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ABFM ITE 2023/2024 EXAM
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ABFM ITE 2023/2024 EXAM WITH 200QUESTIONS AND ANSWERS UPDATED COMPLETELY 100% SOLVED CORRECTLY, GRADE A+| RATIONALES INCLUDED
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ABFM ITE 2023/2024 EXAM WITH 200QUESTIONS AND ANSWERSUPDATED COMPLETELY 100% SOLVED CORRECTLY, GRADE A+|
RATIONALES INCLUDED
A 67-year old male sees you for a Medicare annual wellness visit. He tells you that his best
friend had a stroke and he asks about his risk for stroke. He has a family history of
cardiovascular disease in his father, who had a myocardial infarction at age 65 and died from a
thrombotic stroke at age 71. The patient exercises regularly and has a BMI of 27 kg/m2. His only
current medical condition is hyperlipidemia, and his cholesterol level is at goal on rosuvastatin
(Crestor), 10 mg daily. He also takes aspirin, 81 mg daily. His blood pressure 125/78 mmHg.
Based on US Preventive Services Task Force guidelines, which one of the following would be
most appropriate at this time?
A. No additional testing for stroke risk
B. Auscultation for carotid bruits
C. Carotid duplex ultrasonography
D. Magnetic resonance angiography
E. CT angiography of the carotid arteries
ANSWER: A
No additional testing for stroke risk Carotid artery disease affects extra cranial carotid arteries
and is caused by atherosclerosis.
This patient is asymptomatic and has no history of an ischemic stroke, neurology symptoms
referable to the carotid arteries such as amaurosis fugal, or TIA. He has risk factors for
cardiovascular disease (age, male sex, hyperlipidemia_, but the USPSTF recommends against
specific screening asymptomatic carotid artery stenosis (D recommendation) which a low
prevalence in the general adult population. Stroke is a leading cause of disability and death in the
US, but asymptomatic carotid artery stenosis causes a relatively small portion of strokes.
Auscultation of the carotid arteries for bruits has been found to have poor accuracy for detecting
carotid stenosis and is not a reasonable screening approach. Appropriate modalities for detecting
carotid stenosis include carotid duplex ultrasonography, magnetic resonance angiography, and
computed tomography, but there are not recommended for screening asymptomatic patients.
A 28 year old female presents for evaluation of nasal congestion, sneezing, watery eyes, and
postnasal drip. This has been an intermittent issue for her every spring and she would like to
manage it more effectively.
Which one of the following treatments has been shown to be the most effective and best tolerated
first-line therapy for this patient's condition?
A. A leukotriene receptor agonist
B. Intranasal corticosteroid monotherapy
,C. Intranasal corticosteroids plus an oral antihistamine
D. Inhaled corticosteroids
E. Annual triamcinolone injections
ANSWER: B
Intranasal corticosteroid monotherapy
This patient has seasonal allergic rhinitis. A joint guideline statement from the American
Academy of Allergy, Asthma, and Immunology/American College of Allergy, Asthma and
Immunology Joint Task Force on Practice Parameters recommends that mono therapy with
intranasal corticosteroids would be prescribed initially in patients equal to or more than 12 years
of age rather than combined treatment with oral antihistamines because data has not shown an
additional benefit to adding the antihistamine. Higher patient adherence and tolerance and fewer
side effects were seen with the mono therapy regimen. High quality evidence indicates that
intranasal corticosteroids were more effective than leukotriene receptor antagonists. Inhaled
corticosteroids and triamcinolone injections are not appropriate first line options for the
treatment of seasonal allergic rhinitis
A 68 year old female presents with a 2 month history of watery diarrhea. She has not had any
blood or pus in her stools, and the stools are not oily. She has not had any history of fever, chills,
or weight loss, and has not traveled recently. She smokes one pack of cigarettes per day. Her
medications include ibuprofen, sertraline and pantoprazole. A CBC, metabolic panel, CRP, IgA
anti tissue transglutaminase level, total IgA level, and stool guaiac test are all normal.
Which one of the following tests would be mostly likely to yield a diagnosis?
A. C difficile toxin
B. Colonoscopy
C. Fecal calprotectin
D. A stool culture
E. Stool exam for ova and parasites
ANSWER: B
Colonoscopy
In patients with chronic nonbloody diarrhea, the differential diagnosis includes microscopic
(lymphocytic or collagenous) colitis. The mucosa appears normal on colonoscopy but a biopsy
will show lymphocytic infiltration of the epithelium. The etiology is unknown but there are
several risk factors to consider, including older age, female sex, and smoking status. Drugs with
a high level of evidence causing microscopic colitis include NSAIDs, PPIs, sertraline, acarbose,
aspirin, and ticlopidine. C. diff should be suspected in individuals who have taken antibiotics in
the past 3 months. Fecal calprotectin is elevated in inflammatory diarrhea such as Crohn's
disease or ulcerative colitis. A stool culture would be indicated if there is a suspicion of an
infectious bacterial diarrhea such as Shigella or Salmonella, but these bacteria tend to cause
,bloody diarrhea. Checking for a parasitic infection should be considered for patients with a
history of recent travel or exposure to unpurified water.
A 23 year old male with opioid use disorder requests buprenorphine therapy. He is still actively
using immediate release oxycodone and he took a dose 2 hours ago.
This patient should begin buprenorphine induction
A. Now
B. In 2 hours
C. 8-12 hours after his last opioid use
D. 24 hours after his last opioid use
E. 1 week after his last opioid use
ANSWER: C
8-12 hours after his last opioid use
Buprenorphine is a partial opioid agonist. In order to reduce the risk of precipitated withdrawal,
buprenorphine induction should begin once the patient is exhibiting signs of mild to moderate
withdrawal, usually 8-12 hours after the last opioid use. Waiting until a patient goes through a
full withdrawal increases the chances that the patient will revert back to using opioids.
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
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