100+ Free ABIM Geriatric Medicine Practice Questions

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An 82-year-old woman in your internal medicine clinic has lost 5 kg (11 lb) unintentionally over the past year, reports feeling exhausted, has a slow gait (>7 seconds to walk 4 meters), low grip strength, and is sedentary most of the week. By Fried criteria, how should she be classified?

Robust

Pre-frail

Frail

Sarcopenic only

to track

2026 Statistics

Key Facts: ABIM Geriatric Medicine Exam

~220

Max MCQ Questions

Single-best-answer format

1 Day

Exam Length

Computer-based at Pearson VUE (~10 hours)

~$2,500

ABIM Registration Fee

Plus annual MOC fee

12 mo

Required Fellowship

ACGME-accredited Geriatric Medicine

10 yr

MOC Cycle

Recertification exam or LKA

Joint

ABIM + ABFM

Single shared examination

The ABIM Geriatric Medicine subspecialty exam is a 1-day computer-based exam with up to ~220 single-best-answer MCQs, administered jointly by ABIM and ABFM at Pearson VUE. Candidates must hold continuous primary ABIM Internal Medicine certification and have completed a 12-month ACGME Geriatric Medicine fellowship. Content spans frailty and functional assessment (Fried, EWGSOP2, CGA, PPS), falls (STEADI) and osteoporosis (FRAX, bisphosphonates, denosumab, romosozumab), cognitive disorders (CAM, dementia subtypes, lecanemab/donanemab, APOE ε4), polypharmacy (2023 AGS Beers, STOPP/START, anticholinergic burden, DOAC renal dosing), geriatric syndromes (NPIAP staging, incontinence types, MEALS ON WHEELS), mental health (PHQ-9/GDS), and end-of-life care (hospice, POLST, capacity, MAID). Initial fee approximately $2,500; maintained via 10-year recertification exam or LKA.

Sample ABIM Geriatric Medicine Practice Questions

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

1An 82-year-old woman in your internal medicine clinic has lost 5 kg (11 lb) unintentionally over the past year, reports feeling exhausted, has a slow gait (>7 seconds to walk 4 meters), low grip strength, and is sedentary most of the week. By Fried criteria, how should she be classified?

A.Robust

B.Pre-frail

C.Frail

D.Sarcopenic only

Explanation: Fried's phenotype defines frailty by 5 criteria: unintentional weight loss >10 lb/year, self-reported exhaustion, weakness (low grip strength), slow walking speed, and low physical activity. 3 or more = frail; 1-2 = pre-frail; 0 = robust. She meets all 5. Exam Tip: Frailty predicts hospitalization, delirium, post-op mortality, and disability in internal medicine populations.

2Which assessment is most consistent with the EWGSOP2 (2019) definition of sarcopenia?

A.Low appendicular lean mass alone on DEXA

B.Low muscle strength (e.g., grip strength) as the primary criterion, confirmed by low muscle quantity/quality

C.BMI less than 22 kg/m² in an older adult

D.Unintentional weight loss of 5% in 6 months

Explanation: EWGSOP2 (2019) made low muscle strength the primary defining feature (probable sarcopenia). Confirmed sarcopenia requires both low strength AND low muscle quantity/quality; severe sarcopenia adds low physical performance (e.g., gait speed). Exam Tip: SARC-F is a validated 5-item screen (Strength, Assistance walking, Rise from chair, Climb stairs, Falls).

3A 78-year-old independent woman in your general medicine clinic completes the Timed Up and Go (TUG) test in 14 seconds. What does this result suggest?

A.Normal mobility and low fall risk

B.Increased fall risk; further multifactorial assessment is warranted

C.Diagnostic of sarcopenia

D.An indication for immediate hospitalization

Explanation: TUG ≥12 seconds is associated with increased fall risk per the CDC STEADI initiative and should prompt a multifactorial fall assessment (medications, vision, orthostasis, footwear, home hazards, strength/balance). Exam Tip: Gait speed <0.8 m/s predicts adverse outcomes including mortality and disability.

4According to the CDC STEADI algorithm, which sequence is the initial fall-risk screening in primary care?

A.Order DEXA and vitamin D level for all adults ≥65

B.Ask 3 key questions (fall in past year? unsteady? worried about falling?) and perform a gait/balance test

C.Prescribe vitamin D 2000 IU and a walker for everyone ≥65

D.Refer all older adults to physical therapy annually

Explanation: STEADI (Stopping Elderly Accidents, Deaths & Injuries) starts with the 3 key questions, then gait/balance testing (TUG, 30-second chair stand, 4-stage balance). Positive screen triggers multifactorial assessment. Exam Tip: Evidence-based fall prevention bundles include exercise with balance (Otago, Tai Chi), medication review, vision correction, vitamin D when deficient, and home hazard modification.

5Per USPSTF and geriatric guidelines, which vitamin D dose is appropriate for community-dwelling older adults at risk of falls who are deficient?

A.50,000 IU daily indefinitely

B.400 IU daily

C.Approximately 800 IU daily (or equivalent) when deficient

D.10,000 IU daily for all adults ≥65

Explanation: Guidelines support 800 IU/day when deficient; routine high-dose supplementation for fall prevention in unselected populations is not supported by USPSTF. Exam Tip: USPSTF (2024) recommends AGAINST vitamin D supplementation for primary fall prevention in community-dwelling adults ≥60 without deficiency or osteoporosis.

6An 85-year-old man is admitted to the medicine service with pneumonia and becomes acutely confused overnight with inattention, disorganized thinking, and fluctuating consciousness. Which bedside tool best confirms delirium?

A.Mini-Mental State Examination (MMSE)

B.Confusion Assessment Method (CAM)

C.Geriatric Depression Scale (GDS)

D.PHQ-9

Explanation: CAM is the most widely used bedside instrument for delirium: (1) acute onset/fluctuating course AND (2) inattention, plus either (3) disorganized thinking OR (4) altered consciousness. 4AT is a briefer alternative. Exam Tip: MMSE assesses cognition but is not specific for delirium; GDS/PHQ-9 screen depression. Inpatient delirium is highly tested on ABIM subspecialty exams.

7Which medication is most commonly implicated as a precipitating factor for delirium in older inpatients on a hospitalist service?

A.Acetaminophen

B.Diphenhydramine (anticholinergic)

C.Metformin

D.Atorvastatin

Explanation: Anticholinergics (e.g., diphenhydramine), benzodiazepines, opioids, corticosteroids, and certain antibiotics are frequent precipitants. Predisposing factors: age, cognitive impairment, sensory deficits, comorbidity. Exam Tip: Best approach to inpatient delirium is prevention via the HELP bundle (orientation, early mobilization, sleep protocols, hydration, vision/hearing aids).

8Which feature most strongly suggests Dementia with Lewy Bodies (DLB) rather than Alzheimer disease?

A.Gradual progressive memory loss without motor symptoms

B.Recurrent, well-formed visual hallucinations plus fluctuating cognition and parkinsonism

C.Stepwise decline with focal neurologic deficits

D.Early behavioral disinhibition and executive dysfunction

Explanation: Core DLB features: fluctuating cognition, recurrent visual hallucinations, REM sleep behavior disorder, and parkinsonism. AD presents with early amnestic impairment; vascular dementia is stepwise; FTD presents with behavioral/language changes. Exam Tip: Avoid typical antipsychotics in DLB — severe sensitivity reactions. The 1-year rule distinguishes DLB (cognitive symptoms before or within 1 yr of parkinsonism) from PDD.

9A 62-year-old executive develops progressive disinhibition, apathy, and loss of empathy with relatively preserved memory. Neuroimaging shows frontal/temporal atrophy. Most likely diagnosis?

A.Alzheimer disease

B.Vascular dementia

C.Behavioral-variant frontotemporal dementia (bvFTD)

D.Normal pressure hydrocephalus

Explanation: bvFTD often presents in the 50s-60s with early personality and behavioral changes, executive dysfunction, and relative memory sparing. Primary progressive aphasia (semantic, nonfluent) is the language variant. Exam Tip: NPH classically presents with wet, wobbly, wacky — gait apraxia, urinary incontinence, and cognitive impairment — and may be reversible with CSF shunting.

10Which CSF biomarker pattern supports Alzheimer disease?

A.Low Aβ42, high total tau and phospho-tau (low Aβ42/Aβ40 ratio)

B.High Aβ42 and low total tau

C.Normal Aβ42 with high glucose

D.Elevated 14-3-3 protein without tau elevation

Explanation: AD shows decreased CSF Aβ42 (amyloid accumulates in plaques) and increased total tau and phospho-tau (pTau181). The Aβ42/Aβ40 ratio is more robust than Aβ42 alone. Amyloid PET and plasma p-tau217 are emerging alternatives. Exam Tip: AT(N) biomarker framework: A=amyloid, T=tau, (N)=neurodegeneration — central to 2024 revised diagnostic criteria.

About the ABIM Geriatric Medicine Exam

The ABIM Geriatric Medicine Subspecialty Certification recognizes internists with advanced expertise in the care of older adults. Offered jointly with the American Board of Family Medicine (ABFM), the same examination is used by both boards. Eligibility requires continuous ABIM Internal Medicine certification plus completion of a minimum 12-month ACGME-accredited Geriatric Medicine fellowship. The exam tests expert knowledge of frailty, delirium, dementia (including anti-amyloid therapies), falls and osteoporosis, polypharmacy (Beers/STOPP-START), incontinence, pressure injuries, sensory loss, nutrition, mental health, and end-of-life care — with emphasis on hospitalist and ambulatory general medicine contexts.

Questions

220 scored questions

Time Limit

1-day computer-based exam (approximately 10 hours on-site)

Passing Score

Criterion-referenced (absolute standard)

Exam Fee

~$2,500 ABIM registration fee (plus annual MOC fee) (American Board of Internal Medicine (ABIM) — offered jointly with ABFM)

ABIM Geriatric Medicine Exam Content Outline

20%

Frailty, Functional Assessment, and Mobility

Fried criteria, EWGSOP2 sarcopenia, SARC-F, CFS, ADL/IADL (Katz, Lawton), PPS/Karnofsky, TUG ≥12s, gait speed <0.8 m/s, comprehensive geriatric assessment on internal medicine services

18%

Falls, Osteoporosis, and Musculoskeletal

STEADI, multifactorial prevention, exercise and balance (Otago, Tai Chi), vitamin D 800 IU, medication review, vision; DEXA, FRAX, bisphosphonate duration, denosumab rebound fractures, teriparatide, romosozumab CV warning, hip fracture co-management

20%

Cognitive Disorders: Delirium and Dementia

CAM/4AT, predisposing vs precipitating factors; AD, vascular, LBD, FTD; cholinesterase inhibitors, memantine; anti-amyloid mAbs (lecanemab Jan 2023, donanemab Jul 2024), ARIA-E/ARIA-H, APOE ε4 homozygosity; BPSD (non-pharm first, citalopram, brexpiprazole Rexulti 2023)

15%

Polypharmacy, Beers, STOPP/START

2023 AGS Beers criteria (benzos, anticholinergics, H1 antihistamines, NSAIDs, glyburide, chronic PPI), STOPP/START, geriatric PK changes, anticholinergic burden, DOAC renal dosing (apixaban rule)

12%

Geriatric Syndromes

NPIAP pressure-injury staging and Braden; urge/stress/overflow/functional incontinence; presbycusis + OTC hearing aids, AMD, glaucoma, cataract; MEALS ON WHEELS, MNA, weight-loss workup

Mental Health, Preventive Care, and Vaccination

Depression (PHQ-9, GDS, sertraline/escitalopram), suicide risk (older white men, C-SSRS), AWV cognitive screening CPT 99483; high-dose/adjuvanted influenza ≥65, RSV ≥75, PCV20/PCV21, recombinant zoster ≥50

End-of-Life Care and Care Models

Palliative vs hospice, Medicare Hospice Benefit, POLST/MOLST, capacity (Appelbaum), MAID, double effect, palliative sedation; elder mistreatment and mandated APS reporting; PACE, hospital at home, SNF vs IRF, ACE units

How to Pass the ABIM Geriatric Medicine Exam

What You Need to Know

Passing score: Criterion-referenced (absolute standard)
Exam length: 220 questions
Time limit: 1-day computer-based exam (approximately 10 hours on-site)
Exam fee: ~$2,500 ABIM registration fee (plus annual MOC fee)

Keys to Passing

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

ABIM Geriatric Medicine Study Tips from Top Performers

1Memorize the 5 Fried frailty criteria — unintentional weight loss, exhaustion, weakness (grip), slow gait, low activity; 3 of 5 = frail, 1-2 = pre-frail. Also know TUG ≥12s and gait speed <0.8 m/s as standard mobility cut-offs applicable in ambulatory IM clinics

2Know anti-amyloid monoclonal antibodies cold — lecanemab (FDA accelerated Jan 2023, traditional Jul 2023) and donanemab (FDA approval Jul 2024) both for early AD (MCI or mild dementia); require baseline + serial MRI for ARIA, APOE ε4 homozygosity raises ARIA risk, anticoagulation is a strong caution

32023 AGS Beers criteria high-yield classes to avoid in internists' patients: long-acting benzos, first-gen antihistamines (diphenhydramine, hydroxyzine), TCAs, glyburide, skeletal muscle relaxants, oxybutynin, and PPIs >8 weeks without indication — always cross-check the anticholinergic burden

4NPIAP staging: Stage 1 (non-blanchable erythema, intact skin); Stage 2 (partial-thickness, exposed dermis); Stage 3 (full-thickness + fat); Stage 4 (bone/muscle/tendon exposed); DTPI (non-blanchable purple discoloration); Unstageable (obscured by eschar/slough) — do NOT debride stable dry heel eschar

5Deprescribe aggressively in frail elders admitted to medicine services: relax HbA1c to 7.5-8.5%, avoid tight BP targets, stop statins if life expectancy <1 year, stop PPIs after 8 weeks if no indication, trial non-pharm first for BPSD and insomnia, apply STOPP/START at least annually

Frequently Asked Questions

What is the ABIM Geriatric Medicine subspecialty certification?

The Geriatric Medicine Subspecialty Certification is a credential offered by the American Board of Internal Medicine jointly with the American Board of Family Medicine. The same examination is used by both boards, and candidates register through their primary board. It recognizes internists with advanced expertise in the care of older adults across hospitalist, ambulatory, nursing home, and palliative care settings.

Who is eligible to take the ABIM Geriatric Medicine exam?

Candidates must maintain continuous primary certification in Internal Medicine (ABIM) in good standing, hold a valid unrestricted US medical license, and complete a minimum 12 months of full-time training in an ACGME-accredited Geriatric Medicine fellowship. The fellowship program director must attest to clinical competence. Family medicine physicians take the same exam through ABFM.

What is the format of the ABIM Geriatric Medicine exam?

The subspecialty exam is a single-day computer-based test delivered at Pearson VUE testing centers. It consists of up to approximately 220 single-best-answer multiple-choice questions organized into timed blocks with scheduled breaks (roughly 10 hours on-site total). A criterion-referenced (absolute) passing standard is applied — performance does not depend on other candidates.

How much does the ABIM Geriatric Medicine exam cost?

The initial ABIM registration fee is approximately $2,500. Once certified, diplomates pay an annual MOC fee and continuously maintain their primary Internal Medicine certification. Certification can be maintained via a 10-year recertification examination OR the Longitudinal Knowledge Assessment (LKA).

What topics are on the ABIM Geriatric Medicine exam?

Content covers frailty and functional assessment (~20%), falls and osteoporosis (~18%), delirium and dementia (~20%), polypharmacy and Beers/STOPP-START (~15%), geriatric syndromes (pressure injuries, incontinence, sensory, nutrition — ~12%), mental health, preventive care and vaccination (~7%), and end-of-life care and care models (~8%). Expect detailed questions on anti-amyloid monoclonal antibodies (lecanemab, donanemab), 2023 AGS Beers updates, DOAC renal dosing, and current ACIP recommendations for older adults.

How should I prepare for the ABIM Geriatric Medicine exam?

Use a structured board-review resource (Geriatric Review Syllabus/GRS, AGS Beers Pocket Card, UpToDate, ACP's MKSAP Geriatric Medicine module). Memorize Fried criteria, EWGSOP2 sarcopenia, CAM/4AT, NPIAP staging, FRAX thresholds, and 2023 Beers cold. Know the anti-amyloid mAbs (approval dates, ARIA monitoring, APOE ε4 caveats). Practice high-volume MCQ banks covering all 7 content domains and review Medicare benefits (hospice, PACE, AWV, CPT 99483).

Is the ABIM Geriatric Medicine exam the same as the ABFM exam?

Yes. ABIM and ABFM jointly sponsor a single Geriatric Medicine examination. Internists register through ABIM and family physicians register through ABFM, but both sit for the identical content, blueprint, and standards. This is why candidates commonly use board-review materials published for both ABIM and ABFM.

How long is ABIM Geriatric Medicine certification valid?

Certification is maintained on a 10-year MOC cycle. Diplomates maintain certification by continuously maintaining their primary ABIM Internal Medicine certification, paying annual MOC fees, and passing either a traditional 10-year recertification exam OR the Longitudinal Knowledge Assessment (LKA), which delivers questions over multi-year cycles.