ABFM Exam Questions with Verified Answers
|2026/2027 Update | A+ Graded
62-year-old male presents with daytime fatigue, sleepiness, snoring at night, and a BMI of 41
kg/m2 . You are concerned that he may have obesity hypoventilation syndrome (OHS) in
addition to possible obstructive sleep apnea. Which one of the following tests is most
appropriate for establishing a diagnosis of OHS? - Answer -Daytime Awake PaCO2; Obesity
hypoventilation syndrome (OHS) is characterized by obesity and alveolar hypoventilation while
awake, which is defined by an awake PaCO2 level >45 mm Hg. Ninety percent of patients have
coexistent obstructive sleep apnea (OSA). The pathogenesis is related to the increased physical
demands on breathing caused by obesity. While decreased PaO2 or oxygen saturation is often
present, it is not part of the diagnostic criteria. In obese patients with lower risk (often with
lower BMIs), a serum HCO3 - level <27 mmol/L may obviate the need for an arterial blood gas
measurement as OHS becomes very unlikely. If the HCO3 - level is 27 mmol/L (a renal
compensatory mechanism for hypoventilation-induced acidosis), a PaCO2 measurement should
be obtained to establish the diagnosis. The first-line treatment for ambulatory patients with this
condition is CPAP. Nighttime measurement of peripheral oxygen saturation during sleep
In a patient with new-onset polymyalgia rheumatica, which one of the following medications
can be added to glucocorticoid therapy in order to reduce the risk of relapse? - Answer -
Methotrexate; Polymyalgia rheumatica (PMR) should be treated with glucocorticoids to induce
remission. There is good evidence that adjunctive therapy with methotrexate reduces both the
cumulative dose of corticosteroids needed and the risk of relapse (evidence rating A). NSAIDs
such as ibuprofen and indomethacin reduce pain but do not modify the inflammatory process.
Icosapent ethyl is a derivative of omega-3 fatty acids that reduces cardiovascular events and
may improve rheumatoid arthritis, likely via anti-inflammatory properties. However, it has not
been shown to be effective in PMR. Mesalamine is used to reduce inflammation in
inflammatory bowel disease but is not effective against PMR.
. You are caring for a 21-year-old female with previously diagnosed bipolar II disorder,
generalized anxiety disorder, attention-deficit/hyperactivity disorder, and insomnia. The patient
1|Page
,presents with new symptoms of chills, excess sweating, flushing, and nausea of approximately 2
hours' duration. The patient felt normal upon awakening, took methylphenidate (Ritalin), 5 mg
with breakfast, and went to work. She began to feel shaky around lunchtime and took a second
dose of methylphenidate, 5 mg. Thirty minutes later she began having agitation, chills,
sweating, flushing, and nausea and had to leave work. Her current medications include the
following: Desvenlafaxine , 50 mg daily Doxepin, 10 mg daily Methylphenidate, 5 mg twice daily
Ziprasidone (Geodon), 40 mg twice daily ; examination reveals an alert and anxious patient with
damp skin, a temperature of 38.1°C (100.6°F), and a heart rate of 110 beats/min. The pup -
Answer -Discontinue All Meds; Serotonin syndrome is a serious condition that can be life-
threatening. This patient is taking multiple serotonergic medications and displays features
suggestive of serotonin syndrome. Signs and symptoms of serotonin syndrome include mental
status changes (e.g., agitation, hallucinations, delirium, coma), autonomic instability (e.g.,
hyperthermia, tachycardia, labile blood pressure, diaphoresis, dizziness, flushing),
neuromuscular changes (e.g., tremor, rigidity, hyperreflexia), and gastrointestinal symptoms
(e.g., nausea, vomiting, diarrhea). A timely diagnosis and immediate discontinuation of
serotonergic medications can help prevent worsening of the condition. Supportive care,
sometimes in a hospital or intensive-care setting depending on severity, is the mainstay of
treatment. Severe symptoms that necessitate hospital management include a temperature
>38.5°C, confusion, delirium, and rigidity. Multiple classes of medications are associated with
serotonin syndrome, including SSRIs/SNRIs, tricyclic antidepressants, antipsychotics, stimulants,
triptans, and others. Changing to a different stimulant, or to a nonstimulant, would not help
resolve serotonin syndrome, nor would symptomatic treatment with diphenhydramine or
similar agents. Serotonin syndrome has been reported with 5-HT3 receptor antagonists such as
ondansetron, particularly when used in combination with other serotonergic medications.
what kind of med is doxepin? - Answer -TCA
The daughter of an 82-year-old bedbound female with Alzheimer dementia requests a home
visit to discuss transitions of care due to continued deterioration of her mother's condition. The
daughter has been the caregiver for the past 5 years since her mother began to struggle with
independently managing her activities of daily living (ADLs). Recently, the patient's appetite has
significantly diminished, and her daughter is concerned that she has lost 15 lb in the last 6
months. She asks about feeding tube placement, medications to help her appetite, or ways to
2|Page
, improve her dementia. The patient no longer recognizes her daughter and is nonverbal but
smiles when approached at her bedside upon examination. Her vital signs are stable, she
appears cachectic, a physical examination is unremarkable, and pain is not present upon
palpation. Which one of the following is recommended at this time? - Answer -Assited Oral
Feeding; According to the American Geriatrics Society's Choosing Wisely recommendations, oral
handfeeding is no worse for outcomes such as aspiration pneumonia, patient comfort, and
death compared to percutaneous feeding tube placement. Agitation and pressure ulcers may
worsen with tube feeding. High-calorie shakes or supplements and appetite stimulants are not
recommended as they may increase weight but do not improve patient-oriented outcomes such
as functional status, quality of life, or survival. Furthermore, appetite stimulants such as
megestrol acetate may increase the risk of thrombosis and edema, and hasten death. According
to randomized, controlled trials, cholinesterase inhibitors may statistically improve cognitive
testing results, but they do not produce meaningful improvement. This patient is approaching
end-stage Alzheimer dementia and initiating a cholinesterase inhibitor will not improve
functioning and may even worsen appetite, as a common side effect is gastrointestinal
disturbance.
24-year-old male presents for evaluation of a soft-tissue mass on his arm. Which one of the
following features, if present, should prompt further evaluation with advanced imaging? -
Answer -Soft-tissue masses that are >5 cm in diameter carry a higher risk of malignancy and
should prompt further evaluation with advanced imaging. Other features that raise concern for
possible malignancy include rapid growth, sudden presentation without explanation, and
lesions that are firm, deep, and adhere to surrounding structures. Both benign and malignant
masses can be painless, but a lack of tenderness with palpation alone would not prompt the
need for advanced imaging. Advanced imaging would also not be necessary for a mass that has
a fluctuant texture, has grown persistently and slowly over several years, or is superficially
located (above the fascia).
In patients with type 2 diabetes, medications from which one of the following classes have been
shown to reduce the progression of chronic kidney disease? - Answer -SGLT2 inhibitors; SGLT2
inhibitors are recommended for people with stage 3 or higher chronic kidney disease (CKD) and
type 2 diabetes, as they slow CKD progression, reduce cardiovascular events, and reduce heart
failure risk independent of glucose management. GLP-1 receptor agonists reduce the risk of
3|Page
|2026/2027 Update | A+ Graded
62-year-old male presents with daytime fatigue, sleepiness, snoring at night, and a BMI of 41
kg/m2 . You are concerned that he may have obesity hypoventilation syndrome (OHS) in
addition to possible obstructive sleep apnea. Which one of the following tests is most
appropriate for establishing a diagnosis of OHS? - Answer -Daytime Awake PaCO2; Obesity
hypoventilation syndrome (OHS) is characterized by obesity and alveolar hypoventilation while
awake, which is defined by an awake PaCO2 level >45 mm Hg. Ninety percent of patients have
coexistent obstructive sleep apnea (OSA). The pathogenesis is related to the increased physical
demands on breathing caused by obesity. While decreased PaO2 or oxygen saturation is often
present, it is not part of the diagnostic criteria. In obese patients with lower risk (often with
lower BMIs), a serum HCO3 - level <27 mmol/L may obviate the need for an arterial blood gas
measurement as OHS becomes very unlikely. If the HCO3 - level is 27 mmol/L (a renal
compensatory mechanism for hypoventilation-induced acidosis), a PaCO2 measurement should
be obtained to establish the diagnosis. The first-line treatment for ambulatory patients with this
condition is CPAP. Nighttime measurement of peripheral oxygen saturation during sleep
In a patient with new-onset polymyalgia rheumatica, which one of the following medications
can be added to glucocorticoid therapy in order to reduce the risk of relapse? - Answer -
Methotrexate; Polymyalgia rheumatica (PMR) should be treated with glucocorticoids to induce
remission. There is good evidence that adjunctive therapy with methotrexate reduces both the
cumulative dose of corticosteroids needed and the risk of relapse (evidence rating A). NSAIDs
such as ibuprofen and indomethacin reduce pain but do not modify the inflammatory process.
Icosapent ethyl is a derivative of omega-3 fatty acids that reduces cardiovascular events and
may improve rheumatoid arthritis, likely via anti-inflammatory properties. However, it has not
been shown to be effective in PMR. Mesalamine is used to reduce inflammation in
inflammatory bowel disease but is not effective against PMR.
. You are caring for a 21-year-old female with previously diagnosed bipolar II disorder,
generalized anxiety disorder, attention-deficit/hyperactivity disorder, and insomnia. The patient
1|Page
,presents with new symptoms of chills, excess sweating, flushing, and nausea of approximately 2
hours' duration. The patient felt normal upon awakening, took methylphenidate (Ritalin), 5 mg
with breakfast, and went to work. She began to feel shaky around lunchtime and took a second
dose of methylphenidate, 5 mg. Thirty minutes later she began having agitation, chills,
sweating, flushing, and nausea and had to leave work. Her current medications include the
following: Desvenlafaxine , 50 mg daily Doxepin, 10 mg daily Methylphenidate, 5 mg twice daily
Ziprasidone (Geodon), 40 mg twice daily ; examination reveals an alert and anxious patient with
damp skin, a temperature of 38.1°C (100.6°F), and a heart rate of 110 beats/min. The pup -
Answer -Discontinue All Meds; Serotonin syndrome is a serious condition that can be life-
threatening. This patient is taking multiple serotonergic medications and displays features
suggestive of serotonin syndrome. Signs and symptoms of serotonin syndrome include mental
status changes (e.g., agitation, hallucinations, delirium, coma), autonomic instability (e.g.,
hyperthermia, tachycardia, labile blood pressure, diaphoresis, dizziness, flushing),
neuromuscular changes (e.g., tremor, rigidity, hyperreflexia), and gastrointestinal symptoms
(e.g., nausea, vomiting, diarrhea). A timely diagnosis and immediate discontinuation of
serotonergic medications can help prevent worsening of the condition. Supportive care,
sometimes in a hospital or intensive-care setting depending on severity, is the mainstay of
treatment. Severe symptoms that necessitate hospital management include a temperature
>38.5°C, confusion, delirium, and rigidity. Multiple classes of medications are associated with
serotonin syndrome, including SSRIs/SNRIs, tricyclic antidepressants, antipsychotics, stimulants,
triptans, and others. Changing to a different stimulant, or to a nonstimulant, would not help
resolve serotonin syndrome, nor would symptomatic treatment with diphenhydramine or
similar agents. Serotonin syndrome has been reported with 5-HT3 receptor antagonists such as
ondansetron, particularly when used in combination with other serotonergic medications.
what kind of med is doxepin? - Answer -TCA
The daughter of an 82-year-old bedbound female with Alzheimer dementia requests a home
visit to discuss transitions of care due to continued deterioration of her mother's condition. The
daughter has been the caregiver for the past 5 years since her mother began to struggle with
independently managing her activities of daily living (ADLs). Recently, the patient's appetite has
significantly diminished, and her daughter is concerned that she has lost 15 lb in the last 6
months. She asks about feeding tube placement, medications to help her appetite, or ways to
2|Page
, improve her dementia. The patient no longer recognizes her daughter and is nonverbal but
smiles when approached at her bedside upon examination. Her vital signs are stable, she
appears cachectic, a physical examination is unremarkable, and pain is not present upon
palpation. Which one of the following is recommended at this time? - Answer -Assited Oral
Feeding; According to the American Geriatrics Society's Choosing Wisely recommendations, oral
handfeeding is no worse for outcomes such as aspiration pneumonia, patient comfort, and
death compared to percutaneous feeding tube placement. Agitation and pressure ulcers may
worsen with tube feeding. High-calorie shakes or supplements and appetite stimulants are not
recommended as they may increase weight but do not improve patient-oriented outcomes such
as functional status, quality of life, or survival. Furthermore, appetite stimulants such as
megestrol acetate may increase the risk of thrombosis and edema, and hasten death. According
to randomized, controlled trials, cholinesterase inhibitors may statistically improve cognitive
testing results, but they do not produce meaningful improvement. This patient is approaching
end-stage Alzheimer dementia and initiating a cholinesterase inhibitor will not improve
functioning and may even worsen appetite, as a common side effect is gastrointestinal
disturbance.
24-year-old male presents for evaluation of a soft-tissue mass on his arm. Which one of the
following features, if present, should prompt further evaluation with advanced imaging? -
Answer -Soft-tissue masses that are >5 cm in diameter carry a higher risk of malignancy and
should prompt further evaluation with advanced imaging. Other features that raise concern for
possible malignancy include rapid growth, sudden presentation without explanation, and
lesions that are firm, deep, and adhere to surrounding structures. Both benign and malignant
masses can be painless, but a lack of tenderness with palpation alone would not prompt the
need for advanced imaging. Advanced imaging would also not be necessary for a mass that has
a fluctuant texture, has grown persistently and slowly over several years, or is superficially
located (above the fascia).
In patients with type 2 diabetes, medications from which one of the following classes have been
shown to reduce the progression of chronic kidney disease? - Answer -SGLT2 inhibitors; SGLT2
inhibitors are recommended for people with stage 3 or higher chronic kidney disease (CKD) and
type 2 diabetes, as they slow CKD progression, reduce cardiovascular events, and reduce heart
failure risk independent of glucose management. GLP-1 receptor agonists reduce the risk of
3|Page
