NEWEST FAMILY MEDICINE - GERIATRIC
MEDICINE CERTIFICATION EXAM FOR
THE AMERICAN BOARD OF FAMILY
MEDICINE (ABMS) | Q&A WITH
RATIONALES
1. An 82-year-old male presents with a 6-month
history of progressive memory loss, difficulty
managing finances, and getting lost while driving. He
is aware of his deficits and becomes tearful when
discussing them. What is the most likely diagnosis?
A) Alzheimer's disease
B) Vascular dementia
C) Depression with pseudodementia
D) Frontotemporal dementia
Correct answer: A
Rationale: Early Alzheimer's disease typically
presents with progressive episodic memory
impairment, executive dysfunction, and preserved
insight early on. The presence of distress and
awareness argues against pseudodementia.
,2. A 78-year-old female on hydrochlorothiazide for
hypertension falls at home when standing up from a
chair. She denies loss of consciousness. Her blood
pressure is 100/70 supine and 70/40 standing with
dizziness. What is the most appropriate next step?
A) Increase hydrochlorothiazide
B) Discontinue hydrochlorothiazide
C) Add fludrocortisone
D) Order carotid Doppler
Correct answer: B
Rationale: Orthostatic hypotension from thiazide
diuretics requires discontinuation of the offending
agent. Fludrocortisone is second-line after non-
pharmacologic measures and deprescribing.
3. An 85-year-old male with atrial fibrillation on
warfarin has a fall from standing with a head strike.
He is on no antiplatelet agents. GCS is 15. What is the
most appropriate next step?
A) Discharge home with observation instructions
B) CT head without contrast immediately
C) Hold warfarin for 3 days
D) Admission for 24-hour observation
Correct answer: B
,Rationale: Any fall with head strike in an elderly
patient on anticoagulation requires immediate non-
contrast CT head regardless of GCS or neurologic
exam due to risk of delayed intracranial hemorrhage.
4. A 76-year-old female reports urinary incontinence
that occurs when she coughs, sneezes, or laughs.
She denies urgency or nocturia. Post-void residual is
30 mL. What is first-line non-pharmacologic
treatment?
A) Pelvic floor muscle exercises (Kegel)
B) Bladder training with scheduled voiding
C) Vaginal estrogen
D) Pessary placement
Correct answer: A
Rationale: Stress urinary incontinence from urethral
hypermobility responds best to pelvic floor muscle
training. Bladder training is for urgency incontinence.
Vaginal estrogen is adjunctive.
5. An 80-year-old male with Parkinson's disease has a
2-month history of progressive difficulty walking and
recurrent falls. His levodopa-carbidopa dose was
increased 3 months ago. Exam shows choreiform
, movements of the trunk and limbs. What is the most
likely diagnosis?
A) Parkinson's disease progression
B) Levodopa-induced dyskinesia
C) Huntington's disease
D) Tardive dyskinesia
Correct answer: B
Rationale: Levodopa-induced dyskinesia occurs in
50-80% of Parkinson's patients after 5+ years of
treatment but can occur earlier. Chorea is
characteristic. Management involves dose reduction
or adjustment.
6. An 84-year-old female is admitted after a hip
fracture repair. She becomes acutely confused on
post-operative day 2 with fluctuating consciousness
and hallucinations. Vital signs are normal. What is the
most appropriate initial intervention?
A) Haloperidol 0.5 mg IM
B) Identify and treat underlying causes (infection,
medications, electrolyte imbalance)
C) Lorazepam 1 mg IV for agitation
D) Transfer to psychiatry unit
Correct answer: B
MEDICINE CERTIFICATION EXAM FOR
THE AMERICAN BOARD OF FAMILY
MEDICINE (ABMS) | Q&A WITH
RATIONALES
1. An 82-year-old male presents with a 6-month
history of progressive memory loss, difficulty
managing finances, and getting lost while driving. He
is aware of his deficits and becomes tearful when
discussing them. What is the most likely diagnosis?
A) Alzheimer's disease
B) Vascular dementia
C) Depression with pseudodementia
D) Frontotemporal dementia
Correct answer: A
Rationale: Early Alzheimer's disease typically
presents with progressive episodic memory
impairment, executive dysfunction, and preserved
insight early on. The presence of distress and
awareness argues against pseudodementia.
,2. A 78-year-old female on hydrochlorothiazide for
hypertension falls at home when standing up from a
chair. She denies loss of consciousness. Her blood
pressure is 100/70 supine and 70/40 standing with
dizziness. What is the most appropriate next step?
A) Increase hydrochlorothiazide
B) Discontinue hydrochlorothiazide
C) Add fludrocortisone
D) Order carotid Doppler
Correct answer: B
Rationale: Orthostatic hypotension from thiazide
diuretics requires discontinuation of the offending
agent. Fludrocortisone is second-line after non-
pharmacologic measures and deprescribing.
3. An 85-year-old male with atrial fibrillation on
warfarin has a fall from standing with a head strike.
He is on no antiplatelet agents. GCS is 15. What is the
most appropriate next step?
A) Discharge home with observation instructions
B) CT head without contrast immediately
C) Hold warfarin for 3 days
D) Admission for 24-hour observation
Correct answer: B
,Rationale: Any fall with head strike in an elderly
patient on anticoagulation requires immediate non-
contrast CT head regardless of GCS or neurologic
exam due to risk of delayed intracranial hemorrhage.
4. A 76-year-old female reports urinary incontinence
that occurs when she coughs, sneezes, or laughs.
She denies urgency or nocturia. Post-void residual is
30 mL. What is first-line non-pharmacologic
treatment?
A) Pelvic floor muscle exercises (Kegel)
B) Bladder training with scheduled voiding
C) Vaginal estrogen
D) Pessary placement
Correct answer: A
Rationale: Stress urinary incontinence from urethral
hypermobility responds best to pelvic floor muscle
training. Bladder training is for urgency incontinence.
Vaginal estrogen is adjunctive.
5. An 80-year-old male with Parkinson's disease has a
2-month history of progressive difficulty walking and
recurrent falls. His levodopa-carbidopa dose was
increased 3 months ago. Exam shows choreiform
, movements of the trunk and limbs. What is the most
likely diagnosis?
A) Parkinson's disease progression
B) Levodopa-induced dyskinesia
C) Huntington's disease
D) Tardive dyskinesia
Correct answer: B
Rationale: Levodopa-induced dyskinesia occurs in
50-80% of Parkinson's patients after 5+ years of
treatment but can occur earlier. Chorea is
characteristic. Management involves dose reduction
or adjustment.
6. An 84-year-old female is admitted after a hip
fracture repair. She becomes acutely confused on
post-operative day 2 with fluctuating consciousness
and hallucinations. Vital signs are normal. What is the
most appropriate initial intervention?
A) Haloperidol 0.5 mg IM
B) Identify and treat underlying causes (infection,
medications, electrolyte imbalance)
C) Lorazepam 1 mg IV for agitation
D) Transfer to psychiatry unit
Correct answer: B
