Acute Care and Diagnosis
35%of exam
Chronic Care Management
25%of exam
Emergent and Urgent Care
20%of exam
Preventive Care
15%of exam
Foundations of Care
5%of exam
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- Current numeric cutoff unpublished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
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
- 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
- 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
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
- 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
- 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
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
- 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
- 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
- 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
- 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
BE FAST: balance, eyes, face, arm, speech, time
Sudden balance lossSudden visual changeFace or arm weaknessSpeech change; call 911
Stroke Concern vs Migraine Pattern
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
- 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
- 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
- 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
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
- 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
- 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
- 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
- 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
SBAR: situation, background, assessment, recommendation
State immediate concernGive relevant contextShare current assessmentRequest next action
Sensitivity vs Positive Predictive Value
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
- 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
PICO: patient, intervention, comparison, outcome
Specify populationName interventionChoose comparatorDefine 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
Buy on AmazonSame family resources
Explore More ABFM Family Medicine Certifications
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.