ABIM IM BOARDS ITE 2027 LATEST EXAM UPDATE
REAL QUESTIONS AND VERIFIED ANSWERS
|INTERNAL MEDICINE PREP|ALREADY GRADED A+
GUARANTEED PASS (MOST RECENT!!!)
Cardiology
1. A 68-year-old man with hypertension and diabetes presents with exertional dyspnea.
Echocardiography reveals concentric left ventricular hypertrophy, normal ejection fraction, and
impaired relaxation. BNP is mildly elevated. Which finding most strongly supports the diagnosis of
heart failure with preserved ejection fraction (HFpEF)?
A. Reduced left ventricular end-diastolic volume
B. Elevated pulmonary capillary wedge pressure during exercise
C. QRS prolongation on ECG
D. Reduced stroke volume at rest
E. Global hypokinesis on echocardiography
Answer: B
Rationale: HFpEF is characterized by normal systolic function but impaired diastolic filling. Hemodynamic
testing often reveals elevated filling pressures during exertion, even when resting pressures are normal .
2. A 72-year-old woman presents with syncope. ECG shows sinus rhythm with intermittent dropped
QRS complexes without PR prolongation. Which conduction abnormality is most likely?
A. First-degree AV block
B. Mobitz I (Wenckebach)
C. Mobitz II AV block
D. Complete heart block
E. Sinus arrest
Answer: C
Rationale: Mobitz II is characterized by intermittent non-conducted P waves without progressive PR
prolongation and carries a high risk of progression to complete heart block, often causing syncope .
3. A 55-year-old man with a history of an anterior wall MI presents with progressive dyspnea.
Echocardiography reveals an ejection fraction of 25% with anteroapical akinesis. In addition to ACE
inhibitor and beta-blocker therapy, which medication has been shown to reduce mortality in this
population?
A. Digoxin
1|Page
,B. Spironolactone
C. Amiodarone
D. Diltiazem
E. Hydralazine
Answer: B
Rationale: Spironolactone (an aldosterone antagonist) reduces mortality in patients with NYHA class III-
IV heart failure and EF ≤35% when added to standard therapy. This is based on the RALES trial.
4. A 60-year-old woman with hypertension and hyperlipidemia presents with sudden onset of severe
chest pain radiating to the back. The pain is described as tearing. Blood pressure is 180/100 in the
right arm and 110/70 in the left arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Acute pericarditis
E. Esophageal rupture
Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing chest pain radiating to the
back, with blood pressure differential between arms. Hypertensive patients are at highest risk.
5. A 48-year-old man is found to have a blood pressure of 152/96 mm Hg on three separate occasions.
He has no symptoms, and his physical exam is unremarkable. Laboratory studies show normal renal
function and electrolytes. Which initial medication would be most appropriate for this patient?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
E. Any of the above are appropriate initial choices
Answer: E
Rationale: According to JNC 8 and recent guidelines, initial antihypertensive therapy can include a
thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker. The choice depends on patient
characteristics and comorbidities.
Pulmonology
6. A 55-year-old woman with progressive dyspnea has pulmonary function tests showing reduced TLC,
reduced DLCO, and a normal FEV1/FVC ratio. HRCT demonstrates subpleural reticulation and
honeycombing. What is the most likely diagnosis?
A. Hypersensitivity pneumonitis
B. Sarcoidosis
C. Idiopathic pulmonary fibrosis
D. Chronic eosinophilic pneumonia
E. Bronchiolitis obliterans
2|Page
,Answer: C
Rationale: Subpleural reticulation with honeycombing and restrictive physiology is classic for idiopathic
pulmonary fibrosis (UIP pattern) .
7. A 67-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and
chronic cough with scant sputum. Pulmonary function tests show FEV1/FVC < 0.70 and FEV1 45% of
predicted. Which medication is most likely to reduce his exacerbation frequency?
A. Inhaled albuterol as needed
B. Long-acting beta-agonist (LABA)
C. Long-acting muscarinic antagonist (LAMA)
D. LAMA/LABA combination
E. Inhaled corticosteroid alone
Answer: D
Rationale: LAMA/LABA combination therapy reduces exacerbations and improves lung function more
than monotherapy in COPD. Triple therapy (ICS/LAMA/LABA) is recommended for patients with frequent
exacerbations and high blood eosinophil counts.
8. A 32-year-old woman presents with episodic wheezing, chest tightness, and cough that occurs at
night and with exercise. She has a history of allergic rhinitis. Spirometry shows FEV1/FVC of 75%, and
FEV1 improves by 14% after bronchodilator. What is the most appropriate initial treatment?
A. Montelukast
B. Inhaled corticosteroids (ICS)
C. ICS/LABA combination
D. Oral prednisone burst
E. Short-acting beta-agonist (SABA) as needed only
Answer: B
Rationale: ICS is the preferred initial controller therapy for patients with persistent asthma. SABA alone is
insufficient for persistent symptoms.
9. A 45-year-old woman with a history of breast cancer treated with radiation 10 years ago presents
with progressive dyspnea and dry cough. PFTs show restrictive pattern with low DLCO. HRCT shows
ground-glass opacities with traction bronchiectasis. Which diagnosis is most likely?
A. Radiation pneumonitis
B. Idiopathic pulmonary fibrosis
C. Sarcoidosis
D. Drug-induced lung disease
E. Hypersensitivity pneumonitis
Answer: A
Rationale: Radiation pneumonitis can occur months to years after thoracic radiation and presents with
progressive dyspnea, cough, and radiographic findings in the radiation field.
10. A 28-year-old woman presents with acute onset of pleuritic chest pain and dyspnea. She is taking
oral contraceptives. Spiral CT angiography reveals a filling defect in a segmental pulmonary artery.
Which finding is most associated with an underlying thrombophilia?
3|Page
, A. Antiphospholipid antibodies
B. Factor V Leiden mutation
C. Prothrombin gene mutation
D. Protein C deficiency
E. All of the above
Answer: E
Rationale: All listed are inherited or acquired thrombophilias that increase risk of venous
thromboembolism in young patients, especially with additional risk factors like OCP use.
Gastroenterology
11. A 42-year-old man presents with chronic diarrhea, weight loss, and iron-deficiency anemia.
Duodenal biopsy reveals villous atrophy and crypt hyperplasia. Which additional finding is most
likely?
A. Positive anti-mitochondrial antibodies
B. Elevated fecal calprotectin
C. IgA anti-tissue transglutaminase antibodies
D. Elevated gastrin level
E. Decreased pancreatic elastase
Answer: C
Rationale: Villous atrophy and crypt hyperplasia with iron-deficiency anemia are classic for celiac
disease. IgA anti-tissue transglutaminase is the most sensitive and specific serologic test .
12. A cirrhotic patient presents with confusion and asterixis. Which treatment is first-line?
A. Rifaximin alone
B. Lactulose
C. Neomycin
D. Protein restriction
E. IV antibiotics
Answer: B
Rationale: Lactulose is first-line therapy for hepatic encephalopathy, reducing ammonia absorption by
acidifying the gut .
13. A 58-year-old man with a history of GERD presents with progressive dysphagia to solids. Upper
endoscopy reveals a distal esophageal stricture. Biopsies show columnar epithelium with intestinal
metaplasia. Which finding would place this patient at highest risk for progression to esophageal
adenocarcinoma?
A. Low-grade dysplasia
B. High-grade dysplasia
C. Long-segment Barrett's esophagus
D. PPI-refractory symptoms
E. Family history of esophageal cancer
4|Page
REAL QUESTIONS AND VERIFIED ANSWERS
|INTERNAL MEDICINE PREP|ALREADY GRADED A+
GUARANTEED PASS (MOST RECENT!!!)
Cardiology
1. A 68-year-old man with hypertension and diabetes presents with exertional dyspnea.
Echocardiography reveals concentric left ventricular hypertrophy, normal ejection fraction, and
impaired relaxation. BNP is mildly elevated. Which finding most strongly supports the diagnosis of
heart failure with preserved ejection fraction (HFpEF)?
A. Reduced left ventricular end-diastolic volume
B. Elevated pulmonary capillary wedge pressure during exercise
C. QRS prolongation on ECG
D. Reduced stroke volume at rest
E. Global hypokinesis on echocardiography
Answer: B
Rationale: HFpEF is characterized by normal systolic function but impaired diastolic filling. Hemodynamic
testing often reveals elevated filling pressures during exertion, even when resting pressures are normal .
2. A 72-year-old woman presents with syncope. ECG shows sinus rhythm with intermittent dropped
QRS complexes without PR prolongation. Which conduction abnormality is most likely?
A. First-degree AV block
B. Mobitz I (Wenckebach)
C. Mobitz II AV block
D. Complete heart block
E. Sinus arrest
Answer: C
Rationale: Mobitz II is characterized by intermittent non-conducted P waves without progressive PR
prolongation and carries a high risk of progression to complete heart block, often causing syncope .
3. A 55-year-old man with a history of an anterior wall MI presents with progressive dyspnea.
Echocardiography reveals an ejection fraction of 25% with anteroapical akinesis. In addition to ACE
inhibitor and beta-blocker therapy, which medication has been shown to reduce mortality in this
population?
A. Digoxin
1|Page
,B. Spironolactone
C. Amiodarone
D. Diltiazem
E. Hydralazine
Answer: B
Rationale: Spironolactone (an aldosterone antagonist) reduces mortality in patients with NYHA class III-
IV heart failure and EF ≤35% when added to standard therapy. This is based on the RALES trial.
4. A 60-year-old woman with hypertension and hyperlipidemia presents with sudden onset of severe
chest pain radiating to the back. The pain is described as tearing. Blood pressure is 180/100 in the
right arm and 110/70 in the left arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Acute pericarditis
E. Esophageal rupture
Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing chest pain radiating to the
back, with blood pressure differential between arms. Hypertensive patients are at highest risk.
5. A 48-year-old man is found to have a blood pressure of 152/96 mm Hg on three separate occasions.
He has no symptoms, and his physical exam is unremarkable. Laboratory studies show normal renal
function and electrolytes. Which initial medication would be most appropriate for this patient?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
E. Any of the above are appropriate initial choices
Answer: E
Rationale: According to JNC 8 and recent guidelines, initial antihypertensive therapy can include a
thiazide diuretic, ACE inhibitor, ARB, or calcium channel blocker. The choice depends on patient
characteristics and comorbidities.
Pulmonology
6. A 55-year-old woman with progressive dyspnea has pulmonary function tests showing reduced TLC,
reduced DLCO, and a normal FEV1/FVC ratio. HRCT demonstrates subpleural reticulation and
honeycombing. What is the most likely diagnosis?
A. Hypersensitivity pneumonitis
B. Sarcoidosis
C. Idiopathic pulmonary fibrosis
D. Chronic eosinophilic pneumonia
E. Bronchiolitis obliterans
2|Page
,Answer: C
Rationale: Subpleural reticulation with honeycombing and restrictive physiology is classic for idiopathic
pulmonary fibrosis (UIP pattern) .
7. A 67-year-old man with a 40-pack-year smoking history presents with progressive dyspnea and
chronic cough with scant sputum. Pulmonary function tests show FEV1/FVC < 0.70 and FEV1 45% of
predicted. Which medication is most likely to reduce his exacerbation frequency?
A. Inhaled albuterol as needed
B. Long-acting beta-agonist (LABA)
C. Long-acting muscarinic antagonist (LAMA)
D. LAMA/LABA combination
E. Inhaled corticosteroid alone
Answer: D
Rationale: LAMA/LABA combination therapy reduces exacerbations and improves lung function more
than monotherapy in COPD. Triple therapy (ICS/LAMA/LABA) is recommended for patients with frequent
exacerbations and high blood eosinophil counts.
8. A 32-year-old woman presents with episodic wheezing, chest tightness, and cough that occurs at
night and with exercise. She has a history of allergic rhinitis. Spirometry shows FEV1/FVC of 75%, and
FEV1 improves by 14% after bronchodilator. What is the most appropriate initial treatment?
A. Montelukast
B. Inhaled corticosteroids (ICS)
C. ICS/LABA combination
D. Oral prednisone burst
E. Short-acting beta-agonist (SABA) as needed only
Answer: B
Rationale: ICS is the preferred initial controller therapy for patients with persistent asthma. SABA alone is
insufficient for persistent symptoms.
9. A 45-year-old woman with a history of breast cancer treated with radiation 10 years ago presents
with progressive dyspnea and dry cough. PFTs show restrictive pattern with low DLCO. HRCT shows
ground-glass opacities with traction bronchiectasis. Which diagnosis is most likely?
A. Radiation pneumonitis
B. Idiopathic pulmonary fibrosis
C. Sarcoidosis
D. Drug-induced lung disease
E. Hypersensitivity pneumonitis
Answer: A
Rationale: Radiation pneumonitis can occur months to years after thoracic radiation and presents with
progressive dyspnea, cough, and radiographic findings in the radiation field.
10. A 28-year-old woman presents with acute onset of pleuritic chest pain and dyspnea. She is taking
oral contraceptives. Spiral CT angiography reveals a filling defect in a segmental pulmonary artery.
Which finding is most associated with an underlying thrombophilia?
3|Page
, A. Antiphospholipid antibodies
B. Factor V Leiden mutation
C. Prothrombin gene mutation
D. Protein C deficiency
E. All of the above
Answer: E
Rationale: All listed are inherited or acquired thrombophilias that increase risk of venous
thromboembolism in young patients, especially with additional risk factors like OCP use.
Gastroenterology
11. A 42-year-old man presents with chronic diarrhea, weight loss, and iron-deficiency anemia.
Duodenal biopsy reveals villous atrophy and crypt hyperplasia. Which additional finding is most
likely?
A. Positive anti-mitochondrial antibodies
B. Elevated fecal calprotectin
C. IgA anti-tissue transglutaminase antibodies
D. Elevated gastrin level
E. Decreased pancreatic elastase
Answer: C
Rationale: Villous atrophy and crypt hyperplasia with iron-deficiency anemia are classic for celiac
disease. IgA anti-tissue transglutaminase is the most sensitive and specific serologic test .
12. A cirrhotic patient presents with confusion and asterixis. Which treatment is first-line?
A. Rifaximin alone
B. Lactulose
C. Neomycin
D. Protein restriction
E. IV antibiotics
Answer: B
Rationale: Lactulose is first-line therapy for hepatic encephalopathy, reducing ammonia absorption by
acidifying the gut .
13. A 58-year-old man with a history of GERD presents with progressive dysphagia to solids. Upper
endoscopy reveals a distal esophageal stricture. Biopsies show columnar epithelium with intestinal
metaplasia. Which finding would place this patient at highest risk for progression to esophageal
adenocarcinoma?
A. Low-grade dysplasia
B. High-grade dysplasia
C. Long-segment Barrett's esophagus
D. PPI-refractory symptoms
E. Family history of esophageal cancer
4|Page
