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Physician Board Certification

ABIM Geriatric Medicine Initial Certification Examination Practice Test

Geriatric medicine applies clinical reasoning to health conditions shaped by aging, frailty, cognition, function, and living circumstances. Practice scenarios cover problems such as falls and fractures, memory change, dementia-related safety, medication-related concerns, acute illness, and chronic disease. They also involve recognizing changes in activities of daily living and matching care plans to an older adult’s goals and support needs.

Exam overview

Exam providerAmerican Board of Internal Medicine
Exam codeNot listed
CategoryPhysician Board Certification

About the ABIM Geriatric Medicine Initial Certification Examination Exam

Clinical decisions in older adults often require weighing immediate medical risks against function, safety, independence, and treatment burden. Scenarios may ask you to distinguish reversible contributors to cognitive decline from progressive impairment, identify urgent complications such as venous thromboembolism, and manage abnormalities such as hyponatremia without unsafe correction. Other tasks include preventing additional fractures and pressure-related skin damage, assessing fluid overload in heart failure, and identifying when occupational therapy or home-based support can help with daily activities. Dementia care may call for practical risk reduction while preserving autonomy. Advance care planning connects a patient’s stated preferences with decisions about future deterioration and hospitalization. Across these situations, focus on changes from baseline, severity, likely causes, safety, and the patient’s priorities.

Sample Practice Questions

Review a selection from this exam's published US Practice Tests practice bank.

Question 1

An 84-year-old with osteoporosis sustains a low-trauma vertebral fracture. Which intervention is most appropriate to reduce risk of another fracture, assuming no contraindication?

  1. ATreat osteoporosis with an evidence-based pharmacologic agent and address calcium, vitamin D, and fall risk
  2. BUse calcium supplements alone as definitive treatment
  3. CWait for a second fracture before considering treatment
  4. DRecommend strict bed rest to protect the spine
Show answerCorrect answer: A

A fragility fracture indicates high future fracture risk and warrants osteoporosis treatment in addition to attention to adequate calcium and vitamin D intake and modifiable fall risks. Supplements alone are generally insufficient treatment for a patient at this level of risk, and bed rest can worsen deconditioning.

Question 2

A 79-year-old reports a gradual decline in memory over 18 months. Which feature most strongly supports evaluating for a reversible contributor before attributing the change solely to a neurodegenerative disorder?

  1. AThe change has progressed gradually over more than a year
  2. BThe patient takes a medication with known cognitive adverse effects
  3. CThe patient remains independent in basic self-care
  4. DA first-degree relative had dementia
Show answerCorrect answer: B

Medication review is an important part of assessing cognitive change because some drugs can worsen cognition and may be modifiable contributors. A medication effect does not exclude an underlying neurodegenerative disorder, but it should be considered in the evaluation.

Question 3

An 85-year-old with moderate dementia has a history of wandering and now lives alone. A neighbor reports that the patient left the stove on twice. Which response best addresses immediate safety while respecting the patient’s needs?

  1. ARecommend moving directly to a nursing facility without further assessment
  2. BAssess decision-making capacity and home risks, then involve the patient and appropriate supports in a safety plan
  3. CTell the neighbor to supervise the patient without discussing the plan with the patient
  4. DAdvise the patient to stop cooking and avoid all activities at home
Show answerCorrect answer: B

Safety concerns call for an individualized assessment of the specific risks, the person’s capacity for relevant decisions, preferences, and available supports. A collaborative plan may include supervision, stove-safety measures, or additional services. The least restrictive safe approach is preferable to blanket restrictions or an automatic change in living arrangement.

Question 4

A 74-year-old with reduced mobility has a new unilateral swollen calf and sudden shortness of breath. What is the most appropriate next step?

  1. AArrange urgent medical evaluation for a potentially serious thromboembolic event
  2. BRecommend calf massage and observe for a week
  3. CStart a routine walking program before further evaluation
  4. DReassure the patient that these symptoms are expected with aging
Show answerCorrect answer: A

Unilateral calf swelling together with sudden shortness of breath raises concern for venous thromboembolism, including pulmonary embolism, which requires urgent evaluation. Massage or delay could be harmful, and these symptoms should not be attributed to aging.

Question 5

An 82-year-old with advanced dementia has lost the ability to walk and now needs help with dressing and bathing. Which term best describes these newly required tasks?

  1. AInstrumental activities of daily living
  2. BBasic activities of daily living
  3. CExecutive functions
  4. DSocial cognition
Show answerCorrect answer: B

Walking, dressing, bathing, toileting, transferring, continence, and feeding are commonly classified as basic activities of daily living. Instrumental activities include more complex tasks such as shopping, cooking, transportation, and managing finances.

Question 6

An 81-year-old who lives alone is discharged after an acute illness. The patient has lost strength and is unsure how to bathe and prepare meals safely, but wants to return home. Which service is most directly suited to assessing and improving performance of these daily tasks at home?

  1. AHome-based occupational therapy
  2. BA routine outpatient dermatology visit
  3. CA sleep study performed in a laboratory
  4. DA screening colonoscopy
Show answerCorrect answer: A

Occupational therapy can assess function in the person’s actual home environment and address bathing, meal preparation, transfers, equipment needs, and task adaptations. Home-based assessment is especially relevant when safety and function in daily activities are the main concerns.

Question 7

A 78-year-old has a serum sodium of 126 mmol/L discovered during evaluation of fatigue. The patient is alert, has no seizures or severe neurologic symptoms, and the duration is uncertain. Which general management principle is most appropriate?

  1. ACorrect the sodium rapidly to the normal range with hypertonic saline
  2. BDetermine the likely cause and correct sodium cautiously with monitoring
  3. CRestrict all dietary sodium and avoid repeat laboratory testing
  4. DTreat with a loop diuretic regardless of volume status
Show answerCorrect answer: B

For chronic or duration-uncertain hyponatremia without severe symptoms, management should address the cause and avoid overly rapid correction, which can cause osmotic demyelination. The appropriate fluid strategy depends on the underlying mechanism and volume status.

How to use this practice test

The free practice bank contains 50 questions; each session presents up to 20 random questions. Use a session to work through geriatric clinical scenarios, then review the results to identify areas for closer study, such as cognition, functional assessment, acute complications, or care planning.

Preparation tips

  • For memory-change cases, organize the differential around onset and course, medication effects, delirium, mood, and other potentially reversible contributors.
  • Practice separating basic and instrumental activities of daily living, and connect functional losses to appropriate home services or safety interventions.
  • Review immediate assessment priorities for older adults with unilateral leg swelling and sudden dyspnea, including concern for venous thromboembolism.
  • For frailty-related prevention, connect osteoporosis and low-trauma fracture history with secondary fracture prevention, and immobility with pressure-injury prevention.
  • Work through heart failure and hyponatremia scenarios by assessing severity, volume status, neurologic symptoms, and the patient’s goals before choosing next steps.
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