF
without another indication (e.g., CAD). Calcium channel blockers (non-
dihydropyridine) are generally avoided in HFrEF, but in HFpEF, they can be used,
though spironolactone may be preferred.
Rotation 1.2: Heart Failure and Coronary Artery Disease
6. A 65-year-old man with ischemic cardiomyopathy has an echocardiogram
showing EF of 30%. He is currently on lisinopril 10 mg BID, carvedilol 12.5 mg
BID, and furosemide 40 mg daily. His potassium is 4.8 mEq/L and creatinine is
1.4 mg/dL (eGFR 52). Which additional medication has a mortality benefit in this
patient?
pg. 3
, 4
• A) Digoxin
• B) Isosorbide dinitrate/hydralazine
• C) Spironolactone or eplerenone
• D) Amlodipine
; Correct Answer : C) Spironolactone or eplerenone
*Rationale: In patients with HFrEF (EF ≤35%), mineralocorticoid receptor
antagonists (MRAs) like spironolactone or eplerenone have proven mortality
benefit (RALES, EMPHASIS-HF trials). Potassium and renal function must be
monitored closely. His K+ of 4.8 and eGFR 52 allow cautious use. Isosorbide
dinitrate/hydralazine is particularly beneficial in African Americans (A-HeFT trial).
Digoxin reduces hospitalizations but not mortality.*
7. A 58-year-old post-MI patient with an EF of 30% is already on optimal medical
therapy including an ACE inhibitor, beta-blocker, and MRA. He has a QRS
duration of 150 ms with a left bundle branch block pattern. What additional
therapy is indicated to reduce mortality?
• A) Amiodarone
• B) Cardiac resynchronization therapy (CRT)
• C) Implantable cardioverter-defibrillator (ICD) only
• D) Both CRT and ICD (CRT-D)
; Correct Answer : D) Both CRT and ICD (CRT-D)
*Rationale: In patients with HFrEF, EF ≤35%, LBBB with QRS ≥150 ms, and NYHA
class II-IV symptoms despite optimal medical therapy, CRT is indicated to improve
symptoms and reduce mortality. An ICD is also indicated for primary prevention
of sudden cardiac death in ischemic cardiomyopathy with EF ≤35%. The
combination device (CRT-D) provides both benefits.*
8. A 55-year-old male with chronic stable angina reports chest pain occurring
with minimal exertion over the past week, but none at rest. His current regimen
pg. 4
ABFM ITE EXAM AND ACTUAL EXAM NEWEST 2026 TEST
BANK| AMERICAN BOARD OF FAMILY MEDICINE IN-
TRAINING EXAM PREP WITH COMPLETE 200 REAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) ALREADY GRADED A+
ABFM ITE 2026 Test Bank
200 High-Yield, Difficult Questions with Rotations
SECTION 1: CARDIOVASCULAR MEDICINE (Questions 1–25)
Rotation 1.1: Hypertension Guidelines & Management
1. A 52-year-old male has repeated blood pressure readings of 138/86 mmHg.
He has no history of diabetes, chronic kidney disease, or cardiovascular disease.
According to the ACC/AHA 2017 guideline, how is his blood pressure classified?
• A) Normal
• B) Elevated
• C) Stage 1 hypertension
• D) Stage 2 hypertension
; Correct Answer : C) Stage 1 hypertension
*Rationale: ACC/AHA defines Stage 1 hypertension as SBP 130-139 or DBP 80-89
mmHg. Elevated is SBP 120-129 and DBP <80. This patient's SBP of 138 and DBP of
86 both fall within Stage 1.*
2. The same patient with Stage 1 hypertension has a 10-year ASCVD risk
calculated at 8%. What is the initial management recommendation?
• A) Initiate antihypertensive medication immediately
pg. 1
,2
• B) Initiate lifestyle modifications alone; reassess in 3-6 months
• C) Initiate lifestyle modifications and start a thiazide diuretic
• D) Refer to cardiology
; Correct Answer : B) Initiate lifestyle modifications alone; reassess in 3-6
months
*Rationale: For Stage 1 hypertension with ASCVD risk <10%, the guideline
recommends lifestyle modifications alone for the first 3-6 months. If blood
pressure is not controlled after that period, pharmacotherapy is initiated.*
3. A 68-year-old African American female with Stage 2 hypertension (148/94
mmHg) and no compelling indications is started on pharmacotherapy. Which is
the recommended first-line agent?
• A) Lisinopril
• B) Losartan
• C) Amlodipine
• D) Metoprolol
; Correct Answer : C) Amlodipine (or a thiazide diuretic)
Rationale: In the general non-Black population, first-line agents include ACE
inhibitors, ARBs, CCBs, or thiazides. In Black patients (including African
Americans), thiazide diuretics or CCBs are preferred as initial monotherapy
because ACE inhibitors and ARBs are less effective as monotherapy for
hypertension in this population.
4. A patient with hypertension also has type 2 diabetes and microalbuminuria
(urine albumin-to-creatinine ratio 150 mg/g). His blood pressure is 144/90
mmHg. Which class of medication is most strongly indicated?
• A) Beta-blocker
• B) Calcium channel blocker
pg. 2
,3
• C) ACE inhibitor or ARB
• D) Loop diuretic
; Correct Answer : C) ACE inhibitor or ARB
*Rationale: ACE inhibitors and ARBs are first-line for patients with diabetes and
albuminuria due to their reno-protective effects, slowing progression of diabetic
nephropathy. A BP target of <130/80 is recommended.*
5. A 72-year-old woman with a history of heart failure with preserved ejection
fraction (HFpEF) and hypertension has a blood pressure of 146/88 mmHg. She is
on lisinopril 20 mg daily. Which additional medication would be most
appropriate?
• A) Diltiazem
• B) Spironolactone or chlorthalidone
• C) Metoprolol succinate
• D) Clonidine
; Correct Answer : B) Spironolactone or chlorthalidone
Rationale: In HFpEF with hypertension, diuretics are useful for volume
management. Spironolactone (per TOPCAT trial) has shown benefit in HFpEF.
Chlorthalidone is effective for BP control. Beta-blockers are not first-line for HFpEF
without another indication (e.g., CAD). Calcium channel blockers (non-
dihydropyridine) are generally avoided in HFrEF, but in HFpEF, they can be used,
though spironolactone may be preferred.
Rotation 1.2: Heart Failure and Coronary Artery Disease
6. A 65-year-old man with ischemic cardiomyopathy has an echocardiogram
showing EF of 30%. He is currently on lisinopril 10 mg BID, carvedilol 12.5 mg
BID, and furosemide 40 mg daily. His potassium is 4.8 mEq/L and creatinine is
1.4 mg/dL (eGFR 52). Which additional medication has a mortality benefit in this
patient?
pg. 3
, 4
• A) Digoxin
• B) Isosorbide dinitrate/hydralazine
• C) Spironolactone or eplerenone
• D) Amlodipine
; Correct Answer : C) Spironolactone or eplerenone
*Rationale: In patients with HFrEF (EF ≤35%), mineralocorticoid receptor
antagonists (MRAs) like spironolactone or eplerenone have proven mortality
benefit (RALES, EMPHASIS-HF trials). Potassium and renal function must be
monitored closely. His K+ of 4.8 and eGFR 52 allow cautious use. Isosorbide
dinitrate/hydralazine is particularly beneficial in African Americans (A-HeFT trial).
Digoxin reduces hospitalizations but not mortality.*
7. A 58-year-old post-MI patient with an EF of 30% is already on optimal medical
therapy including an ACE inhibitor, beta-blocker, and MRA. He has a QRS
duration of 150 ms with a left bundle branch block pattern. What additional
therapy is indicated to reduce mortality?
• A) Amiodarone
• B) Cardiac resynchronization therapy (CRT)
• C) Implantable cardioverter-defibrillator (ICD) only
• D) Both CRT and ICD (CRT-D)
; Correct Answer : D) Both CRT and ICD (CRT-D)
*Rationale: In patients with HFrEF, EF ≤35%, LBBB with QRS ≥150 ms, and NYHA
class II-IV symptoms despite optimal medical therapy, CRT is indicated to improve
symptoms and reduce mortality. An ICD is also indicated for primary prevention
of sudden cardiac death in ischemic cardiomyopathy with EF ≤35%. The
combination device (CRT-D) provides both benefits.*
8. A 55-year-old male with chronic stable angina reports chest pain occurring
with minimal exertion over the past week, but none at rest. His current regimen
pg. 4
