ABFM ITE EXAM 2024 | INCLUDES THE ACTUAL EXAM
WITH 200 ACCURATE QUESTIONS AND ANSWERS WITH
RATIONALES | ACCURATE AND VERIFIED FOR
GUARANTEED PASS | LATEST UPDATE | CONTAINS A
STUDY GUIDE AT THE END
A 45 year old left hand dominant female presents to your office with a lump on her hand. She
first noticed the lump 2 weeks ago and thinks it has gotten bigger. She does not recall any injury.
She has not had any numbness, weakness, or tingling. She has minimal discomfort when she
presses on the lump, and it does not affect her activity. On examination her left wrist is
neurovascularly intact.
Which one of the following management options would you recommend?
A. Re-examination if she develops numbness, weakness, or increased pain
B. Immobilization of the wrist for 6 weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the lesion with a corticosteroid
E. Referral for excision of the lesion
ANSWER: A. Re-examination if she develops numbness, weakness or increased pain
This patient has a ganglion cyst, which is common and resolves spontaneously in 50% of cases,
and watchful waiting would be most appropriate at this time. Treatment is indicated if the cyst is
causing significant symptoms such as pain, numbness, or weakness, or for cosmetic symptoms.
Aspiration of the lesion is the initial treatment, although recurrence may occur in 85% of cases.
Immobilizing the wrist with a splint or brace is sometimes helpful in the short term if the patient
is bothered by the symptoms, but immobilization does not provide lasting relief and could cause
muscle atrophy. Corticosteroid injections have not shown any benefit. Referral for excision is
appropriate if there has been no improvement. Patients should be advised that there is a 10%-
15% recurrence rate even after excision.
A 57 year old female with diabetes mellitus comes to your office for a routine follow up. Her
current medications include metformin 1000 mg twice daily. She tells you that she does not
exercise regularly and finds it difficult to follow a healthy diet. HbA1c today is 7.5%. She does
not want to add medications at this time, but she does want to het her HbA1c below 7%, which is
the goal that was previously discussed.
Which one of the following would be the most effective way to improve glucose control for this
patient.
A. Discuss the components of a healthy diabetic diet and encourage her to follow it more closely.
B. Discuss the importance of regular exercise and encourage her to exercise 30-45 minutes daily.
C. Recommend that she check her glucose level 1-3 times daily to help determine what
adjustments need to be made.
,D. Start her on an additional medication
E. Refer her to a diabetes educator for medical nutrition therapy.
ANSWER: E. Refer her to a diabetes educator for medical nutrition therapy
Counseling by a diabetic educator or a team of educators for medical nutrition therapy lowers
HbA1c by 0.2-0.8 percentage points in patients with type 2 diabetes. While a healthy diabetic
diet and regular exercise is important, simply reminding the patient of that fact is not likely to be
as successful as comprehensive diabetic education. According to the Society of General Internal
Medicine in the Choosing Wisely campaign, patients with type 2 diabetes who are not on insulin
therapy should not check their blood glucose level daily. An additional medication will likely
decrease HbA1c, but this patient has expressed a desire to avoid additional medication, is near
goal, and is not currently managing her diabetes with adequate lifestyle changes, so it would be
appropriate to respect her wishes and pursue proven interventions that do not require medication.
During a newborn examination the patient's mother asks what she can do to decrease the risk of
food allergies in her newborn son. She tells you that there is no family history of atopic
dermatitis or asthma but she has a cousin with a peanut allergy. The remainder of the
examination is unremarkable.
You tell her that food allergy risk can be reduced by
A. breastfeeding for at least 1 year
B. Using soy based formula instead of cow's milk based formula
C. introducing peanut-containing food when solids are started
D. Avoiding all house pets
E. Avoiding a day care setting
ANSWER: C. Introducing peanut containing food when solids are started
Food allergy affects 4-6% of children in the US. IgE-mediated food allergy is the best
understood, and symptoms can range from rhinorrhea to anaphylaxis. The two most common
allergens are cow's milk and peanuts. The onset of symptoms is usually within 2 hours of
exposure and they resolve within several hours. The National Institute of Allergy and Infectious
Diseases in 2017 recommended that healthy infants without known food allergy or who have
mild to moderate eczema may be introduced to peanut-containing foods with other solid foods. If
the parents are concerned about a reaction, introduction of peanut-containing foods may be done
in the physician's office. Infants with severe eczema, egg allergy, or both should undergo peanut-
specific IgE or skin prick testing. While breastfeeding may decrease atopic disease, there is
insufficient evidence that it reduces the likelihood of food allergy, and using a soy based formula
will not prevent food allergy. If there is a dog in the home there is less risk of allergy to eggs.
Children who are exposed to farm animals or who attend day care are less likely to develop
atopic disease.
Which one of the following antihypertensive medications is LEAST likely to exacerbate erectile
dysfunction?
,A. Clonidine (Catapres)
B. Doxazosin (Cardura)
C. Hydrochlorothiazine
D. Losartan (Cozaar)
E. Metoprolol
ANSWER: D. Losartan
Angiotensin receptor blockers (ARBs) such as losartan are least likely to cause or exacerbate
erectile dysfunction. ARBs may have a favorable effect on erectile dysfunction by inhibiting
vasoconstriction activity of angiotensin. Clonidine, alpha blockers, hydrochlorothiazide, and
beta-blockers are more likely to negatively affect erectile function.
You are providing end of life care for a 53 year old female with end stage colon cancer. Her
family reports that she is having significant abdominal pain, nausea, and vomiting, and she is not
able to tolerate oral intake. You suspect a malignant bowel obstruction.
Which one of the following interventions would be most likely to significantly improve her
symptoms?
A. Medical cannabis
B. Dexamethasone
C. Morphine
D. Octreotide (Sandostatin)
E. Polyethylene glycol (Miralax)
ANSWER: B. Dexamethasone
Malignant bowel obstruction is a common issues with GI cancers. Corticosteroids can help
alleviate these symptoms, which is the focus in end of life care. Corticosteroids have numerous
beneficial effects in these situations, such as central antiemetic, anti-inflammatory, anti-
secretory, and analgesic effects. Intravenous dexamethasone is generally recommended at a
dosage of 4 mg 3-4 times daily for malignant bowel obstruction because it has more greater anti-
inflammatory effects than methylprednisolone. Although octreotide is commonly used for this
purpose, there is little evidence to support its use. Medical cannabis can be used to treat nausea
and vomiting in end of life care but is not effective for bowel obstruction. Morphine can be used
to treat pain and end of life dyspnea, but not for nausea and vomiting. The use of polyethylene
glycol for a malignant obstruction could worsen the patient's symptoms significantly.
A 3 year old male has developed multiple large areas of bullous impetigo on the legs, buttocks,
and trunk after being bitten numerous times by ants.
Which one of the following would be the most appropriate treatment?
A. Topical mupirocin ointment
B. Oral azithromycin
C. Oral tetracycline
, D. Oral trimethoprim/sufamethoxazole
E. Intramuscular penicillin G benzathine
ANSWER: D. Oral trimethoprim/sulfamethoxazole
Impetigo may be caused by Strep progenies or Staph aureus, but bullous impetigo is caused
exclusively by S aureus. Oral trimethoprim/sulfamethoxazole is an appropriate treatment for skin
infections caused by S. aureus, including susceptible cases of MRSA. Topical mupirocin
ointment is not practical in very widespread cases or in cases with large bullae. Neither
azithromycin nor penicillin is preferred treatment for impetigo, due to a high rate of treatment
failure. Tetracycline should be avoided in children under 8 years of age due to propensity to
cause permanent staining of the teeth.
A 60 year old male with diabetes mellitus and hypertension sees you for routine follow up. He
has no acute health concerns during today's visit. His current medications include metformin,
lisinopril, and HCTZ. He smokes cigarettes and has a 40 pack year smoking history. His vital
signs and a physical examination are normal. An in-office dipstick urinalysis reveals 1+ blood
and trace protein but is otherwise normal.
Which one of the following would be the most appropriate follow up?
A. Repeat dipstick urinalysis in 3 months
B. Microscopic urinalysis
C. Renal ultrasonography
D. CT urography
E. Referral for cystoscopy
ANSWER: B. Microscopic urinalysis
Microscopic hematuria also known as microhematuria, is defined as >3 RBCs/hpf on
microscopy. Dipstick analysis alone is insufficient to diagnose microscopic hematuria, as blood
that is seen on dipstick analysis may represent a false positive result caused by myoglobinuria,
hemoglobinuria, dehydration, exercise, menstrual period, or povidone iodine, as opposed to true
hematuria. Thus, when the presence of blood is suggested by dipstick urinalysis, confirmation
with microscopic analysis should be obtained. The current guideline from the American
Urological Association stratifies further workup for microscopic hematuria based on the patient's
overall risk of genitourinary malignancy, rather an automatic referral for cystoscopy and CT
urography for all adults > 35 years old with microhematuria, as was recommended in the
previous AUA guideline. Patients who are at low risk also may be given the option to repeat a
urinalysis in 6 months. For this patient the next step would be microscopic urinalysis to
determine the presence of hematuria, and if present, to quantify it. If microscopic UA confirms
the presence of hematuria, then CT urography and cystoscopy would be indicated, as his age,
male sex, and smoking history place him at increased risk of malignancy. Repeating the dipstick
analysis in 3 months would be inappropriate in this situation, as the presence or absence of true
microscopic hematuria needs to be clarified because of his high risk history.
WITH 200 ACCURATE QUESTIONS AND ANSWERS WITH
RATIONALES | ACCURATE AND VERIFIED FOR
GUARANTEED PASS | LATEST UPDATE | CONTAINS A
STUDY GUIDE AT THE END
A 45 year old left hand dominant female presents to your office with a lump on her hand. She
first noticed the lump 2 weeks ago and thinks it has gotten bigger. She does not recall any injury.
She has not had any numbness, weakness, or tingling. She has minimal discomfort when she
presses on the lump, and it does not affect her activity. On examination her left wrist is
neurovascularly intact.
Which one of the following management options would you recommend?
A. Re-examination if she develops numbness, weakness, or increased pain
B. Immobilization of the wrist for 6 weeks and then re-examination
C. Aspiration of the lesion
D. Aspiration and injection of the lesion with a corticosteroid
E. Referral for excision of the lesion
ANSWER: A. Re-examination if she develops numbness, weakness or increased pain
This patient has a ganglion cyst, which is common and resolves spontaneously in 50% of cases,
and watchful waiting would be most appropriate at this time. Treatment is indicated if the cyst is
causing significant symptoms such as pain, numbness, or weakness, or for cosmetic symptoms.
Aspiration of the lesion is the initial treatment, although recurrence may occur in 85% of cases.
Immobilizing the wrist with a splint or brace is sometimes helpful in the short term if the patient
is bothered by the symptoms, but immobilization does not provide lasting relief and could cause
muscle atrophy. Corticosteroid injections have not shown any benefit. Referral for excision is
appropriate if there has been no improvement. Patients should be advised that there is a 10%-
15% recurrence rate even after excision.
A 57 year old female with diabetes mellitus comes to your office for a routine follow up. Her
current medications include metformin 1000 mg twice daily. She tells you that she does not
exercise regularly and finds it difficult to follow a healthy diet. HbA1c today is 7.5%. She does
not want to add medications at this time, but she does want to het her HbA1c below 7%, which is
the goal that was previously discussed.
Which one of the following would be the most effective way to improve glucose control for this
patient.
A. Discuss the components of a healthy diabetic diet and encourage her to follow it more closely.
B. Discuss the importance of regular exercise and encourage her to exercise 30-45 minutes daily.
C. Recommend that she check her glucose level 1-3 times daily to help determine what
adjustments need to be made.
,D. Start her on an additional medication
E. Refer her to a diabetes educator for medical nutrition therapy.
ANSWER: E. Refer her to a diabetes educator for medical nutrition therapy
Counseling by a diabetic educator or a team of educators for medical nutrition therapy lowers
HbA1c by 0.2-0.8 percentage points in patients with type 2 diabetes. While a healthy diabetic
diet and regular exercise is important, simply reminding the patient of that fact is not likely to be
as successful as comprehensive diabetic education. According to the Society of General Internal
Medicine in the Choosing Wisely campaign, patients with type 2 diabetes who are not on insulin
therapy should not check their blood glucose level daily. An additional medication will likely
decrease HbA1c, but this patient has expressed a desire to avoid additional medication, is near
goal, and is not currently managing her diabetes with adequate lifestyle changes, so it would be
appropriate to respect her wishes and pursue proven interventions that do not require medication.
During a newborn examination the patient's mother asks what she can do to decrease the risk of
food allergies in her newborn son. She tells you that there is no family history of atopic
dermatitis or asthma but she has a cousin with a peanut allergy. The remainder of the
examination is unremarkable.
You tell her that food allergy risk can be reduced by
A. breastfeeding for at least 1 year
B. Using soy based formula instead of cow's milk based formula
C. introducing peanut-containing food when solids are started
D. Avoiding all house pets
E. Avoiding a day care setting
ANSWER: C. Introducing peanut containing food when solids are started
Food allergy affects 4-6% of children in the US. IgE-mediated food allergy is the best
understood, and symptoms can range from rhinorrhea to anaphylaxis. The two most common
allergens are cow's milk and peanuts. The onset of symptoms is usually within 2 hours of
exposure and they resolve within several hours. The National Institute of Allergy and Infectious
Diseases in 2017 recommended that healthy infants without known food allergy or who have
mild to moderate eczema may be introduced to peanut-containing foods with other solid foods. If
the parents are concerned about a reaction, introduction of peanut-containing foods may be done
in the physician's office. Infants with severe eczema, egg allergy, or both should undergo peanut-
specific IgE or skin prick testing. While breastfeeding may decrease atopic disease, there is
insufficient evidence that it reduces the likelihood of food allergy, and using a soy based formula
will not prevent food allergy. If there is a dog in the home there is less risk of allergy to eggs.
Children who are exposed to farm animals or who attend day care are less likely to develop
atopic disease.
Which one of the following antihypertensive medications is LEAST likely to exacerbate erectile
dysfunction?
,A. Clonidine (Catapres)
B. Doxazosin (Cardura)
C. Hydrochlorothiazine
D. Losartan (Cozaar)
E. Metoprolol
ANSWER: D. Losartan
Angiotensin receptor blockers (ARBs) such as losartan are least likely to cause or exacerbate
erectile dysfunction. ARBs may have a favorable effect on erectile dysfunction by inhibiting
vasoconstriction activity of angiotensin. Clonidine, alpha blockers, hydrochlorothiazide, and
beta-blockers are more likely to negatively affect erectile function.
You are providing end of life care for a 53 year old female with end stage colon cancer. Her
family reports that she is having significant abdominal pain, nausea, and vomiting, and she is not
able to tolerate oral intake. You suspect a malignant bowel obstruction.
Which one of the following interventions would be most likely to significantly improve her
symptoms?
A. Medical cannabis
B. Dexamethasone
C. Morphine
D. Octreotide (Sandostatin)
E. Polyethylene glycol (Miralax)
ANSWER: B. Dexamethasone
Malignant bowel obstruction is a common issues with GI cancers. Corticosteroids can help
alleviate these symptoms, which is the focus in end of life care. Corticosteroids have numerous
beneficial effects in these situations, such as central antiemetic, anti-inflammatory, anti-
secretory, and analgesic effects. Intravenous dexamethasone is generally recommended at a
dosage of 4 mg 3-4 times daily for malignant bowel obstruction because it has more greater anti-
inflammatory effects than methylprednisolone. Although octreotide is commonly used for this
purpose, there is little evidence to support its use. Medical cannabis can be used to treat nausea
and vomiting in end of life care but is not effective for bowel obstruction. Morphine can be used
to treat pain and end of life dyspnea, but not for nausea and vomiting. The use of polyethylene
glycol for a malignant obstruction could worsen the patient's symptoms significantly.
A 3 year old male has developed multiple large areas of bullous impetigo on the legs, buttocks,
and trunk after being bitten numerous times by ants.
Which one of the following would be the most appropriate treatment?
A. Topical mupirocin ointment
B. Oral azithromycin
C. Oral tetracycline
, D. Oral trimethoprim/sufamethoxazole
E. Intramuscular penicillin G benzathine
ANSWER: D. Oral trimethoprim/sulfamethoxazole
Impetigo may be caused by Strep progenies or Staph aureus, but bullous impetigo is caused
exclusively by S aureus. Oral trimethoprim/sulfamethoxazole is an appropriate treatment for skin
infections caused by S. aureus, including susceptible cases of MRSA. Topical mupirocin
ointment is not practical in very widespread cases or in cases with large bullae. Neither
azithromycin nor penicillin is preferred treatment for impetigo, due to a high rate of treatment
failure. Tetracycline should be avoided in children under 8 years of age due to propensity to
cause permanent staining of the teeth.
A 60 year old male with diabetes mellitus and hypertension sees you for routine follow up. He
has no acute health concerns during today's visit. His current medications include metformin,
lisinopril, and HCTZ. He smokes cigarettes and has a 40 pack year smoking history. His vital
signs and a physical examination are normal. An in-office dipstick urinalysis reveals 1+ blood
and trace protein but is otherwise normal.
Which one of the following would be the most appropriate follow up?
A. Repeat dipstick urinalysis in 3 months
B. Microscopic urinalysis
C. Renal ultrasonography
D. CT urography
E. Referral for cystoscopy
ANSWER: B. Microscopic urinalysis
Microscopic hematuria also known as microhematuria, is defined as >3 RBCs/hpf on
microscopy. Dipstick analysis alone is insufficient to diagnose microscopic hematuria, as blood
that is seen on dipstick analysis may represent a false positive result caused by myoglobinuria,
hemoglobinuria, dehydration, exercise, menstrual period, or povidone iodine, as opposed to true
hematuria. Thus, when the presence of blood is suggested by dipstick urinalysis, confirmation
with microscopic analysis should be obtained. The current guideline from the American
Urological Association stratifies further workup for microscopic hematuria based on the patient's
overall risk of genitourinary malignancy, rather an automatic referral for cystoscopy and CT
urography for all adults > 35 years old with microhematuria, as was recommended in the
previous AUA guideline. Patients who are at low risk also may be given the option to repeat a
urinalysis in 6 months. For this patient the next step would be microscopic urinalysis to
determine the presence of hematuria, and if present, to quantify it. If microscopic UA confirms
the presence of hematuria, then CT urography and cystoscopy would be indicated, as his age,
male sex, and smoking history place him at increased risk of malignancy. Repeating the dipstick
analysis in 3 months would be inappropriate in this situation, as the presence or absence of true
microscopic hematuria needs to be clarified because of his high risk history.
