2025 ABFM ITE EXAM VERSION B LATEST
WITH 200 ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
(100% CORRECT DETAILED ANSWERS)
ABFM ITE TEST (BRAND NEW!)
A 12-year-old female is brought to your office because of a lesion on her left
lateral upper eyelid (shown below). The lesion started 3 days ago as a small, red
"pimple," and since then it has increased in size and is tender. She does not have
any fever, tearing, or conjunctival irritation.
No treatment has been attempted.
Which one of the following would be the most appropriate initial management?
A) Warm, damp compresses for 10 minutes four times daily
B) Topical erythromycin ophthalmic ointment (Ilotycin)
C) Topical hydrocortisone 0.5%
D) Systemic antibiotics with coverage for staphylococci
E) Incisional drainage using a sterile 18- or 20-gauge needle
ANSWER: A
Rationale: This patient presents with an external hordeolum or stye. Warm, damp
compresses for 10 minutes four
times a day would be the best initial management. Topical erythromycin ointment
and topical
hydrocortisone cream are not indicated for treatment of a stye. Although
staphylococci are commonly
involved in this process, antibiotics are not recommended unless there is evidence
of adjoining cellulitis.
Warm compresses allow for spontaneous drainage and resolution. Anti-
inflammatory medications are not
recommended for hordeolum externum management, however they could become
necessary if it becomes
a chalazion. If the hordeolum has not resolved in about 1 week, incision may be
necessary.
pg. 1
,You see a 60-year-old male for an initial office visit. He has a past history of a
myocardial infarction. He has smoked two packs of cigarettes daily since the age
of 18. He says that he enjoys smoking and has no plans to quit.
Which one of the following would be the most appropriate response?
A) I must advise you that smoking is very bad for your health
B) Did you know that smoking increases your risk of another heart attack?
C) What do you know about smoking's effect on your health in general?
D) Would it be okay if we discuss smoking?
E) Can I schedule a follow-up appointment soon to focus on quitting smoking?
64
ANSWER: D
Rationale: The stages of change model includes precontemplation, contemplation,
preparation, action, and maintenance. Identifying which stage a patient is in can
help guide physicians in counseling strategies. The goal is to move the patient
toward taking action. This patient is in the precontemplation stage. He has no
interest in changing and is opposed to quitting smoking. At this stage it is best to
use the motivational interviewing technique of asking permission before presenting
information and if given permission to share it in a neutral manner. Motivational
interviewing has been shown to be useful in primary care for helping patients to
reduce weight, blood pressure, and alcohol use (SOR A). Emphasizing the
consequences of smoking or asking to schedule a follow-up visit
to focus on smoking cessation may increase resistance and may also reduce patient
openness to physician input at this stage.
A 68-year-old female with a history of diabetes mellitus, hypertension, and heart
failure with preserved ejection fraction presents with a long-standing diabetic foot
ulcer. The patient reports no signs of any gastrointestinal bleeding, no blood in her
urine, no bleeding gums, and no vaginal bleeding. Her medications include
metformin (Glucophage), insulin glargine (Lantus), lisinopril (Prinivil, Zestril),
atorvastatin (Lipitor), and furosemide (Lasix).
A CBC reveals a WBC count of 7600/mm3 (N 4500-11,000), a hemoglobin level
of 9.7 g/dL
pg. 2
,(N 14.0-17.5), a mean corpuscular volume of 89 m3 (N 80-100), and a platelet
count of 412,000/mm3 (N 150,000-400,000).
To further assess the patient's anemia you obtain the following laboratory results:
Ferritin 293 ng/mL (N 22-275)
Serum iron 43 g/dL (N 50-175)
Transferrin 190 mg/dL (N 177-264)
Reticulocyte count 3.2% (N 0.5-1.5)
Vitamin B12 564 pg/mL (N 230-1050)
Haptoglobin 198 mg/dL (N 63-273)
Which one of the following is the most likely cause of her anemia?
A) Anemia of chronic disease
B) Bone marrow suppression
C) Hemolysis
D) Iron deficiency
E) Vitamin B12 deficiency
ANSWER: A
Rationale: This patient has findings most consistent with anemia of chronic
disease, also known as anemia of inflammation. This condition is thought to be
primarily a disorder of iron distribution in response to systemic inflammation,
which also biases hematopoiesis toward myeloid cell production rather than
erythropoiesis and shortens the erythrocyte lifespan. Anemia of chronic disease is a
normocytic and normochromic anemia. Iron studies typically show evidence of
iron restriction without systemic iron deficiency. A common challenge in diagnosis
is when true iron deficiency coexists with anemia of chronic disease.
This patient's normal WBC and platelet counts make bone marrow suppression less
likely. The normal haptoglobin level and low reticulocyte count are not consistent
with hemolysis. She has a normocytic rather than microcytic anemia and her
ferritin level is elevated. These two factors make iron deficiency less likely
despite her low serum iron level. The low normal transferrin level is also consistent
with anemia of chronic disease rather than iron deficiency. Her normal vitamin
B12 level makes a deficiency unlikely. Her history of a chronic foot ulcer and
elevated inflammatory markers (ferritin and platelets) are consistent with anemia
of chronic disease.
A 42-year-old Asian male presents for follow-up of elevated blood pressure. He
has no additional chronic medical problems and is otherwise asymptomatic. An
examination is significant for a blood pressure of 162/95 mm Hg but is otherwise
pg. 3
, unremarkable.
Laboratory Findings
Sodium 138 mEq/L (N 135-145) Potassium 3.9 mEq/L (N 3.5-5.5) Fastingglucose
86mg/dLBUN 14 mg/dL (N 10-20) Creatinine 0.6mg/dL(N0.6-1.3)
Urinemicroalbumin negative
According to the American College of Cardiology/American Heart Association
2017 guidelines, which one of the following would be the most appropriate
medication to initiate at this time?
A) Clonidine (Catapres), 0.1 mg twice daily
B) Hydralazine, 25 mg three times daily
C) Lisinopril/hydrochlorothiazide (Zestoretic), 10/12.5 mg daily
D) Metoprolol tartrate (Lopressor), 25 mg twice daily
E) Triamterene (Dyrenium), 50 mg daily
ANSWER: C
Rationale: This patient has hypertension and according to both JNC 8 and
American College of Cardiology/American Heart Association 2017 guidelines,
antihypertensive treatment should be initiated. For the general non-African-
American population, monotherapy with an ACE inhibitor, an angiotensin receptor
blocker, a calcium channel blocker, or a thiazide diuretic would be appropriate for
initial management. It is also appropriate to initiate combination antihypertensive
therapy as an initial management strategy, although patients should not take an
ACE inhibitor and an angiotensin receptor blocker simultaneously. Studies have
shown that blood pressure control is achieved faster with the initiation of
combination therapy compared to monotherapy, without an increase in morbidity.
Lisinopril/hydrochlorothiazide would be an appropriate choice in this patient. -
Blockers, vasodilators, -blockers, and potassium-sparing diuretics are not
recommended as initial choices for the treatment of hypertension.
During rounds at the nursing home, you are informed that there are two residents
on the unit with laboratory-confirmed influenza. According to CDC guidelines,
who should receive chemoprophylaxis for influenza?
A) Only symptomatic residents on the same unit
B) Only symptomatic residents in the entire facility
C) All asymptomatic residents on the same unit
D) All residents of the facility regardless of symptoms
E) All staff regardless of symptoms
pg. 4
