ABFM CERTIFICATION EXAM 2025
NEWEST EXAM QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES | A+ GRADE
1. A 42-year-old female presents for follow-up after being treated
for recurrent respiratory problems at an urgent care facility. She is
feeling a little better after a short course of oral prednisone and
use of an albuterol (Proventil, Ventolin) inhaler. She has had a
gradual increase in shortness of breath, a chronic cough, and a
decrease in her usual activity level over the past year. She has
brought a copy of a recent chest radiograph report for your review
that describes panlobular basal emphysema. She does not have
a history of smoking, secondhand smoke exposure, or
occupational exposures. Spirometry in the office reveals an
FEV1/FVC ratio of
0.67 with no change after bronchodilator administration.
Which one of the following underlying conditions is the most likely
cause for this clinical
presentation?
A) 1-Antitrypsin deficiency
B) Bronchiectasis
C) Diffuse panbronchiolitis
D) Interstitial lung disease
E) Lef Correct Answer A
This patient presents with symptoms of chronic obstructive
lung disease, and spirometry confirms airflow limitation or
obstruction with an FEV1/FVC <0.7. Her age, the lack of
tobacco smoke or occupational
exposures, and the chest radiograph findings are typical of
1-antitrypsin deficiency. While left heart
,failure, interstitial lung disease, bronchiectasis, and diffuse
panbronchiolitis are all causes of chronic
cough, they are not necessarily associated with the
development of COPD and these spirometry findings.
Furthermore, the radiologic findings in this patient are not
consistent with these conditions. Left heart
failure would present with pulmonary edema on a chest
radiograph and volume restriction on pulmonary
function testing. Bronchiectasis would present with
bronchial dilation and bronchial wall thickening on a
chest radiograph. Interstitial lung disease would present with
reticular or increased interstitial markings.
Diffuse panbronchiolitis would present with diffuse small
centrilobular nodular opacities along with
hyperinflation.
2. An otherwise healthy 57-year-old male presents with mild
fatigue, decreased libido, and erectile dysfunction. A subsequent
evaluation of serum testosterone reveals hypogonadism.
Which one of the following would you recommend at this time?
A) No further diagnostic testing
B) A prolactin level
C) A serum iron level and total iron binding capacity
D) FSH and LH levels
E) Karyotyping Correct Answer D
In men who are diagnosed with hypogonadism with
symptoms of testosterone deficiency and unequivocally
and consistently low serum testosterone concentrations,
further evaluation with FSH and LH levels is advised as the
initial workup to distinguish between primary and secondary
hypogonadism. If secondary hypogonadism is indicated by
low or inappropriately normal FSH and LH levels, prolactin
and serum iron levels and measurement of total iron binding
capacity are recommended to determine secondary causes
,of hypogonadism, with possible further evaluation to include
other pituitary hormone levels and MRI of the pituitary. If
primary hypogonadism is found, karyotyping may be
indicated for Klinefelter's syndrome.
3. A 4-year-old female is brought to your office because of a
history of constipation over the past several months. Her mother
reports that the child has 1-2 bowel movements per week
composed of small lumps of hard stool. She strains to have the
bowel movements, and they are painful. The child eats normally
like her two siblings.
Which one of the following would be most effective at this time?
A) Daily fiber supplements
B) Lactulose
C) Magnesium hydroxide (Milk of Magnesia)
D) Polyethylene glycol (MiraLAX)
E) Senna Correct Answer D
This patient presents with symptoms compatible with
functional constipation. Daily use of polyethylene
glycol (PEG) solution has been found to be more effective
than lactulose, senna, or magnesium hydroxide in head-to-
head studies. Evidence does not support the use of fiber
supplements in the treatment of
functional constipation. No adverse effects were reported
with PEG therapy at any dosing regimen.
Low-dose regimens of PEG are 0.3 g/kg/day and high-dose
regimens are up to 1.0-1.5 g/kg/day.
4. A 30-year-old female presents with a 5-day history of subjective
fever and malaise. She does not have a thermometer at home but
has felt alternately warm and chilled. She has felt generally unwell
and is sleeping more than usual. She has had a decreased
appetite but has been drinking fluids without difficulty. She does
not have a runny nose, cough, headache, abdominal pain,
, vomiting, diarrhea, joint pain, rash, or pain with urination. Her
medical history includes substance use disorder and she takes
buprenorphine/naloxone (Suboxone). She smokes one pack of
cigarettes daily, has 0-2 alcoholic drinks daily, and began using
intravenous heroin again 1
week ago.
An examination reveals a blood pressure of 112/68 mm Hg, a
pulse rate of 88 beats/min, a respiratory rate of 16/min, a
temperature of 38.9°C (102.0°F), and an oxygen saturation of
95% on room air. The patient appears fatigued and uncomfortable
but nontoxic. Her Correct Answer C
A patient who uses intravenous drugs and has a fever
without a clear source must be evaluated for
infectious endocarditis (IE). The first step in this evaluation is
to obtain blood cultures. Although this
patient might have a less serious condition, it is critical to
evaluate for bacteremia in this situation. If the
concern for IE is high, blood cultures should be obtained and
antibiotics may be started while waiting for results and
arranging for urgent echocardiography.
IE in people who inject drugs is more likely to be right-sided,
specifically involving the tricuspid valve.
Right-sided IE is less frequently associated with systemic
findings of endocarditis such as Janeway lesions or Roth
spots. Patients often do not have a heart murmur.
5. During a newborn examination you note a foot deformity, with
the front half of the foot turned inward. Applying gentle pressure
to the forefoot while holding the heel steady brings the heel and
forefoot into alignment.
Which one of the following would you recommend?
A) Observation only
B) Adjustable shoes
C) Serial casting
NEWEST EXAM QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES | A+ GRADE
1. A 42-year-old female presents for follow-up after being treated
for recurrent respiratory problems at an urgent care facility. She is
feeling a little better after a short course of oral prednisone and
use of an albuterol (Proventil, Ventolin) inhaler. She has had a
gradual increase in shortness of breath, a chronic cough, and a
decrease in her usual activity level over the past year. She has
brought a copy of a recent chest radiograph report for your review
that describes panlobular basal emphysema. She does not have
a history of smoking, secondhand smoke exposure, or
occupational exposures. Spirometry in the office reveals an
FEV1/FVC ratio of
0.67 with no change after bronchodilator administration.
Which one of the following underlying conditions is the most likely
cause for this clinical
presentation?
A) 1-Antitrypsin deficiency
B) Bronchiectasis
C) Diffuse panbronchiolitis
D) Interstitial lung disease
E) Lef Correct Answer A
This patient presents with symptoms of chronic obstructive
lung disease, and spirometry confirms airflow limitation or
obstruction with an FEV1/FVC <0.7. Her age, the lack of
tobacco smoke or occupational
exposures, and the chest radiograph findings are typical of
1-antitrypsin deficiency. While left heart
,failure, interstitial lung disease, bronchiectasis, and diffuse
panbronchiolitis are all causes of chronic
cough, they are not necessarily associated with the
development of COPD and these spirometry findings.
Furthermore, the radiologic findings in this patient are not
consistent with these conditions. Left heart
failure would present with pulmonary edema on a chest
radiograph and volume restriction on pulmonary
function testing. Bronchiectasis would present with
bronchial dilation and bronchial wall thickening on a
chest radiograph. Interstitial lung disease would present with
reticular or increased interstitial markings.
Diffuse panbronchiolitis would present with diffuse small
centrilobular nodular opacities along with
hyperinflation.
2. An otherwise healthy 57-year-old male presents with mild
fatigue, decreased libido, and erectile dysfunction. A subsequent
evaluation of serum testosterone reveals hypogonadism.
Which one of the following would you recommend at this time?
A) No further diagnostic testing
B) A prolactin level
C) A serum iron level and total iron binding capacity
D) FSH and LH levels
E) Karyotyping Correct Answer D
In men who are diagnosed with hypogonadism with
symptoms of testosterone deficiency and unequivocally
and consistently low serum testosterone concentrations,
further evaluation with FSH and LH levels is advised as the
initial workup to distinguish between primary and secondary
hypogonadism. If secondary hypogonadism is indicated by
low or inappropriately normal FSH and LH levels, prolactin
and serum iron levels and measurement of total iron binding
capacity are recommended to determine secondary causes
,of hypogonadism, with possible further evaluation to include
other pituitary hormone levels and MRI of the pituitary. If
primary hypogonadism is found, karyotyping may be
indicated for Klinefelter's syndrome.
3. A 4-year-old female is brought to your office because of a
history of constipation over the past several months. Her mother
reports that the child has 1-2 bowel movements per week
composed of small lumps of hard stool. She strains to have the
bowel movements, and they are painful. The child eats normally
like her two siblings.
Which one of the following would be most effective at this time?
A) Daily fiber supplements
B) Lactulose
C) Magnesium hydroxide (Milk of Magnesia)
D) Polyethylene glycol (MiraLAX)
E) Senna Correct Answer D
This patient presents with symptoms compatible with
functional constipation. Daily use of polyethylene
glycol (PEG) solution has been found to be more effective
than lactulose, senna, or magnesium hydroxide in head-to-
head studies. Evidence does not support the use of fiber
supplements in the treatment of
functional constipation. No adverse effects were reported
with PEG therapy at any dosing regimen.
Low-dose regimens of PEG are 0.3 g/kg/day and high-dose
regimens are up to 1.0-1.5 g/kg/day.
4. A 30-year-old female presents with a 5-day history of subjective
fever and malaise. She does not have a thermometer at home but
has felt alternately warm and chilled. She has felt generally unwell
and is sleeping more than usual. She has had a decreased
appetite but has been drinking fluids without difficulty. She does
not have a runny nose, cough, headache, abdominal pain,
, vomiting, diarrhea, joint pain, rash, or pain with urination. Her
medical history includes substance use disorder and she takes
buprenorphine/naloxone (Suboxone). She smokes one pack of
cigarettes daily, has 0-2 alcoholic drinks daily, and began using
intravenous heroin again 1
week ago.
An examination reveals a blood pressure of 112/68 mm Hg, a
pulse rate of 88 beats/min, a respiratory rate of 16/min, a
temperature of 38.9°C (102.0°F), and an oxygen saturation of
95% on room air. The patient appears fatigued and uncomfortable
but nontoxic. Her Correct Answer C
A patient who uses intravenous drugs and has a fever
without a clear source must be evaluated for
infectious endocarditis (IE). The first step in this evaluation is
to obtain blood cultures. Although this
patient might have a less serious condition, it is critical to
evaluate for bacteremia in this situation. If the
concern for IE is high, blood cultures should be obtained and
antibiotics may be started while waiting for results and
arranging for urgent echocardiography.
IE in people who inject drugs is more likely to be right-sided,
specifically involving the tricuspid valve.
Right-sided IE is less frequently associated with systemic
findings of endocarditis such as Janeway lesions or Roth
spots. Patients often do not have a heart murmur.
5. During a newborn examination you note a foot deformity, with
the front half of the foot turned inward. Applying gentle pressure
to the forefoot while holding the heel steady brings the heel and
forefoot into alignment.
Which one of the following would you recommend?
A) Observation only
B) Adjustable shoes
C) Serial casting
