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Physician Board Certification

ABIM Infectious Disease Initial Certification Examination Practice Test

Infectious disease practice spans bacterial, viral, fungal, and parasitic illnesses, with decisions shaped by infection site, severity, host factors, and microbiology. The available questions feature urinary infections, syphilis, skin abscesses, device-associated infections, tuberculosis, malaria, and infections in people with HIV or other immunosuppression.

Exam overview

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

About the ABIM Infectious Disease Initial Certification Examination Exam

Clinical reasoning in infectious disease connects a patient’s presentation to likely pathogens, diagnostic tests, and treatment urgency. Questions may ask you to interpret culture and susceptibility results, distinguish colonization or latent infection from active disease, and choose antimicrobial therapy that accounts for resistance, infection site, severity, and route of administration. Other decisions include source control for abscesses, management of prosthetic-device infections, catheter assessment in candidemia, and prevention of severe parasitic disease before immunosuppression. Work through each case by identifying immediate threats, relevant host risks, and the evidence that changes treatment; then consider drug selection, duration, and follow-up where the scenario provides enough information. These skills reflect common infectious disease consultations in inpatient and outpatient care, including antimicrobial stewardship and coordination of diagnostic testing.

Sample Practice Questions

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

Question 1

A 24-year-old woman has acute dysuria and urinary frequency without fever, flank pain, or vaginal symptoms. Urinalysis is consistent with cystitis. She is not pregnant and has normal renal function. Which is an appropriate first-line oral treatment option?

  1. ANitrofurantoin for 5 days
  2. BNitrofurantoin for 1 day
  3. CA single dose of intravenous cefepime
  4. DOral vancomycin for 10 days
Show answerCorrect answer: A

Nitrofurantoin 100 mg orally twice daily for 5 days is a standard option for uncomplicated acute cystitis in an appropriate patient. It is not suitable for suspected pyelonephritis because it does not reach adequate renal tissue concentrations.

Question 2

A 67-year-old woman develops fever and flank pain. Urine and blood cultures grow Escherichia coli that produces an extended-spectrum beta-lactamase. The isolate is susceptible to meropenem. She is hospitalized with pyelonephritis and bacteremia. Which antimicrobial approach is most appropriate initially?

  1. AIntravenous meropenem
  2. BOral amoxicillin-clavulanate
  3. CIntravenous ceftriaxone
  4. DOral nitrofurantoin
Show answerCorrect answer: A

A carbapenem such as meropenem is an appropriate initial treatment for serious ESBL-producing Enterobacterales infection, including bacteremic pyelonephritis, when the isolate is susceptible. Nitrofurantoin does not achieve adequate serum or renal parenchymal concentrations for pyelonephritis or bacteremia.

Question 3

A 41-year-old woman with HIV who recently moved from a region where Strongyloides is endemic is being evaluated before starting high-dose corticosteroids for an autoimmune condition. She has no gastrointestinal symptoms or eosinophilia. Which approach is most appropriate to reduce the risk of severe disease associated with immunosuppression?

  1. AScreen for Strongyloides infection and treat if present before immunosuppression when feasible
  2. BBegin empiric fluconazole prophylaxis
  3. CDefer all evaluation unless diarrhea develops
  4. DGive a single dose of praziquantel without testing
Show answerCorrect answer: A

Strongyloides can persist for decades, and corticosteroid exposure can precipitate life-threatening hyperinfection. In people with relevant epidemiologic exposure who are about to receive substantial immunosuppression, screening and treatment of infection when feasible are important; absence of eosinophilia or symptoms does not reliably exclude infection.

Question 4

A 33-year-old man has a painless genital ulcer that resolved without treatment several weeks ago. He now has a positive nontreponemal test and a positive treponemal test, with no neurologic, ocular, or auditory symptoms. He has no documented prior syphilis treatment. Which treatment is appropriate when the duration of infection cannot be established?

  1. AOne dose of intramuscular benzathine penicillin G
  2. BIntramuscular benzathine penicillin G once weekly for three doses
  3. COral doxycycline for 7 days
  4. DIntravenous aqueous penicillin G for 14 days
Show answerCorrect answer: B

When syphilis is of unknown duration and there is no evidence of neurosyphilis or another manifestation requiring a different regimen, treatment is benzathine penicillin G weekly for three doses. A single dose is used for early syphilis; the history here does not establish that the infection is early.

Question 5

A 70-year-old woman with diabetes has fever and a fluctuant abscess on her forearm. She is otherwise stable, and there is no surrounding extensive cellulitis. What is the most important initial treatment for an uncomplicated cutaneous abscess?

  1. AIncision and drainage
  2. BTopical mupirocin alone
  3. CSystemic antifungal therapy
  4. DImmediate wide excision of all surrounding skin
Show answerCorrect answer: A

Incision and drainage is the key treatment for a localized cutaneous abscess because it provides source control. Whether adjunctive antibiotics are needed depends on features such as systemic illness, lesion extent, host factors, and risk for resistant organisms.

Question 6

A patient with a prosthetic joint infection has debridement and retention of the implant. Cultures grow methicillin-susceptible Staphylococcus aureus. Which statement about antimicrobial management is most accurate?

  1. AA rifampin-containing combination is often considered because of activity against staphylococcal biofilm
  2. BRifampin should be used alone to prevent resistance
  3. CAntibiotics have no role after surgical debridement
  4. DA single dose of an aminoglycoside is definitive treatment
Show answerCorrect answer: A

For selected staphylococcal prosthetic joint infections managed with debridement and implant retention, rifampin may be used with another active agent because of its biofilm activity. It must not be used alone because resistance can emerge rapidly.

Question 7

A hospitalized patient develops fever and watery diarrhea after a course of clindamycin. Stool testing confirms Clostridioides difficile infection, and there is no hypotension, ileus, or megacolon. Which treatment is preferred?

  1. AOral vancomycin or fidaxomicin
  2. BIntravenous vancomycin alone
  3. COral metronidazole as first-line therapy in all cases
  4. DLoperamide without antimicrobial therapy
Show answerCorrect answer: A

For an initial episode of nonfulminant C. difficile infection, oral vancomycin or fidaxomicin is recommended. Intravenous vancomycin does not achieve adequate colonic concentrations, and antimotility therapy alone is inappropriate.

How to use this practice test

Access the free practice bank for up to 20 randomly selected questions per session from its 50 published questions. After completing a session, review the results to identify which clinical decisions need closer review, such as interpreting susceptibility data or selecting treatment for severe infection.

Preparation tips

  • For urinary infection cases, distinguish cystitis from pyelonephritis and bacteremia, then connect culture susceptibility and illness severity to antimicrobial choice.
  • Review syphilis staging and treatment decisions, including how an unknown duration changes management when prior treatment is undocumented.
  • Practice separating source control from antibiotic selection in abscesses, prosthetic-joint infections, and catheter-associated candidemia.
  • Compare latent and active tuberculosis evaluation, and review prevention strategies for Strongyloides risk before corticosteroid treatment.
  • Revisit severe malaria management, including how altered mental status and inability to take oral medication affect treatment route and urgency.
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