100+ Free ABFM Palliative Care Practice Questions

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A family physician sees a 71-year-old woman with metastatic colon cancer in clinic. She is taking morphine sustained-release 30 mg PO every 12 hours (60 mg/day) with good pain control but persistent, refractory nausea attributed to morphine. You rotate to oral hydromorphone. Using standard equianalgesic dosing and accounting for incomplete cross-tolerance, what is the most appropriate starting daily dose of oral hydromorphone?

Hydromorphone 15 mg/day (divided Q4H)

Hydromorphone 7.5-11 mg/day (divided Q4H)

Hydromorphone 30 mg/day (divided Q4H)

Hydromorphone 3 mg/day (divided Q4H)

to track

2026 Statistics

Key Facts: ABFM Palliative Care Exam

240

Max MCQ Questions

Up to 240 single-best-answer items

1 Day

Exam Length

Comprehensive computer-based

~$1,300

CAQ Fee

ABFM-published, subject to change

12 mo

Required Fellowship

ACGME-accredited HPM fellowship

LKA

5-Year MOC Option

Or one-day recertification exam

Cosponsoring Boards

Shared exam via ABIM

The ABFM HPM CAQ exam is a 1-day computer-based test of up to 240 single-best-answer MCQs administered by ABIM at Pearson VUE. Candidates must continuously maintain ABFM Family Medicine certification and have completed a 12-month ACGME HPM fellowship. Content covers pain management, non-pain symptoms (dyspnea, nausea, delirium, OIC), communication and advance care planning, ethics (capacity, palliative sedation, MAID), psychosocial and spiritual care, and prognostication (PPS, Karnofsky, FAST, hospice eligibility). CAQ maintained through ABFM certification plus either the one-day exam or the Longitudinal Knowledge Assessment (LKA).

Sample ABFM Palliative Care Practice Questions

Try these sample questions to test your ABFM Palliative Care exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A family physician sees a 71-year-old woman with metastatic colon cancer in clinic. She is taking morphine sustained-release 30 mg PO every 12 hours (60 mg/day) with good pain control but persistent, refractory nausea attributed to morphine. You rotate to oral hydromorphone. Using standard equianalgesic dosing and accounting for incomplete cross-tolerance, what is the most appropriate starting daily dose of oral hydromorphone?

A.Hydromorphone 15 mg/day (divided Q4H)

B.Hydromorphone 7.5-11 mg/day (divided Q4H)

C.Hydromorphone 30 mg/day (divided Q4H)

D.Hydromorphone 3 mg/day (divided Q4H)

Explanation: Oral morphine 30 mg = oral hydromorphone 7.5 mg (equianalgesic). So 60 mg/day morphine PO converts to ~15 mg/day hydromorphone PO. Because of incomplete cross-tolerance, reduce the calculated equianalgesic dose by 25-50%, giving a starting dose of roughly 7.5-11 mg/day. Exam Tip: Always reduce by 25-50% for incomplete cross-tolerance when rotating, except when rotating to methadone (non-linear, larger reduction).

2A 4-year-old child with neuroblastoma and intact cognition reports pain in your FM clinic. Which pain assessment tool is most appropriate?

A.Numeric Rating Scale (0-10)

B.PAINAD (Pain Assessment in Advanced Dementia)

C.Wong-Baker FACES Pain Rating Scale

D.Brief Pain Inventory

Explanation: The Wong-Baker FACES scale (ages 3+ with intact cognition) uses 6 faces from smiling to crying and is validated for self-report in young children. The NRS requires abstract numerical thinking usually not developed until ~7-8 years. PAINAD is for nonverbal adults with advanced dementia. FLACC is observational for infants/preverbal/unresponsive patients. Exam Tip: Match the tool to the patient — self-report whenever possible; observational scales only when communication is impaired.

3According to the WHO analgesic ladder, which medication class is appropriate for Step 1 (mild pain)?

A.Strong opioids such as morphine or hydromorphone

B.Weak opioids such as codeine or tramadol

C.Non-opioid analgesics such as acetaminophen or NSAIDs

D.Adjuvants such as gabapentin or TCAs alone

Explanation: The WHO ladder: Step 1 = non-opioids (acetaminophen, NSAIDs) +/- adjuvants for mild pain. Step 2 adds weak opioids (codeine, tramadol, low-dose hydrocodone). Step 3 uses strong opioids (morphine, oxycodone, hydromorphone, fentanyl). Adjuvants can be added at any step. Exam Tip: Originally designed for cancer pain, current practice often skips Step 2 in severe cancer pain, going directly to low-dose strong opioids.

4A 63-year-old patient with advanced lung cancer cared for in a community-hospice home setting is on morphine ER 60 mg PO every 12 hours (total daily dose 120 mg). What is the appropriate morphine immediate-release breakthrough dose?

A.Morphine IR 5 mg PO Q4H PRN

B.Morphine IR 60 mg PO Q4H PRN

C.Morphine IR 12-24 mg PO Q1H PRN

D.Morphine IR 1-2 mg PO Q1H PRN

Explanation: Breakthrough dose = 10-20% of the total 24-hour opioid dose offered every 1 hour PO PRN (every 15-30 min for parenteral). 120 mg × 10-20% = 12-24 mg. Oral morphine IR peaks around 60 minutes, so Q1H dosing matches its pharmacokinetics. Exam Tip: Never limit breakthrough to Q4H for uncontrolled pain.

5A 79-year-old nursing-home resident with advanced Alzheimer dementia is nonverbal. She appears restless and grimaces with repositioning. Which tool is most appropriate to assess her pain?

A.PAINAD (Pain Assessment in Advanced Dementia)

B.Numeric Rating Scale

C.Brief Pain Inventory

D.McGill Pain Questionnaire

Explanation: PAINAD is a 5-item observational scale (breathing, vocalization, facial expression, body language, consolability), 0-10, validated for nonverbal patients with advanced dementia. NRS, BPI, and McGill require reliable self-report. Exam Tip: FLACC for infants/children and unresponsive adults; PAINAD for dementia; CPOT/BPS in ICU.

6A 55-year-old woman with metastatic pancreatic cancer develops burning, lancinating leg pain consistent with neuropathic pain. She is already on controlled-release opioids. Which adjuvant has the strongest evidence for first-line use?

A.Ibuprofen

B.Gabapentin

C.Acetaminophen

D.Methocarbamol

Explanation: Gabapentinoids (gabapentin, pregabalin), SNRIs (duloxetine), and TCAs (nortriptyline, amitriptyline) are first-line adjuvants for neuropathic pain. NSAIDs and acetaminophen alone are ineffective. Exam Tip: For diabetic neuropathy, duloxetine and pregabalin have FDA approval; for postherpetic neuralgia, gabapentin, pregabalin, and topical lidocaine/capsaicin are first-line.

7A community-hospice patient on long-term oral opioids has severe constipation despite senna and docusate. Work-up shows no obstruction. Which agent specifically targets the peripheral mu-opioid receptor to reverse OIC without reversing analgesia?

A.Magnesium citrate

B.Methylnaltrexone

C.Lactulose

D.Bisacodyl

Explanation: Methylnaltrexone (and oral naldemedine, naloxegol) are PAMORAs — peripherally-acting mu-opioid receptor antagonists that don't cross the blood-brain barrier, so they reverse OIC without blocking analgesia or precipitating withdrawal. Exam Tip: Constipation is universal with opioids and there's NO tolerance — always prescribe senna prophylactically; reserve PAMORAs for refractory OIC.

8A 72-year-old man with end-stage COPD (FEV1 20% predicted) reports severe dyspnea at rest despite maximal bronchodilators, supplemental O2, and steroids. Which pharmacologic intervention has the strongest evidence for refractory dyspnea?

A.High-dose IV furosemide

B.Low-dose systemic opioids

C.Sublingual nitroglycerin

D.Nebulized albuterol around-the-clock

Explanation: Low-dose systemic opioids (oral or parenteral morphine 2.5-5 mg or equivalent) are first-line for refractory dyspnea in advanced disease (Level 1 evidence). They reduce perception of breathlessness without clinically significant respiratory depression at palliative doses. Benzodiazepines are added only when anxiety is prominent. Nebulized opioids are NOT recommended. Exam Tip: Supplemental O2 helps dyspnea only if hypoxemic; a bedside fan is a useful non-pharmacologic adjunct.

9A patient with advanced cancer develops hyperactive delirium with agitation, hallucinations, and combativeness at home on hospice. After addressing reversible causes, which first-line pharmacologic agent is most appropriate?

A.Lorazepam

B.Haloperidol

C.Diphenhydramine

D.Morphine

Explanation: Haloperidol is first-line for hyperactive delirium (0.5-2 mg PO/IV/SC Q4-6H). Atypicals (risperidone, olanzapine, quetiapine) are alternatives. Benzodiazepines can worsen delirium and are reserved for alcohol/benzo withdrawal or refractory terminal delirium after antipsychotics. Diphenhydramine is strongly anticholinergic and worsens delirium. Exam Tip: Always search for reversible causes (UTI, constipation, hypoxia, dehydration, medications, pain) before labeling as terminal.

10A patient with advanced cancer reports chronic nausea attributed to chemoreceptor trigger zone (CTZ) mechanisms (opioid-induced, metabolic). Which antiemetic is best first-line?

A.Haloperidol

B.Lorazepam

C.Dexamethasone

D.Promethazine

Explanation: Haloperidol is a potent D2 antagonist at the CTZ, highly effective for opioid-induced and metabolic (uremia, hypercalcemia) nausea at low doses (0.5-2 mg). Rational antiemetic selection by mechanism: CTZ (dopamine) = haloperidol; vestibular = meclizine/scopolamine; gastric stasis = metoclopramide; chemo/radiation = 5-HT3 antagonists (ondansetron); raised ICP = dexamethasone; bowel obstruction = anticholinergic (glycopyrrolate) ± octreotide. Exam Tip: Match antiemetic to mechanism — high-yield.

About the ABFM Palliative Care Exam

The ABFM Hospice and Palliative Medicine Certificate of Added Qualifications (CAQ) recognizes family physicians with specialized expertise in outpatient longitudinal serious illness care, community-based hospice, nursing-home end-of-life management, and primary palliative care integration. Since 2014, eligibility requires completion of a 12-month ACGME-accredited HPM fellowship. The exam is the same comprehensive examination used by all 10 cosponsoring ABMS boards and is administered by ABIM on behalf of the ABFM.

Questions

240 scored questions

Time Limit

1-day computer-based exam (approximately 9 hours on-site)

Passing Score

Absolute standard (criterion-referenced)

Exam Fee

~$1,300 CAQ (ABFM-published, subject to change) (American Board of Family Medicine (ABFM) — exam administered by ABIM)

ABFM Palliative Care Exam Content Outline

25%

Pain Assessment and Management

WHO analgesic ladder, opioid pharmacology and rotation, equianalgesic dosing, breakthrough pain, neuropathic adjuvants, assessment tools (numeric, FACES, FLACC, PAINAD), outpatient primary-care pain management

25%

Non-Pain Symptom Management

Dyspnea, nausea/vomiting, delirium, OIC (PAMORAs), anorexia-cachexia, pruritus, terminal secretions, integrative therapies

15%

Psychosocial, Spiritual, Cultural

Total pain (Cicely Saunders), depression vs demoralization, anticipatory grief, FICA, bereavement (13-mo Medicare benefit, prolonged grief DSM-5-TR), pediatric HPM

15%

Communication and Advance Care Planning

SPIKES, REMAP, NURSE statements, Ask-Tell-Ask, goals-of-care, POLST/MOLST, Five Wishes, DNR, surrogate decision-making, serious illness conversation guide

10%

Ethical and Legal Issues

Capacity (4 elements), withholding/withdrawing LST, artificial nutrition/hydration (dementia), palliative sedation vs euthanasia, double effect, PAD/MAID (state-law dependent), nursing-home F-tags

10%

Prognostication and Hospice Eligibility

PPS, Karnofsky, FAST 7A-7D, NYHA IV / EF <20% for CHF, FEV1 <30% for COPD, Medicare Hospice Benefit (≤6 mo), routine/respite/continuous/GIP levels, pediatric concurrent care

How to Pass the ABFM Palliative Care Exam

What You Need to Know

Passing score: Absolute standard (criterion-referenced)
Exam length: 240 questions
Time limit: 1-day computer-based exam (approximately 9 hours on-site)
Exam fee: ~$1,300 CAQ (ABFM-published, subject to change)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABFM Palliative Care Study Tips from Top Performers

1Memorize equianalgesic conversions cold: morphine 30 mg PO = oxycodone 20 mg PO = hydromorphone 7.5 mg PO = morphine 10 mg IV, and fentanyl 25 mcg/h transdermal patch approximates 60 MME/day oral morphine. Reduce by 25-50% for incomplete cross-tolerance; methadone conversion is non-linear and much larger reductions apply

2Breakthrough pain dose = 10-20% of the total 24-hour opioid dose; know how to calculate this quickly from any baseline regimen, including transdermal fentanyl

3For opioid-induced constipation, prescribe a stimulant laxative (senna) prophylactically with every opioid; escalate to methylnaltrexone or naldemedine (PAMORAs) for refractory OIC — these don't reverse analgesia

4Nursing-home and advanced dementia: feeding tubes do NOT prolong life, prevent aspiration, or improve pressure ulcers. Hand feeding is preferred and aligns with goals of care

5Know Medicare Hospice Benefit cold: ≤6-month prognosis if disease runs usual course, certified by 2 physicians initially, 4 levels of care (routine, respite, continuous home, general inpatient/GIP), election forfeits curative coverage for the terminal dx, 13-month bereavement benefit for family, pediatric concurrent care under ACA §2302

Frequently Asked Questions

What is the ABFM Hospice and Palliative Medicine CAQ?

The ABFM HPM Certificate of Added Qualifications is a subspecialty credential for family physicians offered through ABFM as one of 10 cosponsoring ABMS boards (with ABIM, ABA, ABEM, ABPMR, ABPN, ABOG, ABP, ABR, and ABS). The same comprehensive examination is administered by ABIM on behalf of all 10 boards and tests expert-level knowledge in pain management, non-pain symptom control, communication, ethics, and end-of-life care — with an FM emphasis on outpatient, community-hospice, and nursing-home care.

Who is eligible to take the ABFM HPM CAQ exam?

Candidates must continuously maintain ABFM primary certification in Family Medicine, hold a valid unrestricted US medical license, and since 2014 have completed a 12-month ACGME-accredited Hospice and Palliative Medicine fellowship. The fellowship program director must attest to clinical competence. Candidates apply through the MyABFM Portfolio under Added Qualifications; ABIM then schedules and administers the exam.

What is the format of the ABFM HPM exam?

The initial HPM CAQ exam is a comprehensive 1-day computer-based examination delivered at Pearson VUE test centers. It consists of up to 240 single-best-answer multiple-choice questions organized into timed blocks with scheduled breaks. An absolute (criterion-referenced) passing standard is applied — your performance does not depend on other candidates. ABFM also offers a Longitudinal Knowledge Assessment (LKA) pathway.

How much does the ABFM HPM CAQ exam cost?

ABFM publishes a CAQ application/exam fee in the range of approximately $1,300 (subject to change — check MyABFM Portfolio for current fees). Candidates must also continuously maintain ABFM Family Medicine certification, which carries its own annual fee. The LKA pathway has separate pricing. No third-party exam-fee disclosure is authoritative — always verify with ABFM directly.

What topics are on the ABFM HPM CAQ exam?

Content follows the ABIM HPM blueprint: pain assessment and management (~25%), non-pain symptom management (~25%), psychosocial/spiritual/cultural care (~15%), communication and advance care planning (~15%), ethical and legal issues (~10%), and disease-specific palliative care and prognostication (~10%). Pain and non-pain symptom management together make up about half the exam. FM candidates should emphasize outpatient longitudinal care, community hospice, and nursing-home scenarios.

How should I prepare for the ABFM HPM CAQ exam?

Start with a structured board-review course or textbook (Oxford Textbook of Palliative Medicine, Fast Facts, AAHPM's UNIPAC or HPM PASS). Master equianalgesic conversions and opioid rotation — these are heavily tested. Practice communication frameworks (SPIKES, REMAP, NURSE). Memorize hospice eligibility criteria, PPS, FAST 7A-7D, NYHA IV for CHF, and the Medicare Hospice Benefit. Finish with a high-volume practice-question bank covering all 6 content domains and FM-specific outpatient scenarios.

How is ABFM HPM certification maintained?

Diplomates must continuously maintain ABFM Family Medicine certification, pay annual CAQ fees, and either pass the one-day recertification exam or participate in the Longitudinal Knowledge Assessment (LKA), which delivers questions quarterly over 5-year cycles. Letting primary FM certification lapse invalidates the CAQ.

Is the ABFM HPM CAQ the same exam as the ABIM HPM exam?

Yes — the initial HPM certification examination is a single, shared comprehensive exam administered by ABIM on behalf of all 10 cosponsoring ABMS boards, including ABFM. Candidates register with their primary board (ABFM for family physicians) but sit for the same examination content regardless of primary specialty. This is why ABFM candidates study from ABIM-published blueprints and broad HPM review resources.