ABFM Family Medicine
Certification Board Exam Prep
2025/2026: 150 Master Questions,
Answers & Rationales [1]
Accelerate your board preparation with this
high-yield digital study guide containing 150
realistic multiple-choice practice questions
specifically engineered for the American Board
of Family Medicine (ABFM) certification exam.
Every question features a clearly highlighted
correct answer and a comprehensive, clinically
grounded rationale detailing crucial primary
care guidelines, diagnostic criteria, and
management protocols. Fully updated to mirror
the newest ABMS test blueprints, this
scannable resource helps busy residents and
practicing family physicians bypass dense
textbooks and secure a passing score on their
very first attempt. [1, 2, 3, 4]
, 1.A 48-year-old female presents to the clinic complaining of progressive, generalized
fatigue and a unintentional 12-pound weight gain over the last four months. She notes
that she feels cold even in warm rooms and has been dealing with worsening
constipation. Physical examination reveals mild periorbital edema, dry skin, and a
delayed relaxation phase in her deep tendon reflexes. Initial laboratory evaluation
confirms primary hypothyroidism. Which of the following is the most appropriate next
step in managing this patient's condition?
A) Initiate Levothyroxine at 1.6 mcg/kg/day and recheck TSH in 6 to 8 weeks
B) Initiate Levothyroxine 25 mcg daily and recheck TSH in 2 weeks
C) Order a thyroid ultrasound and radioactive iodine uptake scan before starting therapy
D) Initiate combination therapy with Levothyroxine (T4) and Liothyronine (T3)
Answer: A) Initiate Levothyroxine at 1.6 mcg/kg/day and recheck TSH in 6 to 8
weeks
Rationale: For young, healthy adults with primary hypothyroidism, full replacement
doses of levothyroxine (approximately 1.6 mcg/kg/day) can be safely initiated
immediately. Serum TSH is the most sensitive indicator of thyroid status and should be
rechecked in 6 to 8 weeks, as it takes several weeks for TSH levels to stabilize after
initiating or changing therapy. In contrast, elderly patients or those with known coronary
artery disease should be started on a lower dose (e.g., 12.5 to 25 mcg daily) to avoid
precipitating myocardial ischemia.
1. A 64-year-old male with a history of long-standing hypertension and type 2 diabetes
mellitus presents for a routine wellness visit. He has no physical complaints, does not
smoke, and his blood pressure today is 128/76 mmHg. Routine laboratory screening
reveals an estimated glomerular filtration rate (eGFR) of 52 mL/min/1.73 m² (previously
55 mL/min/1.73 m² six months ago) and a random spot urine albumin-to-creatinine ratio
(UACR) of 180 mg/g. His current medications include Metformin and Amlodipine. Which
of the following is the most appropriate addition to this patient's regimen to delay the
progression of chronic kidney disease (CKD)?
A) Hydrochlorothiazide
B) Lisinopril
C) Atenolol
D) Spironolactone
Answer: B) Lisinopril
Rationale: In patients with diabetes, hypertension, and albuminuria (defined as a UACR
of 30 mg/g or higher), an Angiotensin-Converting Enzyme (ACE) inhibitor like lisinopril
or an Angiotensin II Receptor Blocker (ARB) is strongly recommended as first-line
therapy. These agents provide renal protection by preferentially dilating the efferent
arteriole, which reduces intraglomerular pressure and slows the progression of diabetic
nephropathy independent of their systemic blood pressure-lowering effects. [1, 2, 3, 4]
2. A 24-year-old primigravida at 10 weeks gestation presents for her first prenatal visit.
She has a history of asthma controlled with an as-needed Albuterol inhaler but has
otherwise been healthy. Her blood type is determined to be A-negative, and her
antibody screen is negative. Her husband's blood type is known to be O-positive. Which
of the following represents the correct management regarding Rho(D) immune globulin
, administration for this patient?
A) Administer Rho(D) immune globulin immediately at this visit
B) Administer Rho(D) immune globulin at 28 weeks gestation and again within 72 hours
of delivery if the infant is Rh-positive
C) Administer Rho(D) immune globulin only if she experiences a miscarriage or
abdominal trauma
D) No Rho(D) immune globulin is needed because her current antibody screen is
negative
Answer: B) Administer Rho(D) immune globulin at 28 weeks gestation and again
within 72 hours of delivery if the infant is Rh-positive
Rationale: Standard obstetric care mandates that Rh-negative, unsensitized women
(antibody screen negative) receive a prophylactic dose of Rho(D) immune globulin at 28
weeks gestation. This prevents maternal alloimmunization from potential fetomaternal
hemorrhage during late pregnancy. A second dose is administered within 72 hours of
delivery if neonatal testing confirms the infant is Rh-positive. Earlier administration is
only warranted during specific events like vaginal bleeding, invasive prenatal testing, or
abdominal trauma. [1, 2, 3]
3. A 68-year-old female presents to the emergency department with acute onset of severe,
left-sided lower quadrant abdominal pain accompanied by low-grade fever and nausea
for the past 24 hours. She reports no vomiting or blood in her stool. On examination,
she has marked tenderness to palpation in the left lower quadrant with localized
guarding but no rebound tenderness. A contrast-enhanced computed tomography (CT)
scan of the abdomen and pelvis reveals localized colonic wall thickening and fat
stranding in the sigmoid colon, consistent with acute uncomplicated diverticulitis. What
is the most appropriate initial management approach?
A) Schedule an urgent outpatient colonoscopy within 48 hours to confirm the diagnosis
B) Admit for inpatient observation, keep NPO, and arrange an emergent surgical
consultation for partial colectomy
C) Initiate empiric outpatient oral antibiotic therapy (e.g., Ciprofloxacin and
Metronidazole) and a clear liquid diet
D) Discharge home with reassurance and recommend a high-fiber diet immediately
Answer: C) Initiate empiric outpatient oral antibiotic therapy (e.g., Ciprofloxacin
and Metronidazole) and a clear liquid diet
Rationale: Acute uncomplicated diverticulitis is typically managed outpatients with oral
antibiotics covering gram-negative rods and anaerobes, along with a temporary clear
liquid diet to allow bowel rest. Colonoscopy is strictly contraindicated during an acute
flare due to an increased risk of colonic perforation and should be delayed for 6 to 8
weeks. Hospitalization and surgical evaluation are reserved for complicated cases
presenting with peritonitis, large abscesses, fistula formation, or bowel obstruction. [1, 2]
4. A 52-year-old male with a history of obesity and moderate tobacco use presents for a
annual physical. He has no active symptoms but mentions that his father died of a
sudden myocardial infarction at age 55. A fasting lipid panel reveals a total cholesterol
of 240 mg/dL, HDL of 38 mg/dL, and an LDL cholesterol of 152 mg/dL. His blood
pressure is 134/82 mmHg. Using the pooled cohort equations, his 10-year
atherosclerotic cardiovascular disease (ASCVD) risk is calculated to be 11.5%. Which
of the following is the most appropriate recommendation regarding statin therapy for this
, patient?
A) Initiate low-intensity statin therapy (e.g., Pravastatin 10 mg daily)
B) Defer statin therapy and recommend a trial of lifestyle modifications for 12 months
C) Initiate moderate- to high-intensity statin therapy (e.g., Atorvastatin 20 mg daily)
D) Order a coronary artery calcium (CAC) score; if it is 0, initiate high-intensity statin
therapy immediately
Answer: C) Initiate moderate- to high-intensity statin therapy (e.g., Atorvastatin 20
mg daily)
Rationale: Current cardiovascular guidelines recommend initiating statin therapy for
primary prevention in adults aged 40 to 75 without diabetes whose 10-year ASCVD risk
is 7.5% or higher (intermediate risk category). Given his calculated risk of 11.5% and a
strong family history of premature cardiovascular disease, initiating a moderate- to high-
intensity statin is appropriate to decrease his long-term risk of cardiovascular events.
Lifestyle modifications should supplement, not delay, pharmacotherapy in this risk
bracket. [1, 2, 3]
5. A 19-year-old female college student presents to the university health clinic seeking
contraception counseling. She states that she frequently forgets to take her daily
medications and desires a highly effective method that requires minimal daily effort or
user adherence. She has no significant medical history and is nulliparous. Which of the
following contraceptive options is the most appropriate recommendation based on her
criteria?
A) Combination oral contraceptive pills
B) Subdermal etonogestrel implant or intrauterine device (IUD)
C) Medroxyprogesterone acetate (Depo-Provera) injection every 12 weeks
D) Diaphragm paired with spermicidal jelly
Answer: B) Subdermal etonogestrel implant or intrauterine device (IUD)
Rationale: Long-Acting Reversible Contraception (LARC) methods, including subdermal
implants and intrauterine devices, are the most effective reversible contraceptive
options because they do not rely on patient compliance or daily memory. They have a
failure rate of less than 1%, making them ideal for individuals who struggle with daily or
cyclic dosing regimens. Nulliparity is not a contraindication to LARC use.
6. A 31-year-old male presents with a 3-day history of intense pain, swelling, and redness
around the cuticle of his right index finger. He admits to a habit of biting his nails when
stressed. Physical examination reveals localized erythema, warmth, and a fluctuant
purulent collection along the lateral nail fold. There is no extension of the swelling into
the palm or tracking lymphangitis. What is the most appropriate primary intervention for
this condition?
A) Prescribe a 10-day course of high-dose intravenous vancomycin
B) Perform an incision and drainage or elevate the nail fold with a small scalpel to allow
drainage
C) Apply a tight compression bandage and immobilize the hand in a splint
D) Reassure the patient and recommend soaking the finger in ice water three times
daily
Answer: B) Perform an incision and drainage or elevate the nail fold with a small
scalpel to allow drainage [1]
Certification Board Exam Prep
2025/2026: 150 Master Questions,
Answers & Rationales [1]
Accelerate your board preparation with this
high-yield digital study guide containing 150
realistic multiple-choice practice questions
specifically engineered for the American Board
of Family Medicine (ABFM) certification exam.
Every question features a clearly highlighted
correct answer and a comprehensive, clinically
grounded rationale detailing crucial primary
care guidelines, diagnostic criteria, and
management protocols. Fully updated to mirror
the newest ABMS test blueprints, this
scannable resource helps busy residents and
practicing family physicians bypass dense
textbooks and secure a passing score on their
very first attempt. [1, 2, 3, 4]
, 1.A 48-year-old female presents to the clinic complaining of progressive, generalized
fatigue and a unintentional 12-pound weight gain over the last four months. She notes
that she feels cold even in warm rooms and has been dealing with worsening
constipation. Physical examination reveals mild periorbital edema, dry skin, and a
delayed relaxation phase in her deep tendon reflexes. Initial laboratory evaluation
confirms primary hypothyroidism. Which of the following is the most appropriate next
step in managing this patient's condition?
A) Initiate Levothyroxine at 1.6 mcg/kg/day and recheck TSH in 6 to 8 weeks
B) Initiate Levothyroxine 25 mcg daily and recheck TSH in 2 weeks
C) Order a thyroid ultrasound and radioactive iodine uptake scan before starting therapy
D) Initiate combination therapy with Levothyroxine (T4) and Liothyronine (T3)
Answer: A) Initiate Levothyroxine at 1.6 mcg/kg/day and recheck TSH in 6 to 8
weeks
Rationale: For young, healthy adults with primary hypothyroidism, full replacement
doses of levothyroxine (approximately 1.6 mcg/kg/day) can be safely initiated
immediately. Serum TSH is the most sensitive indicator of thyroid status and should be
rechecked in 6 to 8 weeks, as it takes several weeks for TSH levels to stabilize after
initiating or changing therapy. In contrast, elderly patients or those with known coronary
artery disease should be started on a lower dose (e.g., 12.5 to 25 mcg daily) to avoid
precipitating myocardial ischemia.
1. A 64-year-old male with a history of long-standing hypertension and type 2 diabetes
mellitus presents for a routine wellness visit. He has no physical complaints, does not
smoke, and his blood pressure today is 128/76 mmHg. Routine laboratory screening
reveals an estimated glomerular filtration rate (eGFR) of 52 mL/min/1.73 m² (previously
55 mL/min/1.73 m² six months ago) and a random spot urine albumin-to-creatinine ratio
(UACR) of 180 mg/g. His current medications include Metformin and Amlodipine. Which
of the following is the most appropriate addition to this patient's regimen to delay the
progression of chronic kidney disease (CKD)?
A) Hydrochlorothiazide
B) Lisinopril
C) Atenolol
D) Spironolactone
Answer: B) Lisinopril
Rationale: In patients with diabetes, hypertension, and albuminuria (defined as a UACR
of 30 mg/g or higher), an Angiotensin-Converting Enzyme (ACE) inhibitor like lisinopril
or an Angiotensin II Receptor Blocker (ARB) is strongly recommended as first-line
therapy. These agents provide renal protection by preferentially dilating the efferent
arteriole, which reduces intraglomerular pressure and slows the progression of diabetic
nephropathy independent of their systemic blood pressure-lowering effects. [1, 2, 3, 4]
2. A 24-year-old primigravida at 10 weeks gestation presents for her first prenatal visit.
She has a history of asthma controlled with an as-needed Albuterol inhaler but has
otherwise been healthy. Her blood type is determined to be A-negative, and her
antibody screen is negative. Her husband's blood type is known to be O-positive. Which
of the following represents the correct management regarding Rho(D) immune globulin
, administration for this patient?
A) Administer Rho(D) immune globulin immediately at this visit
B) Administer Rho(D) immune globulin at 28 weeks gestation and again within 72 hours
of delivery if the infant is Rh-positive
C) Administer Rho(D) immune globulin only if she experiences a miscarriage or
abdominal trauma
D) No Rho(D) immune globulin is needed because her current antibody screen is
negative
Answer: B) Administer Rho(D) immune globulin at 28 weeks gestation and again
within 72 hours of delivery if the infant is Rh-positive
Rationale: Standard obstetric care mandates that Rh-negative, unsensitized women
(antibody screen negative) receive a prophylactic dose of Rho(D) immune globulin at 28
weeks gestation. This prevents maternal alloimmunization from potential fetomaternal
hemorrhage during late pregnancy. A second dose is administered within 72 hours of
delivery if neonatal testing confirms the infant is Rh-positive. Earlier administration is
only warranted during specific events like vaginal bleeding, invasive prenatal testing, or
abdominal trauma. [1, 2, 3]
3. A 68-year-old female presents to the emergency department with acute onset of severe,
left-sided lower quadrant abdominal pain accompanied by low-grade fever and nausea
for the past 24 hours. She reports no vomiting or blood in her stool. On examination,
she has marked tenderness to palpation in the left lower quadrant with localized
guarding but no rebound tenderness. A contrast-enhanced computed tomography (CT)
scan of the abdomen and pelvis reveals localized colonic wall thickening and fat
stranding in the sigmoid colon, consistent with acute uncomplicated diverticulitis. What
is the most appropriate initial management approach?
A) Schedule an urgent outpatient colonoscopy within 48 hours to confirm the diagnosis
B) Admit for inpatient observation, keep NPO, and arrange an emergent surgical
consultation for partial colectomy
C) Initiate empiric outpatient oral antibiotic therapy (e.g., Ciprofloxacin and
Metronidazole) and a clear liquid diet
D) Discharge home with reassurance and recommend a high-fiber diet immediately
Answer: C) Initiate empiric outpatient oral antibiotic therapy (e.g., Ciprofloxacin
and Metronidazole) and a clear liquid diet
Rationale: Acute uncomplicated diverticulitis is typically managed outpatients with oral
antibiotics covering gram-negative rods and anaerobes, along with a temporary clear
liquid diet to allow bowel rest. Colonoscopy is strictly contraindicated during an acute
flare due to an increased risk of colonic perforation and should be delayed for 6 to 8
weeks. Hospitalization and surgical evaluation are reserved for complicated cases
presenting with peritonitis, large abscesses, fistula formation, or bowel obstruction. [1, 2]
4. A 52-year-old male with a history of obesity and moderate tobacco use presents for a
annual physical. He has no active symptoms but mentions that his father died of a
sudden myocardial infarction at age 55. A fasting lipid panel reveals a total cholesterol
of 240 mg/dL, HDL of 38 mg/dL, and an LDL cholesterol of 152 mg/dL. His blood
pressure is 134/82 mmHg. Using the pooled cohort equations, his 10-year
atherosclerotic cardiovascular disease (ASCVD) risk is calculated to be 11.5%. Which
of the following is the most appropriate recommendation regarding statin therapy for this
, patient?
A) Initiate low-intensity statin therapy (e.g., Pravastatin 10 mg daily)
B) Defer statin therapy and recommend a trial of lifestyle modifications for 12 months
C) Initiate moderate- to high-intensity statin therapy (e.g., Atorvastatin 20 mg daily)
D) Order a coronary artery calcium (CAC) score; if it is 0, initiate high-intensity statin
therapy immediately
Answer: C) Initiate moderate- to high-intensity statin therapy (e.g., Atorvastatin 20
mg daily)
Rationale: Current cardiovascular guidelines recommend initiating statin therapy for
primary prevention in adults aged 40 to 75 without diabetes whose 10-year ASCVD risk
is 7.5% or higher (intermediate risk category). Given his calculated risk of 11.5% and a
strong family history of premature cardiovascular disease, initiating a moderate- to high-
intensity statin is appropriate to decrease his long-term risk of cardiovascular events.
Lifestyle modifications should supplement, not delay, pharmacotherapy in this risk
bracket. [1, 2, 3]
5. A 19-year-old female college student presents to the university health clinic seeking
contraception counseling. She states that she frequently forgets to take her daily
medications and desires a highly effective method that requires minimal daily effort or
user adherence. She has no significant medical history and is nulliparous. Which of the
following contraceptive options is the most appropriate recommendation based on her
criteria?
A) Combination oral contraceptive pills
B) Subdermal etonogestrel implant or intrauterine device (IUD)
C) Medroxyprogesterone acetate (Depo-Provera) injection every 12 weeks
D) Diaphragm paired with spermicidal jelly
Answer: B) Subdermal etonogestrel implant or intrauterine device (IUD)
Rationale: Long-Acting Reversible Contraception (LARC) methods, including subdermal
implants and intrauterine devices, are the most effective reversible contraceptive
options because they do not rely on patient compliance or daily memory. They have a
failure rate of less than 1%, making them ideal for individuals who struggle with daily or
cyclic dosing regimens. Nulliparity is not a contraindication to LARC use.
6. A 31-year-old male presents with a 3-day history of intense pain, swelling, and redness
around the cuticle of his right index finger. He admits to a habit of biting his nails when
stressed. Physical examination reveals localized erythema, warmth, and a fluctuant
purulent collection along the lateral nail fold. There is no extension of the swelling into
the palm or tracking lymphangitis. What is the most appropriate primary intervention for
this condition?
A) Prescribe a 10-day course of high-dose intravenous vancomycin
B) Perform an incision and drainage or elevate the nail fold with a small scalpel to allow
drainage
C) Apply a tight compression bandage and immobilize the hand in a splint
D) Reassure the patient and recommend soaking the finger in ice water three times
daily
Answer: B) Perform an incision and drainage or elevate the nail fold with a small
scalpel to allow drainage [1]
