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6 Free ABFM Practice Questions for Family Medicine Residents
If you’re a PGY-3, the ABFM Family Medicine Certification Examination is likely the next big milestone after residency. It covers the full breadth of family medicine in a single day, and since 2025, it’s organized around how family physicians actually practice rather than by organ system.
The six questions below come from the BoardVitals ABFM board review question bank and are written in the same single-best-answer vignette style you’ll see on exam day. Take the quiz, then use the exam overview, blueprint breakdown, and study timeline below to plan your prep for the spring or fall sitting.
Take the Quiz
Family Medicine
Here are 6 highly rated ABFM Family Medicine sample questions taken directly from the BoardVitals Family Medicine Board Review. We’re giving you just a taste of what you might expect on your actual board exam. Good luck!
A 50-year-old male presents to urgent care with left ear pain for a week. What is the appropriate treatment for this patient?
He is a type 2 diabetic and is not always compliant with his medications. He says the ear bothered him a little bit at first, and he scratched the inside with a q-tip for relief. Over the last 2 days, the ear pain has worsened, is swollen, and he has a bad headache and low grade fever. His vitals are BP 130/90, HR 100, RR 18, Sat 99% on RA, and Temp 100.1°F. His ear has the following appearance.
A 14-year-old male is admitted to the primary care clinic for a rash that occurred during the last few days. What is the most likely diagnosis?
He states that he is a wrestler for his high school and that the rash started a few days after one of his wrestling competitions. There’s no PMH. He notes that the rash is found locally on his left arm and left leg, and he denies any fever, nausea, vomiting, and runny nose. The patient’s temperature = 98.5°F, HR = 90, RR = 20, and BP = 110/80. Physical exam shows the rash pictured below:
A 23-year-old black female presents to urgent care with approximately 3 weeks of body and joint aches. What workup is required for this patient?
Past medical history is significant for a kidney stone. She also reports fatigue, hoarse voice, and waxing and waning cough. She does not smoke and denies fever or sputum. She has a family history of hypertension and diabetes. Her vitals upon arrival are BP 130/80, HR 90, RR 20, Temp 99.1, and O2 Sat 99% on RA.
A 45-year-old male comes to urgent care for an extremely painful thumb. What treatment should be offered to this patient?
He thinks he could have pinched it when he was dressing a few days back, although he never had sudden pain. For the past 2 days, the thumb around the nail is swollen, painful, red, and draining liquid. He is vitals are BP 150/80, HR 95, RR 18, and Temp 98.9.
An 81 year old male presents by ambulance to the emergency room for evaluation of new onset confusion. Which of the following is appropriate?
He has a history of hypertension, type 2 diabetes mellitus, hyperlipidemia, and congestive heart failure. He takes metformin, lisinopril, and pravastatin. He lives in a nursing home. He appears acutely ill and confused about the date and place. His blood pressure is 90/60 mmHg. His heart rate is 92 beats per minute, and his respiratory rate is 22/minute. His temperature is 35 degrees C. SaO2 is 92%. He has crackles in his lung bases. Auscultation of the heart reveals a regular rhythm without murmur, rub, or gallop.
A 25-year-old female presents with 2 weeks of a “cold sore” on her upper lip that will not heal. What is the next step in treatment?
She has tried OTC cold sore cream, bacitracin ointment, and warm compresses to no avail. She denies fever, headache, rash, or other symptoms. She is sexually active with a new partner but denies any symptoms besides the sore. She takes no medications. The sore does not hurt, but she occasionally feels the urge to scratch it. Her vitals upon arrival are BP 100/70, HR 65, RR 16, Temp 98.8, and Sat 99% on RA. On exam, the sore pictured below is evident.
There’s Room For Improvement
Don’t beat yourself up, we’re here to help. Study anywhere, any time with BoardVitals. 100% pass guarantee. Go to www.boardvitals.com today!
You’re Almost Ready
But there’s always room for improvement. Study anywhere, any time with BoardVitals. 100% pass guarantee. Share your result with friends and go to www.boardvitals.com today!
You’re Ready
But there’s always room for improvement. Study anywhere, any time with BoardVitals. 100% pass guarantee. Share your result with friends and go to www.boardvitals.com today!
How did you do?
Note which domains gave you trouble. One missed question won’t predict your exam result, but a pattern of misses in one domain is a useful signal about where to focus. For full explanations and more than 2,850 questions across all five domains, start a free trial of the BoardVitals Family Medicine question bank.
Dates and deadlines change each year, so confirm everything on ABFM’s one-day exam page and dates and deadlines page before you register.
The ABFM Exam at a Glance
To earn initial ABFM certification, residents must pass the one-day Family Medicine Certification Examination, which consists of 300 single-best-answer questions taken in one day at a Prometric test center. The exam is broken down into four 95-minute sections of 75 questions each, with 100 minutes of pooled break time
Dates and deadlines change each year, so confirm details with the ABFM before you register.
The ABFM Blueprint, Explained
Since January 2025, the ABFM exam blueprint has been organized around five domains of care based on what family physicians do in practice, not by organ system. Acute and chronic care together make up 60% of the exam.
- Acute Care and Diagnosis (35%): Office-based scenarios where you choose the next diagnostic step, make the diagnosis, or start initial treatment.
- Chronic Care Management (25%): Ongoing management of chronic disease in the clinic or in long-term care settings.
- Emergent and Urgent Care (20%): Decisions needed within hours, whether in the ED, hospital, urgent care, or office.
- Preventive Care (15%): Screening, immunizations, and other preventive services in the ambulatory setting.
- Foundations of Care (5%): Biostatistics, health policy, legal and ethical issues, health equity, and related topics.
Why this matters for how you study
Most residents learn by rotation and organ system, but the exam asks what you would do. A single topic like diabetes can show up as a diagnosis question, a chronic management question, a DKA question in Emergent and Urgent Care, or a screening question in Preventive Care. When you review a topic, practice it across every domain where it could appear.
Don’t skip Foundations of Care because it’s only 5%. Biostatistics and ethics questions are often fast points for prepared test-takers and costly misses for everyone else.
Spring or Fall? Choosing Your Sitting as a PGY-3
Residents in good standing can take the exam during the final months of residency, so most PGY-3s choose between the April window before graduation and the November window after it.
For the 2026 cycle, ABFM required residency to be completed by June 30 for the spring exam and by December 31 for the fall exam. After graduation, you have a seven-year board eligibility period to pass.
The case for spring: You test before graduation, while the content is fresh and study time can fit around residency didactics. Results also arrive before most first jobs begin. The downside is studying during demanding final rotations.
The case for fall: You get more total study time and avoid exam pressure at the end of residency. The downside is less structured time once you’re working, and prep can easily slip during a job transition.
Ask your program director which sitting most of your co-residents choose and whether your program builds in protected study time. Confirm each year’s eligibility deadlines on ABFM’s dates and deadlines page.
Ready for More ABFM Practice?
These six questions are a starting point. The BoardVitals Family Medicine board review gives you more than 2,850 ABFM-style questions mapped to the current blueprint, adaptive quizzes, risk assessment reporting, and a 100% Pass Guarantee.
Start your free Family Medicine trial. No credit card required.
The post 6 Free ABFM Practice Questions for Family Medicine Residents appeared first on BoardVitals Blog.
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