ABFM ITE ACTUAL EXAM
QUESTIONS AND ANSWERS
WITH RATIONALES RATED
A+ 2025
PC
[COMPANY NAME] [Company address]
,A 24-year-old female presents with a 2-day history of mild to moderate pelvic
pain. She has had two male sex partners in the last 6 months and uses oral
contraceptives and sometimes condoms. A physical examination reveals a
temperature of 36.4°C (97.5°F) and moderate cervical motion and uterine
tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows
only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this
patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should
be administered at the time of diagnosis and not delayed until the results of the
nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are
returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a
mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators
such as fever, leukocytosis, or an elevated C-reactive protein level may be
helpful but are neither sensitive nor specific. A positive NAAT is not required for
diagnosis and treatment because an upper tract infection may be present, or
the causative agent may not be gonorrhea or Chlamydia. PID should be
considered a polymicrobial infection. Pelvic ultrasonography may be used if
there is a concern about other pathology such as a tubo-ovarian abscess.
,A 24-year-old patient wants to start the process of transitioning from female to
male. He has been working with a psychiatrist who has confirmed the diagnosis of
gender dysphoria.
Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
ANSWER: E
For patients with gender dysphoria or gender incongruence who desire
hormone treatment, the treatment goal is to suppress endogenous sex
hormone production and maintain sex hormone levels in the normal range for
their affirmed gender. For a female-to-male transgender patient this is most
easily accomplished with testosterone. When testosterone levels are
maintained in the normal genetic male range, gonadotropins and ovarian
hormone production is suppressed, which accomplishes both goals for
hormonal treatment without the need for additional gonadotropin suppression
from medications such as leuprolide.
Clomiphene can increase serum testosterone levels, but only in the presence of
a functioning testicle. Letrozole is an estrogen receptor antagonist, but it would
not increase serum testosterone levels. Spironolactone has androgen receptor
blocking effects and would not accomplish either of the hormone treatment
goals.
Based on American Cancer Society guidelines for cervical cancer screening, when
should HPV DNA co-testing first be performed along with Papanicolaou testing?
A) At the onset of sexual activity
, B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening,
Papanicolaou (Pap) testing should begin at age 21 irrespective of sexual activity
and should be continued every 3 years until age 29. The preferred screening
strategy beginning at age 30 is Pap testing with HPV co-testing, which should be
continued every 5 years until age 65. Cervical screening may be discontinued at
that time if the patient's last two tests have been negative and the patient was
tested within the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes
ANSWER: D
Acid suppression therapy is associated with an increased risk of community-
acquired and health care-associated pneumonia, which is related to gastric
overgrowth by gram-negative bacteria. Long-term treatment of Barrett's
esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI
therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
QUESTIONS AND ANSWERS
WITH RATIONALES RATED
A+ 2025
PC
[COMPANY NAME] [Company address]
,A 24-year-old female presents with a 2-day history of mild to moderate pelvic
pain. She has had two male sex partners in the last 6 months and uses oral
contraceptives and sometimes condoms. A physical examination reveals a
temperature of 36.4°C (97.5°F) and moderate cervical motion and uterine
tenderness. Urine hCG and a urinalysis are negative. Vaginal microscopy shows
only WBCs.
The initiation of antibiotics for treatment of pelvic inflammatory disease in this
patient
A) is appropriate at this time
B) requires an elevated temperature, WBC count, or C-reactive protein level
C) should be based on the results of gonorrhea and Chlamydia testing
D) should be based on the results of pelvic ultrasonography
ANSWER: A
Pelvic inflammatory disease (PID) is a clinical diagnosis, and treatment should
be administered at the time of diagnosis and not delayed until the results of the
nucleic acid amplification testing (NAAT) for gonorrhea and Chlamydia are
returned. The clinical diagnosis is based on an at-risk woman presenting with
lower abdominal or pelvic pain, accompanied by cervical motion, uterine, or
adnexal tenderness that can range from mild to severe. There is often a
mucopurulent discharge or WBCs on saline microscopy. Acute phase indicators
such as fever, leukocytosis, or an elevated C-reactive protein level may be
helpful but are neither sensitive nor specific. A positive NAAT is not required for
diagnosis and treatment because an upper tract infection may be present, or
the causative agent may not be gonorrhea or Chlamydia. PID should be
considered a polymicrobial infection. Pelvic ultrasonography may be used if
there is a concern about other pathology such as a tubo-ovarian abscess.
,A 24-year-old patient wants to start the process of transitioning from female to
male. He has been working with a psychiatrist who has confirmed the diagnosis of
gender dysphoria.
Which one of the following would be the best initial treatment for this patient?
A) Clomiphene
B) Letrozole (Femara)
C) Leuprolide (Eligard)
D) Spironolactone (Aldactone)
E) Testosterone
ANSWER: E
For patients with gender dysphoria or gender incongruence who desire
hormone treatment, the treatment goal is to suppress endogenous sex
hormone production and maintain sex hormone levels in the normal range for
their affirmed gender. For a female-to-male transgender patient this is most
easily accomplished with testosterone. When testosterone levels are
maintained in the normal genetic male range, gonadotropins and ovarian
hormone production is suppressed, which accomplishes both goals for
hormonal treatment without the need for additional gonadotropin suppression
from medications such as leuprolide.
Clomiphene can increase serum testosterone levels, but only in the presence of
a functioning testicle. Letrozole is an estrogen receptor antagonist, but it would
not increase serum testosterone levels. Spironolactone has androgen receptor
blocking effects and would not accomplish either of the hormone treatment
goals.
Based on American Cancer Society guidelines for cervical cancer screening, when
should HPV DNA co-testing first be performed along with Papanicolaou testing?
A) At the onset of sexual activity
, B) At age 21
C) At age 25
D) At age 30
E) At age 35
ANSWER: D
According to American Cancer Society guidelines for cervical cancer screening,
Papanicolaou (Pap) testing should begin at age 21 irrespective of sexual activity
and should be continued every 3 years until age 29. The preferred screening
strategy beginning at age 30 is Pap testing with HPV co-testing, which should be
continued every 5 years until age 65. Cervical screening may be discontinued at
that time if the patient's last two tests have been negative and the patient was
tested within the previous 5 years.
Long-term proton pump inhibitor use is associated with an increased risk for
A) Barrett's esophagus
B) gout
C) hypertension
D) pneumonia
E) type 2 diabetes
ANSWER: D
Acid suppression therapy is associated with an increased risk of community-
acquired and health care-associated pneumonia, which is related to gastric
overgrowth by gram-negative bacteria. Long-term treatment of Barrett's
esophagus is an indication for chronic proton pump inhibitor (PPI) use. PPI
therapy does not increase the risk of gout, hypertension, or type 2 diabetes.
