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AMERICAN BOARD OF FAMILY MEDICINE IN-
TRAINING EXAMINATION (ABFM ITE)
COMPREHENSIVE PRACTICE QUESTIONS &
RATIONALES
UPDATED 2026-2027 | 150+ EXPERT-VERIFIED
QUESTIONS
SECTION 1: CARDIOVASCULAR MEDICINE
Question 1
A 68-year-old male with type 2 diabetes mellitus,
hypertension, and obstructive sleep apnea presents
for follow-up. He does not use tobacco, and his
alcohol consumption consists of two drinks per day.
His BMI is 31.0 kg/m². The patient asks if his family
history of atrial fibrillation increases his own risk.
Which one of the following factors would increase
the risk of atrial fibrillation in this patient?
A) Lisinopril treatment
B) Pioglitazone treatment
C) Alcohol use
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D) CPAP use
E) Physical stress
Answer: C) Alcohol use
Rationale: Alcohol consumption greater than one
drink per day has been associated with an increased
risk of atrial fibrillation. While obesity and OSA are
risk factors, CPAP use would not increase risk.
Pioglitazone is not associated with increased AF risk,
and lisinopril is not a risk factor. Physical stress
alone does not increase AF risk in this context .
Question 2
An 85-year-old female with diabetes mellitus,
hypertension, dementia, and peptic ulcer disease is
in a skilled nursing facility for rehabilitation after hip
fracture repair. She develops confusion, shortness
of breath, and diaphoresis. BP 172/98 mmHg, HR
122 bpm irregular, RR 22/min. EKG shows atrial
fibrillation and 0.2 mV ST-segment elevation.
Troponin is elevated.
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Which condition is an ABSOLUTE contraindication to
fibrinolytic therapy?
A) Poorly controlled hypertension
B) Peptic ulcer disease
C) Alzheimer's dementia
D) Hip fracture repair
E) Ischemic stroke (within 3 months)
Answer: E) Ischemic stroke (within 3 months)
Rationale: History of ischemic stroke within the past
3 months is an absolute contraindication to
fibrinolytic therapy in STEMI patients, unless the
stroke occurred within 4.5 hours. Poorly controlled
hypertension, dementia, peptic ulcer disease, and
major surgery within 3 weeks are relative
contraindications that should be considered
individually .
Question 3
A 55-year-old male presents with acute onset chest
pain. EKG reveals ST-segment elevation.
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What is the recommended "entry to balloon time"
for PCI?
A) 60 minutes
B) 90 minutes
C) 120 minutes
D) 180 minutes
E) 240 minutes
Answer: C) 120 minutes
Rationale: The recommended door-to-balloon time
for percutaneous coronary intervention (PCI) in
STEMI is 120 minutes. The time limit from symptom
onset to balloon inflation should be within 12 hours
for optimal outcomes .
Question 4
A patient with pulmonary hypertension due to left
heart failure asks about vasodilator therapy.
Which statement is correct regarding PDE5 inhibitor
use in this patient?
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AMERICAN BOARD OF FAMILY MEDICINE IN-
TRAINING EXAMINATION (ABFM ITE)
COMPREHENSIVE PRACTICE QUESTIONS &
RATIONALES
UPDATED 2026-2027 | 150+ EXPERT-VERIFIED
QUESTIONS
SECTION 1: CARDIOVASCULAR MEDICINE
Question 1
A 68-year-old male with type 2 diabetes mellitus,
hypertension, and obstructive sleep apnea presents
for follow-up. He does not use tobacco, and his
alcohol consumption consists of two drinks per day.
His BMI is 31.0 kg/m². The patient asks if his family
history of atrial fibrillation increases his own risk.
Which one of the following factors would increase
the risk of atrial fibrillation in this patient?
A) Lisinopril treatment
B) Pioglitazone treatment
C) Alcohol use
1|Page
, 2
D) CPAP use
E) Physical stress
Answer: C) Alcohol use
Rationale: Alcohol consumption greater than one
drink per day has been associated with an increased
risk of atrial fibrillation. While obesity and OSA are
risk factors, CPAP use would not increase risk.
Pioglitazone is not associated with increased AF risk,
and lisinopril is not a risk factor. Physical stress
alone does not increase AF risk in this context .
Question 2
An 85-year-old female with diabetes mellitus,
hypertension, dementia, and peptic ulcer disease is
in a skilled nursing facility for rehabilitation after hip
fracture repair. She develops confusion, shortness
of breath, and diaphoresis. BP 172/98 mmHg, HR
122 bpm irregular, RR 22/min. EKG shows atrial
fibrillation and 0.2 mV ST-segment elevation.
Troponin is elevated.
2|Page
, 3
Which condition is an ABSOLUTE contraindication to
fibrinolytic therapy?
A) Poorly controlled hypertension
B) Peptic ulcer disease
C) Alzheimer's dementia
D) Hip fracture repair
E) Ischemic stroke (within 3 months)
Answer: E) Ischemic stroke (within 3 months)
Rationale: History of ischemic stroke within the past
3 months is an absolute contraindication to
fibrinolytic therapy in STEMI patients, unless the
stroke occurred within 4.5 hours. Poorly controlled
hypertension, dementia, peptic ulcer disease, and
major surgery within 3 weeks are relative
contraindications that should be considered
individually .
Question 3
A 55-year-old male presents with acute onset chest
pain. EKG reveals ST-segment elevation.
3|Page
, 4
What is the recommended "entry to balloon time"
for PCI?
A) 60 minutes
B) 90 minutes
C) 120 minutes
D) 180 minutes
E) 240 minutes
Answer: C) 120 minutes
Rationale: The recommended door-to-balloon time
for percutaneous coronary intervention (PCI) in
STEMI is 120 minutes. The time limit from symptom
onset to balloon inflation should be within 12 hours
for optimal outcomes .
Question 4
A patient with pulmonary hypertension due to left
heart failure asks about vasodilator therapy.
Which statement is correct regarding PDE5 inhibitor
use in this patient?
4|Page
