ABFM FINAL EXAM 2026-2027
PRACTICE EXAM QUESTIONS AND
DETAILED CORRECT ANSWERS | A+
GRADE STUDY GUIDE
Question 1
A 22-year-old male presents to the emergency department with a
3-day history of high fever ($39.5) °C), severe retro-orbital
headache, diffuse body aches, and marked nausea. He returned 5
days ago from a vacation in South America. On physical
examination, he has petechiae on his lower legs, gingival
bleeding upon light probing, and right upper quadrant abdominal
tenderness. Laboratory studies show leukopenia, marked
thrombocytopenia, and a hematocrit elevated at $52\%$.
Bilirubin levels are normal, and there is no scleral icterus.
Which of the following is the most appropriate initial
management step?
A) Administer IV ribavirin and isolate in a negative-pressure
room
B) Initiate aggressive intravenous fluid hydration and supportive
care
C) Prescribe high-dose oral ibuprofen for pain and fever relief
D) Administer intramuscular ceftriaxone and order blood
cultures
Correct Answer: B
,Rationale: The presentation of acute febrile illness with
hemorrhagic manifestations, plasma leakage (elevated
hematocrit), thrombocytopenia, and absence of jaundice
following travel to South America is classic for severe Dengue
fever. Management is supportive, primarily focusing on
judicious fluid resuscitation; NSAIDs and aspirin must be
strictly avoided due to the increased risk of bleeding and platelet
dysfunction.
Question 2
A 68-year-old female presents to the clinic complaining of
bilateral shoulder and pelvic girdle stiffness that is worst in the
morning and lasts for over an hour. Laboratory evaluation
reveals an erythrocyte sedimentation rate (ESR) of 68mm/hr.
She is diagnosed with polymyalgia rheumatica (PMR). Which of
the following is the recommended initial treatment regimen?
A) Oral prednisone, $15mg/day}with a gradual taper over 1–2
years
B) Oral methylprednisolone dose pack tapered from $24mg to
$0mg}$ over 7 days
C) Oral dexamethasone, $8\text{ mg}$ twice daily for 2 weeks
D) Intravenous methylprednisolone, $120\text{ mg}$ every 6
hours
Correct Answer: A
,Rationale: Low-dose oral corticosteroids (typically prednisone
$12.5\text{–}25\text{ mg/day}$) are the standard first-line
therapy for polymyalgia rheumatica, producing a rapid
symptomatic response. Treatment requires a slow taper over a
prolonged period (1 to 2 years) to prevent clinical relapse.
Question 3
A 48-year-old perimenopausal woman seeks medical therapy for
severe, disruptive vasomotor symptoms. Her medical history is
significant for a deep vein thrombosis (DVT) 3 years ago while
taking oral combined contraceptives. She has no other chronic
medical conditions. Which of the following options provides
effective relief for her hot flashes with the lowest risk of venous
thromboembolism?
A) Oral conjugated estrogen combined with
medroxyprogesterone
B) Transdermal bio-identical estrogen cream
C) Oral venlafaxine
D) Oral phytoestrogen supplementation
Correct Answer: C
Rationale: Serotonin-norepinephrine reuptake inhibitors
(SNRIs) like venlafaxine or selective serotonin reuptake
inhibitors (SSRIs) offer non-hormonal, evidence-based relief for
vasomotor symptoms without increasing the risk of venous
thromboembolism. Systemic estrogen therapy (oral or
, transdermal) is contraindicated in patients with a personal
history of VTE.
Question 4
An 82-year-old resident in a long-term care facility develops
severe Clostridioides difficile colitis. Despite 5 days of treatment
with high-dose oral vancomycin, his condition deteriorates with
worsening abdominal distension, fever, and leukocytosis. Which
of the following intravenous antimicrobial regimens should be
added to his treatment plan?
A) Intravenous vancomycin
B) Intravenous metronidazole
C) Intravenous ciprofloxacin
D) Intravenous meropenem
Correct Answer: B
Rationale: For severe or fulminant C. difficile infection
(characterized by hypotension, ileus, or toxic megacolon) failing
oral vancomycin, adding intravenous metronidazole is
recommended because vancomycin administered orally or
rectally may not reach adequate mucosal concentrations in the
setting of severe ileus. Intravenous vancomycin is ineffective for
bowel lumen pathogens as it is not secreted into the GI tract.
PRACTICE EXAM QUESTIONS AND
DETAILED CORRECT ANSWERS | A+
GRADE STUDY GUIDE
Question 1
A 22-year-old male presents to the emergency department with a
3-day history of high fever ($39.5) °C), severe retro-orbital
headache, diffuse body aches, and marked nausea. He returned 5
days ago from a vacation in South America. On physical
examination, he has petechiae on his lower legs, gingival
bleeding upon light probing, and right upper quadrant abdominal
tenderness. Laboratory studies show leukopenia, marked
thrombocytopenia, and a hematocrit elevated at $52\%$.
Bilirubin levels are normal, and there is no scleral icterus.
Which of the following is the most appropriate initial
management step?
A) Administer IV ribavirin and isolate in a negative-pressure
room
B) Initiate aggressive intravenous fluid hydration and supportive
care
C) Prescribe high-dose oral ibuprofen for pain and fever relief
D) Administer intramuscular ceftriaxone and order blood
cultures
Correct Answer: B
,Rationale: The presentation of acute febrile illness with
hemorrhagic manifestations, plasma leakage (elevated
hematocrit), thrombocytopenia, and absence of jaundice
following travel to South America is classic for severe Dengue
fever. Management is supportive, primarily focusing on
judicious fluid resuscitation; NSAIDs and aspirin must be
strictly avoided due to the increased risk of bleeding and platelet
dysfunction.
Question 2
A 68-year-old female presents to the clinic complaining of
bilateral shoulder and pelvic girdle stiffness that is worst in the
morning and lasts for over an hour. Laboratory evaluation
reveals an erythrocyte sedimentation rate (ESR) of 68mm/hr.
She is diagnosed with polymyalgia rheumatica (PMR). Which of
the following is the recommended initial treatment regimen?
A) Oral prednisone, $15mg/day}with a gradual taper over 1–2
years
B) Oral methylprednisolone dose pack tapered from $24mg to
$0mg}$ over 7 days
C) Oral dexamethasone, $8\text{ mg}$ twice daily for 2 weeks
D) Intravenous methylprednisolone, $120\text{ mg}$ every 6
hours
Correct Answer: A
,Rationale: Low-dose oral corticosteroids (typically prednisone
$12.5\text{–}25\text{ mg/day}$) are the standard first-line
therapy for polymyalgia rheumatica, producing a rapid
symptomatic response. Treatment requires a slow taper over a
prolonged period (1 to 2 years) to prevent clinical relapse.
Question 3
A 48-year-old perimenopausal woman seeks medical therapy for
severe, disruptive vasomotor symptoms. Her medical history is
significant for a deep vein thrombosis (DVT) 3 years ago while
taking oral combined contraceptives. She has no other chronic
medical conditions. Which of the following options provides
effective relief for her hot flashes with the lowest risk of venous
thromboembolism?
A) Oral conjugated estrogen combined with
medroxyprogesterone
B) Transdermal bio-identical estrogen cream
C) Oral venlafaxine
D) Oral phytoestrogen supplementation
Correct Answer: C
Rationale: Serotonin-norepinephrine reuptake inhibitors
(SNRIs) like venlafaxine or selective serotonin reuptake
inhibitors (SSRIs) offer non-hormonal, evidence-based relief for
vasomotor symptoms without increasing the risk of venous
thromboembolism. Systemic estrogen therapy (oral or
, transdermal) is contraindicated in patients with a personal
history of VTE.
Question 4
An 82-year-old resident in a long-term care facility develops
severe Clostridioides difficile colitis. Despite 5 days of treatment
with high-dose oral vancomycin, his condition deteriorates with
worsening abdominal distension, fever, and leukocytosis. Which
of the following intravenous antimicrobial regimens should be
added to his treatment plan?
A) Intravenous vancomycin
B) Intravenous metronidazole
C) Intravenous ciprofloxacin
D) Intravenous meropenem
Correct Answer: B
Rationale: For severe or fulminant C. difficile infection
(characterized by hypotension, ileus, or toxic megacolon) failing
oral vancomycin, adding intravenous metronidazole is
recommended because vancomycin administered orally or
rectally may not reach adequate mucosal concentrations in the
setting of severe ileus. Intravenous vancomycin is ineffective for
bowel lumen pathogens as it is not secreted into the GI tract.
