ABIM INTERNAL MEDICINE ITE EXAM COMPLETE
PRACTICE QUESTIONS WITH 100% VERIFIED
ANSWERS AND EXPLANATIONS
1. A 67-year-old man presents with worsening dyspnea on exertion. His exam
reveals a prolonged expiratory phase and wheezing. What is the most likely
diagnosis?
(A) Pulmonary fibrosis
(B) Chronic obstructive pulmonary disease (COPD)
(C) Heart failure
(D) Asthma
Correct Answer: B
Rationale: Age, dyspnea, prolonged expiratory phase, and wheezing are classic for
COPD.
2. Which of the following is a common side effect of thiazide diuretics?
(A) Hypokalemia
(B) Hyperglycemia
(C) Hyponatremia
(D) Hyperkalemia
Correct Answer: A
Rationale: Thiazides cause hypokalemia by increasing distal tubular potassium
excretion.
,3. A 55-year-old woman presents with fatigue and pallor. Labs: Hb 8 g/dL, low
serum ferritin, low serum iron. Most likely diagnosis?
(A) Hemolytic anemia
(B) Anemia of chronic disease
(C) Iron deficiency anemia
(D) Aplastic anemia
Correct Answer: C
Rationale: Low ferritin and low serum iron confirm iron deficiency anemia.
4. In a patient with diabetes, what is the most appropriate target for HbA1c to
reduce the risk of complications?
(A) < 9.0%
(B) < 7.0%
(C) < 6.0%
(D) < 8.0%
Correct Answer: B
Rationale: HbA1c < 7.0% is the general ADA target to reduce
microvascular/macrovascular complications.
5. A 62-year-old male with a history of smoking presents with a new cough and
hemoptysis. A chest X-ray shows a mass in the right lung. What is the next best
step in management?
(A) CT scan of the chest
(B) Biopsy
(C) Observation
(D) Bronchoscopy
Correct Answer: A
Rationale: CT chest is warranted to further evaluate the mass before biopsy.
,6. What is the most common cause of secondary hypertension in adults?
(A) Pheochromocytoma
(B) Renal disease
(C) Primary hyperaldosteronism
(D) Cushing’s syndrome
Correct Answer: B
Rationale: Renal disease (especially CKD) is the most common cause of secondary
hypertension.
7. A 70-year-old woman is found to have a BP of 160/90 mmHg during a routine
visit. She has no other medical history. What is the most appropriate initial
treatment?
(A) Thiazide diuretic
(B) ACE inhibitor
(C) Diuretic (nonspecific)
(D) Beta-blocker
Correct Answer: A
Rationale: Thiazide diuretic is first-line for uncomplicated hypertension in older
adults.
8. What is the mechanism of action of metformin in the management of type 2
diabetes?
(A) Enhances peripheral glucose uptake
(B) Increases insulin secretion
(C) Decreases hepatic glucose production
(D) Increases intestinal glucose absorption
Correct Answer: C
Rationale: Metformin primarily decreases hepatic glucose production and
improves insulin sensitivity.
, 9. A patient presents with a 3-week history of fever, night sweats, and weight
loss. A chest X-ray reveals cavitary lesions in the upper lobes. What is the most
likely diagnosis?
(A) Sarcoidosis
(B) Tuberculosis
(C) Lung cancer
(D) Fungal infection
Correct Answer: B
Rationale: Symptoms + upper lobe cavitary lesions are highly suggestive of
pulmonary tuberculosis.
10. Which of the following findings is most consistent with a diagnosis of heart
failure with preserved ejection fraction (HFpEF)?
(A) S3 gallop
(B) Left ventricular hypertrophy
(C) Reduced ejection fraction
(D) Pulmonary congestion
Correct Answer: B
Rationale: HFpEF is associated with LV hypertrophy and diastolic dysfunction;
ejection fraction is preserved.
11. A 45-year-old woman presents with a butterfly rash on her face, joint pain,
and fatigue. What is the most likely diagnosis?
(A) Systemic lupus erythematosus (SLE)
(B) Psoriasis
(C) Dermatomyositis
(D) Sjögren's syndrome
Correct Answer: A
Rationale: Butterfly rash + systemic symptoms are classic for SLE.
PRACTICE QUESTIONS WITH 100% VERIFIED
ANSWERS AND EXPLANATIONS
1. A 67-year-old man presents with worsening dyspnea on exertion. His exam
reveals a prolonged expiratory phase and wheezing. What is the most likely
diagnosis?
(A) Pulmonary fibrosis
(B) Chronic obstructive pulmonary disease (COPD)
(C) Heart failure
(D) Asthma
Correct Answer: B
Rationale: Age, dyspnea, prolonged expiratory phase, and wheezing are classic for
COPD.
2. Which of the following is a common side effect of thiazide diuretics?
(A) Hypokalemia
(B) Hyperglycemia
(C) Hyponatremia
(D) Hyperkalemia
Correct Answer: A
Rationale: Thiazides cause hypokalemia by increasing distal tubular potassium
excretion.
,3. A 55-year-old woman presents with fatigue and pallor. Labs: Hb 8 g/dL, low
serum ferritin, low serum iron. Most likely diagnosis?
(A) Hemolytic anemia
(B) Anemia of chronic disease
(C) Iron deficiency anemia
(D) Aplastic anemia
Correct Answer: C
Rationale: Low ferritin and low serum iron confirm iron deficiency anemia.
4. In a patient with diabetes, what is the most appropriate target for HbA1c to
reduce the risk of complications?
(A) < 9.0%
(B) < 7.0%
(C) < 6.0%
(D) < 8.0%
Correct Answer: B
Rationale: HbA1c < 7.0% is the general ADA target to reduce
microvascular/macrovascular complications.
5. A 62-year-old male with a history of smoking presents with a new cough and
hemoptysis. A chest X-ray shows a mass in the right lung. What is the next best
step in management?
(A) CT scan of the chest
(B) Biopsy
(C) Observation
(D) Bronchoscopy
Correct Answer: A
Rationale: CT chest is warranted to further evaluate the mass before biopsy.
,6. What is the most common cause of secondary hypertension in adults?
(A) Pheochromocytoma
(B) Renal disease
(C) Primary hyperaldosteronism
(D) Cushing’s syndrome
Correct Answer: B
Rationale: Renal disease (especially CKD) is the most common cause of secondary
hypertension.
7. A 70-year-old woman is found to have a BP of 160/90 mmHg during a routine
visit. She has no other medical history. What is the most appropriate initial
treatment?
(A) Thiazide diuretic
(B) ACE inhibitor
(C) Diuretic (nonspecific)
(D) Beta-blocker
Correct Answer: A
Rationale: Thiazide diuretic is first-line for uncomplicated hypertension in older
adults.
8. What is the mechanism of action of metformin in the management of type 2
diabetes?
(A) Enhances peripheral glucose uptake
(B) Increases insulin secretion
(C) Decreases hepatic glucose production
(D) Increases intestinal glucose absorption
Correct Answer: C
Rationale: Metformin primarily decreases hepatic glucose production and
improves insulin sensitivity.
, 9. A patient presents with a 3-week history of fever, night sweats, and weight
loss. A chest X-ray reveals cavitary lesions in the upper lobes. What is the most
likely diagnosis?
(A) Sarcoidosis
(B) Tuberculosis
(C) Lung cancer
(D) Fungal infection
Correct Answer: B
Rationale: Symptoms + upper lobe cavitary lesions are highly suggestive of
pulmonary tuberculosis.
10. Which of the following findings is most consistent with a diagnosis of heart
failure with preserved ejection fraction (HFpEF)?
(A) S3 gallop
(B) Left ventricular hypertrophy
(C) Reduced ejection fraction
(D) Pulmonary congestion
Correct Answer: B
Rationale: HFpEF is associated with LV hypertrophy and diastolic dysfunction;
ejection fraction is preserved.
11. A 45-year-old woman presents with a butterfly rash on her face, joint pain,
and fatigue. What is the most likely diagnosis?
(A) Systemic lupus erythematosus (SLE)
(B) Psoriasis
(C) Dermatomyositis
(D) Sjögren's syndrome
Correct Answer: A
Rationale: Butterfly rash + systemic symptoms are classic for SLE.
