ABIM Internal Medicine Boards & ITE Exam QUESTIONS AND
VERIFIED ANSWERS WITH RATIONALES JUST RELEASED
2026/2027
10 :Most Tested Coverage Areas
1.0 Cardiovascular Disease (14-15%): ACS, heart failure, valvular disease,
arrhythmias, hypertension, lipids, ECG interpretation, and murmurs.
2. Endocrinology, Diabetes, and Metabolism (9-10%): Diabetes management,
thyroid disease, adrenal disorders, pituitary disorders, and calcium/bone
metabolism.
3. Gastroenterology (9-10%): IBD, GI bleeding, liver disease, cirrhosis,
pancreatitis, and colorectal cancer screening.
4. Infectious Disease (9-10%): Sepsis, common infections by organ system, HIV,
antimicrobial stewardship, and travel medicine.
5. Pulmonary Disease (8-9%): COPD, asthma, pneumonia, ARDS, pleural disease,
and pulmonary hypertension.
6. Rheumatology and Orthopedics (9-10%): RA, SLE, vasculitis, gout,
spondyloarthropathies, and joint complaints.
,7. Hematology (4-6%): Anemia, coagulopathy, and blood disorders.
8. Medical Oncology (6%): Common malignancies, cancer screening guidelines,
and chemotherapy toxicities.
8.Nephrology and Urology (6%): AKI, CKD, acid-base and electrolyte disorders,
and glomerulonephritis.
9. Neurology (4%): Stroke, seizures, peripheral neuropathy, and headache.
QUESTION 1
A 68-year-old man with a 40-pack-year smoking history presents for a
routine wellness visit. According to USPSTF guidelines, which screening
test is recommended for this patient?
A. Colonoscopy every 10 years
B. One-time abdominal ultrasound for AAA
C. Annual PSA testing
D. Chest CT scan annually
Correct Answer: B. One-time abdominal ultrasound for AAA
Detailed Rationale: The USPSTF recommends a one-time abdominal
ultrasound screening for abdominal aortic aneurysm in men aged 65-75
who have ever smoked at least 100 cigarettes.
QUESTION 2
,A patient with a history of heavy alcohol use presents with abdominal
distension and jaundice. Which finding would most strongly suggest the
development of spontaneous bacterial peritonitis?
A. Elevated serum bilirubin
B. Ascitic fluid PMN count >250 cells/mm³
C. Elevated serum amylase
D. Decreased serum albumin
Correct Answer: B. Ascitic fluid PMN count >250 cells/mm³
Detailed Rationale: Spontaneous bacterial peritonitis is diagnosed
when ascitic fluid has a polymorphonuclear leukocyte count greater
than 250 cells/mm³, typically in the setting of cirrhosis.
QUESTION 3
A 55-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Her TSH is elevated and free T4 is low.
What is the most likely diagnosis?
A. Hyperthyroidism
B. Subclinical hypothyroidism
C. Primary hypothyroidism
D. Sick euthyroid syndrome
Correct Answer: C. Primary hypothyroidism
Detailed Rationale: Primary hypothyroidism is characterized by
elevated TSH and low free T4, consistent with the symptoms described.
QUESTION 4
, A 72-year-old man with a history of heart failure presents with
progressive dyspnea and leg swelling. His ejection fraction is 35%.
Which medication class has been shown to improve mortality in this
condition?
A. Beta-blockers
B. Calcium channel blockers
C. Alpha-blockers
D. Thiazolidinediones
Correct Answer: A. Beta-blockers
Detailed Rationale: Beta-blockers (carvedilol, bisoprolol, metoprolol
succinate) improve mortality and reduce hospitalizations in heart failure
with reduced ejection fraction.
QUESTION 5
A 45-year-old man with a history of hypertension presents with acute
onset of severe, tearing chest pain radiating to the back. His blood
pressure is 180/100 mm Hg. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C. Aortic dissection
VERIFIED ANSWERS WITH RATIONALES JUST RELEASED
2026/2027
10 :Most Tested Coverage Areas
1.0 Cardiovascular Disease (14-15%): ACS, heart failure, valvular disease,
arrhythmias, hypertension, lipids, ECG interpretation, and murmurs.
2. Endocrinology, Diabetes, and Metabolism (9-10%): Diabetes management,
thyroid disease, adrenal disorders, pituitary disorders, and calcium/bone
metabolism.
3. Gastroenterology (9-10%): IBD, GI bleeding, liver disease, cirrhosis,
pancreatitis, and colorectal cancer screening.
4. Infectious Disease (9-10%): Sepsis, common infections by organ system, HIV,
antimicrobial stewardship, and travel medicine.
5. Pulmonary Disease (8-9%): COPD, asthma, pneumonia, ARDS, pleural disease,
and pulmonary hypertension.
6. Rheumatology and Orthopedics (9-10%): RA, SLE, vasculitis, gout,
spondyloarthropathies, and joint complaints.
,7. Hematology (4-6%): Anemia, coagulopathy, and blood disorders.
8. Medical Oncology (6%): Common malignancies, cancer screening guidelines,
and chemotherapy toxicities.
8.Nephrology and Urology (6%): AKI, CKD, acid-base and electrolyte disorders,
and glomerulonephritis.
9. Neurology (4%): Stroke, seizures, peripheral neuropathy, and headache.
QUESTION 1
A 68-year-old man with a 40-pack-year smoking history presents for a
routine wellness visit. According to USPSTF guidelines, which screening
test is recommended for this patient?
A. Colonoscopy every 10 years
B. One-time abdominal ultrasound for AAA
C. Annual PSA testing
D. Chest CT scan annually
Correct Answer: B. One-time abdominal ultrasound for AAA
Detailed Rationale: The USPSTF recommends a one-time abdominal
ultrasound screening for abdominal aortic aneurysm in men aged 65-75
who have ever smoked at least 100 cigarettes.
QUESTION 2
,A patient with a history of heavy alcohol use presents with abdominal
distension and jaundice. Which finding would most strongly suggest the
development of spontaneous bacterial peritonitis?
A. Elevated serum bilirubin
B. Ascitic fluid PMN count >250 cells/mm³
C. Elevated serum amylase
D. Decreased serum albumin
Correct Answer: B. Ascitic fluid PMN count >250 cells/mm³
Detailed Rationale: Spontaneous bacterial peritonitis is diagnosed
when ascitic fluid has a polymorphonuclear leukocyte count greater
than 250 cells/mm³, typically in the setting of cirrhosis.
QUESTION 3
A 55-year-old woman presents with fatigue, weight gain, cold
intolerance, and constipation. Her TSH is elevated and free T4 is low.
What is the most likely diagnosis?
A. Hyperthyroidism
B. Subclinical hypothyroidism
C. Primary hypothyroidism
D. Sick euthyroid syndrome
Correct Answer: C. Primary hypothyroidism
Detailed Rationale: Primary hypothyroidism is characterized by
elevated TSH and low free T4, consistent with the symptoms described.
QUESTION 4
, A 72-year-old man with a history of heart failure presents with
progressive dyspnea and leg swelling. His ejection fraction is 35%.
Which medication class has been shown to improve mortality in this
condition?
A. Beta-blockers
B. Calcium channel blockers
C. Alpha-blockers
D. Thiazolidinediones
Correct Answer: A. Beta-blockers
Detailed Rationale: Beta-blockers (carvedilol, bisoprolol, metoprolol
succinate) improve mortality and reduce hospitalizations in heart failure
with reduced ejection fraction.
QUESTION 5
A 45-year-old man with a history of hypertension presents with acute
onset of severe, tearing chest pain radiating to the back. His blood
pressure is 180/100 mm Hg. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C. Aortic dissection
