,ABIM exam COMPLETE EXAM QUESTIONS AND ANSWERS | ALREADY PASSED | 2025 LATEST!!
ABIM Exam Practice Questions for Study
1. A 68-year-old man with a history of COPD on home oxygen presents with 3 days of
increasing purulent sputum, dyspnea, and fever. Chest X-ray shows a new lobar infiltrate.
Sputum Gram stain shows numerous neutrophils with gram-positive diplococci. Which of the
following is the MOST appropriate initial antibiotic therapy?
A. Azithromycin alone
B. Vancomycin plus ceftriaxone
C. Piperacillin-tazobactam
D. Levofloxacin alone
2. A 55-year-old woman with rheumatoid arthritis on methotrexate presents with 2 weeks of
fatigue, jaundice, and confusion. ALT is 2,100 U/L, AST is 2,300 U/L, INR is 3.0. Acetaminophen
level is undetectable. Which of the following is the MOST likely diagnosis?
A. Autoimmune hepatitis
B. Acute hepatitis A infection
C. Methotrexate-induced hepatotoxicity
D. Acetaminophen toxicity secondary to unintentional ingestion
3. In a patient with newly diagnosed systolic heart failure (LVEF 30%) who is already on a low-
dose ACE inhibitor, which of the following medications, when added, has been shown to most
significantly reduce mortality?
A. Furosemide
B. Digoxin
C. A beta-blocker (carvedilol or metoprolol succinate)
D. Spironolactone
4. A 45-year-old asymptomatic man is found to have a serum calcium of 11.2 mg/dL (normal
8.5-10.2) on routine testing. Phosphorus is low-normal, and creatinine is normal. The next
most appropriate diagnostic step is:
A. Initiate hydration with normal saline
B. Order a serum parathyroid hormone (PTH) level
C. Obtain a 24-hour urine for calcium
D. Schedule a bone density scan (DEXA)
,5. A 72-year-old man with diabetes, hypertension, and stage 3b CKD (eGFR 38 mL/min) is
started on lisinopril. One week later, his creatinine rises to 2.1 mg/dL from a baseline of 1.5
mg/dL. The MOST appropriate management is:
A. Immediately stop the lisinopril and administer IV fluids
B. Continue the lisinopril and recheck creatinine in 1 week
C. Switch to an ARB (losartan)
D. Reduce the dose of lisinopril by half
What is a positive stress test - ANSWER Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - ANSWER St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - ANSWER Myocardial perfusion
imaging with adenosine,
NOT exercising!
When to not use doutamine for stress - ANSWER History of VT,
severe HTN,
Low BP,
poor echo images
, When to not use adenosine for stress - ANSWER Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
Normals for PA catheter pressures - ANSWER RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - ANSWER tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - ANSWER RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - ANSWER cardiogenic shock
high RA,
PA very elevated
ABIM Exam Practice Questions for Study
1. A 68-year-old man with a history of COPD on home oxygen presents with 3 days of
increasing purulent sputum, dyspnea, and fever. Chest X-ray shows a new lobar infiltrate.
Sputum Gram stain shows numerous neutrophils with gram-positive diplococci. Which of the
following is the MOST appropriate initial antibiotic therapy?
A. Azithromycin alone
B. Vancomycin plus ceftriaxone
C. Piperacillin-tazobactam
D. Levofloxacin alone
2. A 55-year-old woman with rheumatoid arthritis on methotrexate presents with 2 weeks of
fatigue, jaundice, and confusion. ALT is 2,100 U/L, AST is 2,300 U/L, INR is 3.0. Acetaminophen
level is undetectable. Which of the following is the MOST likely diagnosis?
A. Autoimmune hepatitis
B. Acute hepatitis A infection
C. Methotrexate-induced hepatotoxicity
D. Acetaminophen toxicity secondary to unintentional ingestion
3. In a patient with newly diagnosed systolic heart failure (LVEF 30%) who is already on a low-
dose ACE inhibitor, which of the following medications, when added, has been shown to most
significantly reduce mortality?
A. Furosemide
B. Digoxin
C. A beta-blocker (carvedilol or metoprolol succinate)
D. Spironolactone
4. A 45-year-old asymptomatic man is found to have a serum calcium of 11.2 mg/dL (normal
8.5-10.2) on routine testing. Phosphorus is low-normal, and creatinine is normal. The next
most appropriate diagnostic step is:
A. Initiate hydration with normal saline
B. Order a serum parathyroid hormone (PTH) level
C. Obtain a 24-hour urine for calcium
D. Schedule a bone density scan (DEXA)
,5. A 72-year-old man with diabetes, hypertension, and stage 3b CKD (eGFR 38 mL/min) is
started on lisinopril. One week later, his creatinine rises to 2.1 mg/dL from a baseline of 1.5
mg/dL. The MOST appropriate management is:
A. Immediately stop the lisinopril and administer IV fluids
B. Continue the lisinopril and recheck creatinine in 1 week
C. Switch to an ARB (losartan)
D. Reduce the dose of lisinopril by half
What is a positive stress test - ANSWER Flat or Down sloping
St-segment depression >1 mm
occurring 80 msec after j point
When to stop a stress test - ANSWER St segment depression > 2 mm,
ventricular tachycardia,
drop in SBP > 15,
CP,
dyspnea,
lightheadedness
Stress test of choice with a LBBB or ventricular pacing? - ANSWER Myocardial perfusion
imaging with adenosine,
NOT exercising!
When to not use doutamine for stress - ANSWER History of VT,
severe HTN,
Low BP,
poor echo images
, When to not use adenosine for stress - ANSWER Bronchospasm,
severe valvular dysfunction,
severe carotid stenosis,
2nd degree heart block, t
heophylline dependent
Normals for PA catheter pressures - ANSWER RA <8
RV 30/8
PCWP 3-12
PAP 12--12
Diastolic pressures
elevated & equalized
in all chambers,
low BP - ANSWER tamponade
or restrictive pericarditis
Elevated RA and PA pressures,
decreased or nl PCWP,
hypotension - ANSWER RV MI
Elevated PCWP, RA pressure
decreased SBP/cardiac output - ANSWER cardiogenic shock
high RA,
PA very elevated
