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American Board of Family Medicine (ABFM) Certification
Examination | Latest Verified Questions and Detailed
Answers
OVERVIEW DESCRIPTION:
This comprehensive set of multiple-choice questions is meticulously designed for the
American Board of Family Medicine (ABFM) Certification Examination. The questions are
strategically distributed across the core content areas, with a strong emphasis on Acute Care
and Diagnosis (35%) and Chronic Care Management (25%), reflecting the breadth of family
medicine practice in ambulatory, urgent, and inpatient settings. The material integrates the
examination's key demographic focuses—predominantly Adult Medicine, with significant
representation of Geriatrics, Pediatrics, and Adolescent care. Each question is framed as a
realistic clinical scenario requiring the application of evidence-based guidelines, critical
decision-making, and a nuanced understanding of disease management, preventive care, and
the foundational principles of medical ethics and quality improvement.
Acute Care and Diagnosis (35%) - 105 Questions
QUESTION 1
A 22-year-old college student presents with 3 days of sore throat, fever, and tender
anterior cervical lymphadenopathy. There is no cough. What is the most appropriate
next step?
A) Prescribe amoxicillin empirically
B) Perform a rapid antigen detection test for Group A Streptococcus
C) Obtain a monospot test
D) Prescribe supportive care only
CORRECT ANSWER: B
EXPERT RATIONALE: The Centor criteria (fever, tonsillar exudates, tender adenopathy,
no cough) suggest a high likelihood of GAS pharyngitis. A rapid antigen test should be
performed to confirm the diagnosis before considering antibiotics.
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QUESTION 2
A 68-year-old man with a history of coronary artery disease presents with acute onset of
severe, tearing chest pain radiating to his back. His blood pressure is 180/100 in the
right arm and 110/70 in the left arm. What is the most appropriate initial imaging study?
A) Chest X-ray
B) Echocardiogram
C) Computed tomography angiography of the chest
D) Electrocardiogram
CORRECT ANSWER: C
EXPERT RATIONALE: The presentation is classic for acute aortic dissection. CTA of the
chest is the definitive, rapid imaging study of choice to confirm the diagnosis and assess
the extent of the dissection.
QUESTION 3
A 32-year-old woman presents with acute-onset, sharp right lower quadrant pain,
nausea, and vomiting. She has a temperature of 38.5°C. On exam, she has guarding and
rebound tenderness. What is the next best step?
A) Obtain a CT abdomen and pelvis with IV contrast
B) Administer oral antibiotics and discharge with follow-up
C) Perform a pelvic ultrasound
D) Immediate surgical consultation
CORRECT ANSWER: D
EXPERT RATIONALE: The patient has signs of peritonitis (guarding, rebound)
suggesting appendicitis with possible perforation. Immediate surgical consultation is
required for definitive management.
QUESTION 4
A 55-year-old male smoker presents with a 2-day history of worsening right calf pain.
,3|Page
The calf is swollen, warm, and tender to palpation. What is the most appropriate initial
diagnostic test?
A) D-dimer
B) Venous duplex ultrasound
C) CT venography
D) MRI of the lower extremity
CORRECT ANSWER: B
EXPERT RATIONALE: Venous duplex ultrasound is the initial imaging modality of
choice for suspected deep vein thrombosis (DVT) as it is non-invasive, widely available,
and highly sensitive.
QUESTION 5
A 45-year-old woman presents with sudden onset of dyspnea and sharp, pleuritic chest
pain one week after a total knee arthroplasty. She is tachypneic and hypoxic. What is the
most appropriate next step?
A) CT pulmonary angiography
B) Ventilation-perfusion (V/Q) scan
C) Chest X-ray
D) D-dimer
CORRECT ANSWER: A
EXPERT RATIONALE: In a post-operative patient with a high pre-test probability for
pulmonary embolism (PE), a CT pulmonary angiography is the diagnostic test of choice
to directly visualize emboli.
QUESTION 6
A 28-year-old male presents with acute onset of severe, unilateral testicular pain that
began 2 hours ago. He reports nausea and vomiting. The testis is tender, elevated, and
there is no cremasteric reflex. What is the most appropriate management?
, 4|Page
A) Obtain a scrotal ultrasound with Doppler
B) Prescribe ciprofloxacin for epididymitis
C) Administer analgesics and schedule urology follow-up
D) Immediate surgical exploration
CORRECT ANSWER: D
EXPERT RATIONALE: This presentation is classic for testicular torsion, a urologic
emergency. Delaying intervention with imaging can lead to loss of the testicle;
immediate surgical exploration is required.
QUESTION 7
A 6-year-old child presents with a 2-day history of fever, cough, and coryza. Today, the
mother noticed a diffuse, erythematous, maculopapular rash that began on the face and
has spread to the trunk. What is the most likely diagnosis?
A) Rubella
B) Scarlet fever
C) Measles (Rubeola)
D) Roseola
CORRECT ANSWER: C
EXPERT RATIONALE: Measles presents with the classic triad of cough, coryza, and
conjunctivitis followed by a maculopapular rash that spreads cephalocaudally (head to
trunk to extremities).
QUESTION 8
A 24-year-old woman presents with dysuria and urinary frequency. She is afebrile and
has no flank pain. Urinalysis shows positive nitrites and leukocyte esterase. What is the
appropriate duration of antibiotic therapy?
A) 1 day
B) 3 days
American Board of Family Medicine (ABFM) Certification
Examination | Latest Verified Questions and Detailed
Answers
OVERVIEW DESCRIPTION:
This comprehensive set of multiple-choice questions is meticulously designed for the
American Board of Family Medicine (ABFM) Certification Examination. The questions are
strategically distributed across the core content areas, with a strong emphasis on Acute Care
and Diagnosis (35%) and Chronic Care Management (25%), reflecting the breadth of family
medicine practice in ambulatory, urgent, and inpatient settings. The material integrates the
examination's key demographic focuses—predominantly Adult Medicine, with significant
representation of Geriatrics, Pediatrics, and Adolescent care. Each question is framed as a
realistic clinical scenario requiring the application of evidence-based guidelines, critical
decision-making, and a nuanced understanding of disease management, preventive care, and
the foundational principles of medical ethics and quality improvement.
Acute Care and Diagnosis (35%) - 105 Questions
QUESTION 1
A 22-year-old college student presents with 3 days of sore throat, fever, and tender
anterior cervical lymphadenopathy. There is no cough. What is the most appropriate
next step?
A) Prescribe amoxicillin empirically
B) Perform a rapid antigen detection test for Group A Streptococcus
C) Obtain a monospot test
D) Prescribe supportive care only
CORRECT ANSWER: B
EXPERT RATIONALE: The Centor criteria (fever, tonsillar exudates, tender adenopathy,
no cough) suggest a high likelihood of GAS pharyngitis. A rapid antigen test should be
performed to confirm the diagnosis before considering antibiotics.
,2|Page
QUESTION 2
A 68-year-old man with a history of coronary artery disease presents with acute onset of
severe, tearing chest pain radiating to his back. His blood pressure is 180/100 in the
right arm and 110/70 in the left arm. What is the most appropriate initial imaging study?
A) Chest X-ray
B) Echocardiogram
C) Computed tomography angiography of the chest
D) Electrocardiogram
CORRECT ANSWER: C
EXPERT RATIONALE: The presentation is classic for acute aortic dissection. CTA of the
chest is the definitive, rapid imaging study of choice to confirm the diagnosis and assess
the extent of the dissection.
QUESTION 3
A 32-year-old woman presents with acute-onset, sharp right lower quadrant pain,
nausea, and vomiting. She has a temperature of 38.5°C. On exam, she has guarding and
rebound tenderness. What is the next best step?
A) Obtain a CT abdomen and pelvis with IV contrast
B) Administer oral antibiotics and discharge with follow-up
C) Perform a pelvic ultrasound
D) Immediate surgical consultation
CORRECT ANSWER: D
EXPERT RATIONALE: The patient has signs of peritonitis (guarding, rebound)
suggesting appendicitis with possible perforation. Immediate surgical consultation is
required for definitive management.
QUESTION 4
A 55-year-old male smoker presents with a 2-day history of worsening right calf pain.
,3|Page
The calf is swollen, warm, and tender to palpation. What is the most appropriate initial
diagnostic test?
A) D-dimer
B) Venous duplex ultrasound
C) CT venography
D) MRI of the lower extremity
CORRECT ANSWER: B
EXPERT RATIONALE: Venous duplex ultrasound is the initial imaging modality of
choice for suspected deep vein thrombosis (DVT) as it is non-invasive, widely available,
and highly sensitive.
QUESTION 5
A 45-year-old woman presents with sudden onset of dyspnea and sharp, pleuritic chest
pain one week after a total knee arthroplasty. She is tachypneic and hypoxic. What is the
most appropriate next step?
A) CT pulmonary angiography
B) Ventilation-perfusion (V/Q) scan
C) Chest X-ray
D) D-dimer
CORRECT ANSWER: A
EXPERT RATIONALE: In a post-operative patient with a high pre-test probability for
pulmonary embolism (PE), a CT pulmonary angiography is the diagnostic test of choice
to directly visualize emboli.
QUESTION 6
A 28-year-old male presents with acute onset of severe, unilateral testicular pain that
began 2 hours ago. He reports nausea and vomiting. The testis is tender, elevated, and
there is no cremasteric reflex. What is the most appropriate management?
, 4|Page
A) Obtain a scrotal ultrasound with Doppler
B) Prescribe ciprofloxacin for epididymitis
C) Administer analgesics and schedule urology follow-up
D) Immediate surgical exploration
CORRECT ANSWER: D
EXPERT RATIONALE: This presentation is classic for testicular torsion, a urologic
emergency. Delaying intervention with imaging can lead to loss of the testicle;
immediate surgical exploration is required.
QUESTION 7
A 6-year-old child presents with a 2-day history of fever, cough, and coryza. Today, the
mother noticed a diffuse, erythematous, maculopapular rash that began on the face and
has spread to the trunk. What is the most likely diagnosis?
A) Rubella
B) Scarlet fever
C) Measles (Rubeola)
D) Roseola
CORRECT ANSWER: C
EXPERT RATIONALE: Measles presents with the classic triad of cough, coryza, and
conjunctivitis followed by a maculopapular rash that spreads cephalocaudally (head to
trunk to extremities).
QUESTION 8
A 24-year-old woman presents with dysuria and urinary frequency. She is afebrile and
has no flank pain. Urinalysis shows positive nitrites and leukocyte esterase. What is the
appropriate duration of antibiotic therapy?
A) 1 day
B) 3 days
