American Board of Family Medicine (ABFM)
Examination Test Bank | Complete Questions with
Verified Correct Answers & Rationales - 2026
Latest Update
Question 1
A 34-year-old female with intellectual disability, hypothyroidism, and bipolar disorder
presents for routine follow-up. Her case worker notes that she has been excessively
thirsty and urinating more than usual over the past several months despite limiting her
fluids. She also wakes at night to urinate. Laboratory studies prior to her visit reveal a
therapeutic lithium level, as well as normal creatinine, electrolyte, and blood glucose
levels.
Which one of the following is most likely present in this patient's case?
A. Diabetes insipidus
B. Interstitial cystitis
C. Overactive bladder
D. Psychogenic polydipsia
E. Syndrome of inappropriate antidiuretic hormone secretion
Correct Answer: A
Rationale: Lithium can cause nephrogenic diabetes insipidus by inhibiting the action
of antidiuretic hormone on the kidney. The patient presents with polyuria, polydipsia,
and nocturia with normal glucose and electrolytes, consistent with diabetes insipidus.
Question 2
A 70-year-old female sees you at the request of her surgeon to discuss anticoagulation
management prior to a scheduled cholecystectomy. She has a past medical history of
atrial fibrillation, stage 3a chronic kidney disease, hypertension, depression, and
cerebrovascular disease. She had an ischemic stroke 1 year ago. Her current medications
include amlodipine, losartan, metoprolol succinate, sertraline, and warfarin. Her INR
today is 2.2.
Which one of the following would be the most appropriate perioperative anticoagulation
therapy for this patient?
A. Continuing warfarin with a goal INR of 1.4-1.6
B. Discontinuing warfarin 5 days prior to surgery and bridging with aspirin
pg. 1
,C. Discontinuing warfarin 5 days prior to surgery and bridging with clopidogrel
D. Discontinuing warfarin 5 days prior to surgery and bridging with low-molecular-
weight heparin
E. Discontinuing warfarin 5 days prior to surgery without bridging therapy
Correct Answer: D
Rationale: This patient has a high risk for thromboembolism (CHADS2 score ≥5,
recent stroke within 3 months). For high-risk patients requiring warfarin interruption,
bridging with low-molecular-weight heparin is recommended.
Question 3
A 30-year-old female with obesity and tobacco use disorder presents for evaluation of a
persistent painful lump in her axilla. After an appropriate evaluation you diagnose mild
hidradenitis suppurativa.
In addition to weight loss and smoking cessation counseling, which one of the following
treatment options would be most appropriate?
A. Topical clindamycin gel
B. Topical diclofenac gel
C. Topical triamcinolone cream
D. Oral azithromycin
E. Oral meloxicam
Correct Answer: A
Rationale: Topical clindamycin is first-line therapy for mild hidradenitis suppurativa.
It reduces bacterial colonization and inflammation in affected apocrine glands.
Question 4
A 48-year-old female with a history of ductal carcinoma in situ diagnosed in her early
40s presents to the urgent care clinic because of heavy vaginal bleeding. The bleeding
started 8 days ago as a regular menstrual period, but it has worsened and today she
started passing clots. You estimate her blood loss to be >100 mL today. On examination
she has a blood pressure of 114/65 mm Hg and a pulse rate of 84 beats/min. A CBC is
significant for a hemoglobin level of 8.2 g/dL (N 12.0-16.0). An hCG test is negative.
Which one of the following would be the most appropriate therapy at this time?
A. Oral high-dose progestins
B. Depot medroxyprogesterone acetate
C. Intravenous conjugated estrogen
D. Intravenous ketorolac
E. Intravenous tranexamic acid
pg. 2
,Correct Answer: C
Rationale: This patient is hemodynamically stable but has significant anemia (Hb 8.2)
with heavy bleeding. Intravenous conjugated estrogen is an effective option for acute
heavy uterine bleeding when the patient is hemodynamically stable.
Question 5
A 30-year-old female with a medical history of anxiety and seasonal allergies presents
for evaluation of palpitations and a racing heartbeat that has worsened over the last 3-4
days. Recently, her escitalopram dosage was increased to 20 mg daily and she started
using fluticasone propionate nasal spray and oral cetirizine, 10 mg daily. A CBC,
comprehensive metabolic panel, and TSH level are normal. A urine pregnancy test is
negative. An EKG today shows a heart rate of 85 beats/min and a QTc interval of 500
milliseconds.
Which one of the following would be the most appropriate next step?
A. Reassurance only
B. Discontinuing cetirizine
C. Discontinuing escitalopram
D. Discontinuing fluticasone
E. Echocardiography
Correct Answer: C
Rationale: Escitalopram (an SSRI) is associated with QTc prolongation. A QTc interval
of 500 milliseconds is significant and warrants discontinuation of the offending
medication.
Question 6
Which one of the following medications has been shown to increase the resolution of
metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as
nonalcoholic fatty liver disease?
A. Glyburide
B. Metformin
C. Pioglitazone
D. Repaglinide
E. Vitamin D (cholecalciferol)
Correct Answer: C
Rationale: Pioglitazone has been shown to improve histologic features of nonalcoholic
steatohepatitis, including resolution of steatohepatitis and reduction in fibrosis.
pg. 3
, Question 7
A 45-year-old male presents for a health maintenance examination. He has a history of
hypertension that is well controlled on lisinopril.
Based on guidelines from the U.S. Preventive Services Task Force, this patient should be
screened for which one of the following?
A. Cardiovascular disease with EKG
B. Carotid artery disease with carotid ultrasonography
C. Colon cancer with colonoscopy
D. Prostate cancer with a prostate-specific antigen level
E. Vitamin D deficiency with a vitamin D level
Correct Answer: C
Rationale: The USPSTF recommends screening for colorectal cancer starting at age 45.
Colonoscopy is one accepted screening modality. Routine EKG for cardiovascular
disease, carotid ultrasound, and PSA screening are not recommended for asymptomatic
patients. Vitamin D screening is not recommended by the USPSTF.
Question 8
Laser-assisted in-situ keratomileusis (LASIK) surgery is performed to treat:
A. Cataracts
B. Closed-angle glaucoma
C. Myopia
D. Presbyopia
E. Retinal detachment
Correct Answer: C
Rationale: LASIK is a refractive surgical procedure used to correct myopia
(nearsightedness), hyperopia, and astigmatism by reshaping the cornea.
Question 9
A 65-year-old female is found to have a T-score of -3.3 on a DEXA scan. She has a 30-
pack-year smoking history but quit smoking 5 years ago. X-rays reveal evidence of an
old compression fracture of the thoracic spine.
Which one of the following would be the most appropriate initial treatment?
A. Oral alendronate
B. Oral raloxifene
C. Subcutaneous denosumab
D. Subcutaneous teriparatide
E. Intravenous zoledronic acid
pg. 4
Examination Test Bank | Complete Questions with
Verified Correct Answers & Rationales - 2026
Latest Update
Question 1
A 34-year-old female with intellectual disability, hypothyroidism, and bipolar disorder
presents for routine follow-up. Her case worker notes that she has been excessively
thirsty and urinating more than usual over the past several months despite limiting her
fluids. She also wakes at night to urinate. Laboratory studies prior to her visit reveal a
therapeutic lithium level, as well as normal creatinine, electrolyte, and blood glucose
levels.
Which one of the following is most likely present in this patient's case?
A. Diabetes insipidus
B. Interstitial cystitis
C. Overactive bladder
D. Psychogenic polydipsia
E. Syndrome of inappropriate antidiuretic hormone secretion
Correct Answer: A
Rationale: Lithium can cause nephrogenic diabetes insipidus by inhibiting the action
of antidiuretic hormone on the kidney. The patient presents with polyuria, polydipsia,
and nocturia with normal glucose and electrolytes, consistent with diabetes insipidus.
Question 2
A 70-year-old female sees you at the request of her surgeon to discuss anticoagulation
management prior to a scheduled cholecystectomy. She has a past medical history of
atrial fibrillation, stage 3a chronic kidney disease, hypertension, depression, and
cerebrovascular disease. She had an ischemic stroke 1 year ago. Her current medications
include amlodipine, losartan, metoprolol succinate, sertraline, and warfarin. Her INR
today is 2.2.
Which one of the following would be the most appropriate perioperative anticoagulation
therapy for this patient?
A. Continuing warfarin with a goal INR of 1.4-1.6
B. Discontinuing warfarin 5 days prior to surgery and bridging with aspirin
pg. 1
,C. Discontinuing warfarin 5 days prior to surgery and bridging with clopidogrel
D. Discontinuing warfarin 5 days prior to surgery and bridging with low-molecular-
weight heparin
E. Discontinuing warfarin 5 days prior to surgery without bridging therapy
Correct Answer: D
Rationale: This patient has a high risk for thromboembolism (CHADS2 score ≥5,
recent stroke within 3 months). For high-risk patients requiring warfarin interruption,
bridging with low-molecular-weight heparin is recommended.
Question 3
A 30-year-old female with obesity and tobacco use disorder presents for evaluation of a
persistent painful lump in her axilla. After an appropriate evaluation you diagnose mild
hidradenitis suppurativa.
In addition to weight loss and smoking cessation counseling, which one of the following
treatment options would be most appropriate?
A. Topical clindamycin gel
B. Topical diclofenac gel
C. Topical triamcinolone cream
D. Oral azithromycin
E. Oral meloxicam
Correct Answer: A
Rationale: Topical clindamycin is first-line therapy for mild hidradenitis suppurativa.
It reduces bacterial colonization and inflammation in affected apocrine glands.
Question 4
A 48-year-old female with a history of ductal carcinoma in situ diagnosed in her early
40s presents to the urgent care clinic because of heavy vaginal bleeding. The bleeding
started 8 days ago as a regular menstrual period, but it has worsened and today she
started passing clots. You estimate her blood loss to be >100 mL today. On examination
she has a blood pressure of 114/65 mm Hg and a pulse rate of 84 beats/min. A CBC is
significant for a hemoglobin level of 8.2 g/dL (N 12.0-16.0). An hCG test is negative.
Which one of the following would be the most appropriate therapy at this time?
A. Oral high-dose progestins
B. Depot medroxyprogesterone acetate
C. Intravenous conjugated estrogen
D. Intravenous ketorolac
E. Intravenous tranexamic acid
pg. 2
,Correct Answer: C
Rationale: This patient is hemodynamically stable but has significant anemia (Hb 8.2)
with heavy bleeding. Intravenous conjugated estrogen is an effective option for acute
heavy uterine bleeding when the patient is hemodynamically stable.
Question 5
A 30-year-old female with a medical history of anxiety and seasonal allergies presents
for evaluation of palpitations and a racing heartbeat that has worsened over the last 3-4
days. Recently, her escitalopram dosage was increased to 20 mg daily and she started
using fluticasone propionate nasal spray and oral cetirizine, 10 mg daily. A CBC,
comprehensive metabolic panel, and TSH level are normal. A urine pregnancy test is
negative. An EKG today shows a heart rate of 85 beats/min and a QTc interval of 500
milliseconds.
Which one of the following would be the most appropriate next step?
A. Reassurance only
B. Discontinuing cetirizine
C. Discontinuing escitalopram
D. Discontinuing fluticasone
E. Echocardiography
Correct Answer: C
Rationale: Escitalopram (an SSRI) is associated with QTc prolongation. A QTc interval
of 500 milliseconds is significant and warrants discontinuation of the offending
medication.
Question 6
Which one of the following medications has been shown to increase the resolution of
metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as
nonalcoholic fatty liver disease?
A. Glyburide
B. Metformin
C. Pioglitazone
D. Repaglinide
E. Vitamin D (cholecalciferol)
Correct Answer: C
Rationale: Pioglitazone has been shown to improve histologic features of nonalcoholic
steatohepatitis, including resolution of steatohepatitis and reduction in fibrosis.
pg. 3
, Question 7
A 45-year-old male presents for a health maintenance examination. He has a history of
hypertension that is well controlled on lisinopril.
Based on guidelines from the U.S. Preventive Services Task Force, this patient should be
screened for which one of the following?
A. Cardiovascular disease with EKG
B. Carotid artery disease with carotid ultrasonography
C. Colon cancer with colonoscopy
D. Prostate cancer with a prostate-specific antigen level
E. Vitamin D deficiency with a vitamin D level
Correct Answer: C
Rationale: The USPSTF recommends screening for colorectal cancer starting at age 45.
Colonoscopy is one accepted screening modality. Routine EKG for cardiovascular
disease, carotid ultrasound, and PSA screening are not recommended for asymptomatic
patients. Vitamin D screening is not recommended by the USPSTF.
Question 8
Laser-assisted in-situ keratomileusis (LASIK) surgery is performed to treat:
A. Cataracts
B. Closed-angle glaucoma
C. Myopia
D. Presbyopia
E. Retinal detachment
Correct Answer: C
Rationale: LASIK is a refractive surgical procedure used to correct myopia
(nearsightedness), hyperopia, and astigmatism by reshaping the cornea.
Question 9
A 65-year-old female is found to have a T-score of -3.3 on a DEXA scan. She has a 30-
pack-year smoking history but quit smoking 5 years ago. X-rays reveal evidence of an
old compression fracture of the thoracic spine.
Which one of the following would be the most appropriate initial treatment?
A. Oral alendronate
B. Oral raloxifene
C. Subcutaneous denosumab
D. Subcutaneous teriparatide
E. Intravenous zoledronic acid
pg. 4
