ABFM ITE Exam Master Bank 2026 | 500+
High-Yield Q&A | Family Medicine In-
Training Exam Prep | Graded A+
A 63yo female w/a PMHx of HTN, depression, fibromyalgia, and giant cell arteritis
presents with a 3wk hx of progressive cough & SOB. She's been taking prednisone for the
last 3months and is tapering the dosage. Her current dosage is 25 mg daily.
VS: temperature of 38.1 °C (100.6 °F), RR 28/min, SpO2 88% ORA
On examination, her lungs are CTA ; CXR = B/L perihilar interstitial pulmonary
infiltrates.
You recommend hospital admission and IV abx antibiotics. Cultures are pending.
1. What bug are you worried about?
2. What abx combination would be the most appropriate initial treatment?
ANSWER: Ceftriaxone, doxycycline, and sulfamethoxazole/trimethoprim
1. PCP/PJP = fungus that causes severe pneumonia in immunosuppressed individuals
Pneumocystis jirovecii pneumonia (PJP), previously known as Pneumocystis carinii pneumonia.
It is a classic AIDS-defining illness but can also affect those on prolonged courses of
corticosteroids or other forms of immunosuppression.
,This patient's presentation of notable dyspnea, hypoxia, no focal lung sounds, and bilateral
interstitial
infiltrates on CXR is consistent with PJP.
This pt may also have bacterial CAP so you need to cover for both.
2. Ceftriaxone + Doxycycline, + Sulfamethoxazole/trimethoprim
Abx tx with sulfamethoxazole/trimethoprim for PJP along with standard abx for bacterial pna
should be initiated while additional tests are pending.
An elevated serum lactate dehydrogenase level has a correlation with PJP, although it has
poor specificity, ESP. in pts who don't have HIV.
Serum β-glucan = indicative of a fungal infection and can be supportive of a diagnosis of PJP.
A 32yo female comes to your office with her husband after a recent weeklong episode of
elevated mood and energy that meets the diagnostic criteria for a manic episode. They both
say that she has never had any episodes of depression, low mood, or anhedonia.
What is the most likely dx?
1. Dx = Bipolar I disorder
Bipolar I disorder does NOT require a hx of a major depressive episode and may be diagnosed
and treated based on just 1 manic episode.
Bipolar II disorder requires ≥ 1 hypomanic + 1 major depressive episode.
Bipolar I: ≥ 1 Man1c episode ≥ 1wk of sx, ±depression, ⊕hospitalization, ⊕impaired
,functioning, ⊕psychosis
Bipolar II: ≥ 1 hypoMania episode, >4days but <1wk, ⊕depression, ⊗hospitalization,
⊗impaired functioning, ⊗psychosis
Borderline personality disorder may coexist with bipolar I disorder but the diagnosis is based on
the presence of unstable personal relationships and severe impulsivity.
Cyclothymic disorder = hx of both hypomanic and depressive symptoms that DONT meet the
full criteria for hypomanic or major depressive episodes.
Disruptive mood dysregulation disorder is a condition diagnosed between 6-18yo. and
characterized by severe recurrent outbursts of temper.
A 35-year-old female presents for evaluation of bilateral breast pain that varies in intensity
with her
menstrual cycle. She drinks 2 cups of caffeinated coffee per day and does not take any
regular
medications. Her past medical history is unremarkable and she does not have any family
history of
breast cancer. A physical examination, including a clinical breast examination, is normal. A
urine
hCG test is negative.
Which one of the following would be the most appropriate next step?
, A) A trial of dietary caffeine elimination
B) A trial of topical diclofenac
C) Prolactin and TSH levels
D) Ultrasonography
E) Diagnostic mammography
ANSWER: B
Evidence supports the use of topical NSAIDs such as diclofenac for first-line tx of both cyclic
and noncyclic mastalgia (SOR B). Topical NSAIDs are preferred over oral NSAIDs due to lower
risk for adverse effects
Although caffeine is commonly cited as a contributing cause of breast pain there's no clear
evidence that caffeine avoidance reduces pain.
Patients with galactorrhea should undergo hormone evaluation with measurement of prolactin
and TSH levels, although hormone evaluation is not indicated for patients with breast pain who
present without associated nipple discharge.
Patients without a palpable mass who present with cyclic breast pain, such as the patient in this
scenario, are at low risk for breast cancer and do not require imaging.
Adverse effects of short-term systemic corticosteroids?
Adverse effects short courses of systemic corticosteroids:
- mood & sleep disturbance
- leukocytosis, ↑WBCs
High-Yield Q&A | Family Medicine In-
Training Exam Prep | Graded A+
A 63yo female w/a PMHx of HTN, depression, fibromyalgia, and giant cell arteritis
presents with a 3wk hx of progressive cough & SOB. She's been taking prednisone for the
last 3months and is tapering the dosage. Her current dosage is 25 mg daily.
VS: temperature of 38.1 °C (100.6 °F), RR 28/min, SpO2 88% ORA
On examination, her lungs are CTA ; CXR = B/L perihilar interstitial pulmonary
infiltrates.
You recommend hospital admission and IV abx antibiotics. Cultures are pending.
1. What bug are you worried about?
2. What abx combination would be the most appropriate initial treatment?
ANSWER: Ceftriaxone, doxycycline, and sulfamethoxazole/trimethoprim
1. PCP/PJP = fungus that causes severe pneumonia in immunosuppressed individuals
Pneumocystis jirovecii pneumonia (PJP), previously known as Pneumocystis carinii pneumonia.
It is a classic AIDS-defining illness but can also affect those on prolonged courses of
corticosteroids or other forms of immunosuppression.
,This patient's presentation of notable dyspnea, hypoxia, no focal lung sounds, and bilateral
interstitial
infiltrates on CXR is consistent with PJP.
This pt may also have bacterial CAP so you need to cover for both.
2. Ceftriaxone + Doxycycline, + Sulfamethoxazole/trimethoprim
Abx tx with sulfamethoxazole/trimethoprim for PJP along with standard abx for bacterial pna
should be initiated while additional tests are pending.
An elevated serum lactate dehydrogenase level has a correlation with PJP, although it has
poor specificity, ESP. in pts who don't have HIV.
Serum β-glucan = indicative of a fungal infection and can be supportive of a diagnosis of PJP.
A 32yo female comes to your office with her husband after a recent weeklong episode of
elevated mood and energy that meets the diagnostic criteria for a manic episode. They both
say that she has never had any episodes of depression, low mood, or anhedonia.
What is the most likely dx?
1. Dx = Bipolar I disorder
Bipolar I disorder does NOT require a hx of a major depressive episode and may be diagnosed
and treated based on just 1 manic episode.
Bipolar II disorder requires ≥ 1 hypomanic + 1 major depressive episode.
Bipolar I: ≥ 1 Man1c episode ≥ 1wk of sx, ±depression, ⊕hospitalization, ⊕impaired
,functioning, ⊕psychosis
Bipolar II: ≥ 1 hypoMania episode, >4days but <1wk, ⊕depression, ⊗hospitalization,
⊗impaired functioning, ⊗psychosis
Borderline personality disorder may coexist with bipolar I disorder but the diagnosis is based on
the presence of unstable personal relationships and severe impulsivity.
Cyclothymic disorder = hx of both hypomanic and depressive symptoms that DONT meet the
full criteria for hypomanic or major depressive episodes.
Disruptive mood dysregulation disorder is a condition diagnosed between 6-18yo. and
characterized by severe recurrent outbursts of temper.
A 35-year-old female presents for evaluation of bilateral breast pain that varies in intensity
with her
menstrual cycle. She drinks 2 cups of caffeinated coffee per day and does not take any
regular
medications. Her past medical history is unremarkable and she does not have any family
history of
breast cancer. A physical examination, including a clinical breast examination, is normal. A
urine
hCG test is negative.
Which one of the following would be the most appropriate next step?
, A) A trial of dietary caffeine elimination
B) A trial of topical diclofenac
C) Prolactin and TSH levels
D) Ultrasonography
E) Diagnostic mammography
ANSWER: B
Evidence supports the use of topical NSAIDs such as diclofenac for first-line tx of both cyclic
and noncyclic mastalgia (SOR B). Topical NSAIDs are preferred over oral NSAIDs due to lower
risk for adverse effects
Although caffeine is commonly cited as a contributing cause of breast pain there's no clear
evidence that caffeine avoidance reduces pain.
Patients with galactorrhea should undergo hormone evaluation with measurement of prolactin
and TSH levels, although hormone evaluation is not indicated for patients with breast pain who
present without associated nipple discharge.
Patients without a palpable mass who present with cyclic breast pain, such as the patient in this
scenario, are at low risk for breast cancer and do not require imaging.
Adverse effects of short-term systemic corticosteroids?
Adverse effects short courses of systemic corticosteroids:
- mood & sleep disturbance
- leukocytosis, ↑WBCs
