ABFM Family Medicine One-Day Exam Cheat Sheet

Acute Care and Diagnosis

35% of exam
Respiratory Triage Neurologic and ENT Clues Musculoskeletal and Abdominal Clues Acute Diagnosis Picker

Chronic Care Management

25% of exam
Cardiometabolic Follow-Up Chronic Symptom Monitoring Mental Health and Aging Chronic Follow-Up Picker

Emergent and Urgent Care

20% of exam
Immediate Escalation Time-Sensitive Presentations Emergency Disposition Picker Stroke Recognition

Preventive Care

15% of exam
USPSTF Cancer Screening Other USPSTF Screening Prevention Actions Screening Eligibility Picker

Foundations of Care

5% of exam
Evidence and Communication Test Interpretation Clinical Handoff Evidence Question

Quick Facts

Exam ABFM one-day FMCE
Items 300 single-best-answer MCQs
Sections Four sections; 75 each
Section time 95 minutes each
Break pool 100 optional minutes between sections
Blueprint Five clinical-activity domains
Score cutoff Current numeric cutoff unpublished
FMCLA Separate continuing-certification option

Acute Otitis Media vs Effusion AC

Acute otitis media

Acute inflammatory symptoms
Bulging TM supports diagnosis

Effusion only

Middle-ear fluid present
No acute inflammatory signs
Fluid alone does not prove AOM

Acute Diagnosis Picker AC

Cough + rhinorrhea; stable → Supportive viral-illness assessment ( Antibiotics need bacterial indication )
Fever + focal lung findings → Evaluate pneumonia ( Assess oxygenation and severity )
Positional brief vertigo; no deficits → Assess BPPV ( Examine positional nystagmus )
Vertigo + new neurologic deficit → Emergency central evaluation ( Do not label BPPV )
Bulging TM + acute signs → Assess acute otitis media ( Effusion alone differs )
Hot swollen joint + fever → Urgent septic-arthritis assessment ( Avoid delayed sampling )

Respiratory Triage AC

Acute cough + rhinorrhea Viral cause more likely
Focal crackles + fever Evaluate for pneumonia
Wheeze + reversible symptoms Consider asthma; confirm objectively
New dyspnea + hypoxemia Assess severity and disposition
Pleuritic pain + dyspnea Assess pulmonary embolism risk
Persistent cough + red flags Investigate beyond uncomplicated URI
Stridor at rest Urgent airway severity assessment

BPPV vs Central Vertigo AC

BPPV pattern

Brief, position-triggered spells
Characteristic positional nystagmus

Central concern

New focal neurologic signs
Urgent evaluation indicated
Deficits override benign positional label

Neurologic and ENT Clues AC

Brief positional vertigo BPPV possible; examine nystagmus
Vertigo + focal deficit Urgent central-cause evaluation
New thunderclap headache Emergency secondary-headache evaluation
Recurrent headache + nausea Migraine pattern; check red flags
Bulging TM + acute inflammation Supports acute otitis media
Effusion without acute inflammation Otitis media with effusion
Painful red eye + photophobia Urgent vision-threatening cause evaluation
Sudden unilateral hearing loss Urgent specialist evaluation

Musculoskeletal and Abdominal Clues AC

Calf squeeze; absent plantarflexion Suspect Achilles rupture
Hot joint + fever Urgent septic-joint evaluation
Back pain + saddle anesthesia Emergency cauda-equina evaluation
Leg pain relieved by flexion Neurogenic claudication pattern
Migrating RLQ pain Appendicitis possible; examine
Pelvic pain + possible pregnancy Exclude ectopic pregnancy
Hematemesis or melena Assess GI bleeding severity

Delirium vs Dementia CH

Delirium

Acute fluctuating attention change
Search for trigger

Dementia

Gradual progressive cognitive decline
Assess baseline function
Acute confusion is not baseline dementia

Chronic Follow-Up Picker CH

Stable elevated office BP → Confirm outside clinic ( Before routine treatment decision )
Diabetes + recurrent hypoglycemia → Review regimen and safety ( Individualize targets )
CKD + changing eGFR → Review albuminuria and trend ( Assess reversible contributors )
Asthma + recurrent exacerbations → Reassess control and therapy ( Check technique and triggers )
Depression + suicidal thoughts → Immediate safety assessment ( Determine urgent disposition )
Older adult + acute confusion → Evaluate delirium ( Search for precipitant )

Cardiometabolic Follow-Up CH

Elevated office BP; stable Confirm with out-of-office readings
Diabetes follow-up Review glycemia, complications, hypoglycemia
CKD follow-up Trend eGFR and albuminuria
Heart failure follow-up Track congestion, function, medication tolerance
Atrial fibrillation follow-up Reassess stroke and bleeding risks
ASCVD prevention Reassess risk and treatment adherence
Orthostatic symptoms Check positional BP and medications

Chronic Symptom Monitoring CH

Asthma follow-up Review control and exacerbation history
COPD follow-up Review symptoms and exacerbations
Persistent pain Assess function, harms, goals
Hypothyroidism treatment Interpret TSH with clinical context
Recurrent reflux Review alarm symptoms and response
Osteoarthritis Function and shared treatment goals

Mental Health and Aging CH

Depression follow-up Track response and suicide risk
New confusion in older adult Evaluate delirium and precipitants
Gradual cognitive decline Assess function and reversible contributors
Recurrent falls Review gait, medicines, vision
Polypharmacy Reconcile drugs; assess adverse effects
Chronic opioid therapy Reassess benefit, harms, function

Stroke Recognition UR

BE FAST: balance, eyes, face, arm, speech, time
Sudden balance loss Sudden visual change Face or arm weakness Speech change; call 911

Stroke Concern vs Migraine Pattern UR

Stroke concern

Sudden focal deficit
Activate emergency response

Migraine pattern

Recurrent stereotyped attacks
Check for new red flags
New deficit needs stroke evaluation

Emergency Disposition Picker UR

Sudden unilateral weakness → Activate stroke pathway ( Time-sensitive evaluation )
Chest pressure + diaphoresis → Activate ACS evaluation ( Call emergency services )
Allergen + airway symptoms → Give IM epinephrine ( Activate emergency response )
Infection + hypotension/confusion → Activate sepsis response ( Urgent stabilization )
Possible pregnancy + severe pain → Emergency ectopic evaluation ( Check hemodynamics )
GI bleeding + syncope → Emergency resuscitation assessment ( Assess perfusion )

Immediate Escalation UR

Sudden focal neurologic deficit Activate emergency stroke pathway
Chest pressure + cold sweat Emergency ACS evaluation
Infection + confusion or shock Emergency sepsis assessment
Allergen exposure + airway compromise Immediate epinephrine and emergency care
Severe dyspnea + exhaustion Emergency respiratory support assessment
Unresponsive + abnormal breathing Emergency response; assess resuscitation
Pregnancy + severe abdominal pain Emergency ectopic evaluation

Time-Sensitive Presentations UR

Fever + neck stiffness + confusion Emergency CNS-infection evaluation
Hyperglycemia + vomiting + acidosis Emergency DKA evaluation
Painful red eye + vision loss Emergency ophthalmic evaluation
Postpartum headache + severe BP Urgent hypertensive-disorder evaluation
Infant fever + ill appearance Urgent age-specific sepsis assessment
GI bleed + syncope Emergency hemodynamic assessment
Severe dehydration + lethargy Urgent fluid-status assessment

Screening vs Diagnostic Testing PR

Screening

Asymptomatic eligible person
Risk-based test choice

Diagnosis

Symptoms or positive screen
Evaluate specific concern
Positive screen needs diagnostic follow-up

Screening Eligibility Picker PR

Average-risk colorectal; 45–75 → Offer screening ( Discuss test options )
Average-risk colorectal; 76–85 → Individualize decision ( Health, history, preferences )
Women 40–74; average risk → Biennial mammography ( USPSTF recommendation )
Men 65–75; ever smoked → One-time AAA ultrasound ( USPSTF recommendation )
Women 65+; no known osteoporosis → Screen DXA ( USPSTF recommendation )
Adults 18+; elevated office BP → Confirm outside clinic ( Unless urgent treatment needed )

USPSTF Cancer Screening PR

Average-risk colorectal; 45–75 Offer screening; choose accepted test
Average-risk colorectal; 76–85 Select by health, history, preferences
Positive stool screening test Diagnostic colonoscopy follow-up
Breast; women 40–74 Biennial screening mammography
Lung; 50–80, ≥20 pack-years Annual LDCT; current or quit <15y
Lung; quit 15+ years USPSTF screening criterion unmet

Other USPSTF Screening PR

Adults 18+; hypertension Office screen; confirm outside clinic
Overweight/obesity; ages 35–70 Screen for prediabetes/diabetes
Women 65+; osteoporosis Screen with DXA
Postmenopause <65; increased risk Use clinical risk; consider DXA
Men 65–75; ever smoked One-time AAA ultrasound
HIV; ages 15–65 Offer screening

Prevention Actions PR

Could become pregnant; average risk Daily folic acid 0.4–0.8 mg
Tobacco use Offer cessation support
Immunization review Use current CDC age/risk schedule
Fall risk Assess modifiable contributors
Alcohol use Screen; counsel when indicated
Positive screening result Arrange diagnostic follow-up

Clinical Handoff FO

SBAR: situation, background, assessment, recommendation
State immediate concern Give relevant context Share current assessment Request next action

Sensitivity vs Positive Predictive Value FO

Sensitivity

Condition on disease
Positive proportion among diseased

Positive predictive value

Condition on positive test
Disease proportion among positives
Prevalence changes predictive value

Evidence and Communication FO

Sensitivity Positive among people with disease
Specificity Negative among people without disease
Positive predictive value Disease among positive tests
Negative predictive value No disease among negative tests
Absolute risk reduction Control minus treatment; matched follow-up
NNT 1/ARR; use proportions; round upward
Teach-back Patient explains plan in own words
Qualified interpreter Use for language access

Evidence Question FO

PICO: patient, intervention, comparison, outcome
Specify population Name intervention Choose comparator Define patient-relevant outcome

Common Traps

One-Day Exam vs FMCLA

Initial candidates: one-day FMCE ≠ FMCLA: eligible continuing-certification option

Office BP vs Diagnosis

Elevated office reading prompts confirmation ≠ Stable patient: confirm outside clinic

Fluid vs Acute Ear Infection

Middle-ear effusion can persist ≠ Acute inflammation changes diagnosis

Population Screening vs Symptoms

USPSTF ages: asymptomatic populations ≠ Symptoms require diagnostic evaluation

Stable Vertigo vs Neurologic Deficit

Brief positional spells suggest BPPV ≠ New deficits demand emergency evaluation

Combined Score vs Blueprint Weight

Five domains have official weights ≠ No organ-system subgroup weights published

Last Minute

1. Blueprint: acute 35%, chronic 25%
2. Urgent 20%, prevention 15%, foundations 5%
3. One-day exam: four 75-item sections
4. Each section: 95 testing minutes
5. Break pool: 100 optional minutes
6. FMCLA differs from initial one-day exam
7. Sudden focal deficit: emergency stroke pathway
8. Infection with shock: emergency sepsis evaluation
9. Average-risk colorectal 45–75: offer screening
10. Breast screening 40–74: biennial mammography
11. Positive stool screen: diagnostic colonoscopy
12. Stable elevated office BP: outside confirmation
13. No current numeric pass cutoff published

ABFM Family Medicine Certification

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