ABIM Internal Medicine Comprehensive Exam Review |
Cardiology, Pulmonology, Gastroenterology, Infectious Disease
& More 2026/2027
Question 1
A 58-year-old man with a history of hypertension and myocardial
infarction is evaluated for chronic fatigue and exertional shortness of
breath. Echocardiography reveals a left ventricular ejection fraction of
35% and symmetric left ventricular dilation. He is currently taking
lisinopril and metoprolol succinate. Which of the following foundational
medication classes should be added to reduce mortality and
hospitalizations in heart failure with reduced ejection fraction?
A. Sodium-glucose cotransporter-2 (SGLT2) inhibitors or ARNI
(sacubitril-valsartan)
B. Dihydropyridine calcium channel blockers
C. Nonsteroidal anti-inflammatory drugs
D. Short-acting loop diuretics as monotherapy
Correct Answer: A. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
or ARNI (sacubitril-valsartan)
Detailed Rationale: Guideline-directed medical therapy for heart failure
with reduced ejection fraction (HFrEF) includes four foundational pillars:
ARNI (or ACEi/ARB), beta-blockers, mineralocorticoid receptor
antagonists (MRAs), and SGLT2 inhibitors to improve survival and
reduce hospitalizations.
,Question 2
A 52-year-old woman with type 2 diabetes mellitus has a hemoglobin
A1c of 8.2% despite lifestyle modifications and maximum tolerated
metformin. She has a history of stable coronary artery disease. Which of
the following glucose-lowering agents has demonstrated proven
cardiovascular outcome benefits in patients with established
atherosclerotic cardiovascular disease?
A. Glimepiride
B. Sitagliptin
C. GLP-1 receptor agonist (e.g., dulaglutide) or SGLT2 inhibitor
D. Regular insulin monotherapy
Correct Answer: C. GLP-1 receptor agonist (e.g., dulaglutide) or SGLT2
inhibitor
Detailed Rationale: In patients with type 2 diabetes and established
atherosclerotic cardiovascular disease, GLP-1 receptor agonists and
SGLT2 inhibitors with proven cardiovascular benefit are recommended
independently of baseline hemoglobin A1c.
Question 3
A 64-year-old man with a 45 pack-year smoking history presents with a
3-month history of a persistent cough, hemoptysis, and a 15-lb weight
loss. Chest radiography reveals a hilar mass in the right lung. Laboratory
studies show serum sodium of 124 mEq/L, serum osmolality of 250
mOsm/kg, urine osmolality of 480 mOsm/kg, and urine sodium of 55
mEq/L. He is clinically euvolemic. Which of the following underlying
malignancies is most commonly associated with this presentation?
,A. Small cell lung cancer
B. Squamous cell carcinoma of the lung
C. Adenocarcinoma of the lung
D. Large cell carcinoma of the lung
Correct Answer: A. Small cell lung cancer
Detailed Rationale: Small cell lung cancer is frequently complicated by
the syndrome of inappropriate antidiuretic hormone secretion (SIADH),
leading to euvolemic hypotonic hyponatremia due to ectopic
production of ADH.
Question 4
A 45-year-old man is evaluated for acute kidney injury 3 weeks after
starting a new nonsteroidal anti-inflammatory drug (NSAID) for joint
pain. Serum creatinine is 2.5 mg/dL. Urinalysis shows sterile pyuria,
mild proteinuria, and eosinophiluria. Wright stain of the urine sediment
confirms white blood cell casts containing eosinophils. Which of the
following is the most likely diagnosis?
A. Acute interstitial nephritis
B. Acute tubular necrosis
C. Contrast-induced nephropathy
D. Post-streptococcal glomerulonephritis
Correct Answer: A. Acute interstitial nephritis
Detailed Rationale: Acute interstitial nephritis (AIN) is a hypersensitivity
reaction commonly caused by medications like NSAIDs, antibiotics, or
, proton pump inhibitors, characterized by fever, rash, pyuria,
eosinophiluria, and white blood cell casts.
Question 5
A 60-year-old man with chronic obstructive pulmonary disease presents
with fever, productive cough, and pleuritic chest pain. Vital signs: blood
pressure 125/80 mm Hg, heart rate 95/min, respiratory rate 22/min,
temperature 38.5°C, oxygen saturation 93% on room air. Chest
radiograph demonstrates a right lower lobe consolidation. CURB-65
score is 1. Which of the following is the most appropriate management
setting?
A. Outpatient treatment with oral antibiotics
B. Immediate admission to the intensive care unit
C. Emergency mechanical ventilation
D. Observation without antibiotics
Correct Answer: A. Outpatient treatment with oral antibiotics
Detailed Rationale: Patients with community-acquired pneumonia who
have low risk scores (such as a CURB-65 score of 0 or 1) and stable vital
signs can be managed safely as outpatients with oral antimicrobial
therapy.
Question 6
A 35-year-old woman with a history of Crohn disease presents with a
painful, expanding ulcer on her lower leg with a violaceous,
undermined border and a necrotic base. Biopsy of the lesion shows
neutrophilic dermatosis without evidence of vasculitis or infection.
Which of the following is the most likely diagnosis?
Cardiology, Pulmonology, Gastroenterology, Infectious Disease
& More 2026/2027
Question 1
A 58-year-old man with a history of hypertension and myocardial
infarction is evaluated for chronic fatigue and exertional shortness of
breath. Echocardiography reveals a left ventricular ejection fraction of
35% and symmetric left ventricular dilation. He is currently taking
lisinopril and metoprolol succinate. Which of the following foundational
medication classes should be added to reduce mortality and
hospitalizations in heart failure with reduced ejection fraction?
A. Sodium-glucose cotransporter-2 (SGLT2) inhibitors or ARNI
(sacubitril-valsartan)
B. Dihydropyridine calcium channel blockers
C. Nonsteroidal anti-inflammatory drugs
D. Short-acting loop diuretics as monotherapy
Correct Answer: A. Sodium-glucose cotransporter-2 (SGLT2) inhibitors
or ARNI (sacubitril-valsartan)
Detailed Rationale: Guideline-directed medical therapy for heart failure
with reduced ejection fraction (HFrEF) includes four foundational pillars:
ARNI (or ACEi/ARB), beta-blockers, mineralocorticoid receptor
antagonists (MRAs), and SGLT2 inhibitors to improve survival and
reduce hospitalizations.
,Question 2
A 52-year-old woman with type 2 diabetes mellitus has a hemoglobin
A1c of 8.2% despite lifestyle modifications and maximum tolerated
metformin. She has a history of stable coronary artery disease. Which of
the following glucose-lowering agents has demonstrated proven
cardiovascular outcome benefits in patients with established
atherosclerotic cardiovascular disease?
A. Glimepiride
B. Sitagliptin
C. GLP-1 receptor agonist (e.g., dulaglutide) or SGLT2 inhibitor
D. Regular insulin monotherapy
Correct Answer: C. GLP-1 receptor agonist (e.g., dulaglutide) or SGLT2
inhibitor
Detailed Rationale: In patients with type 2 diabetes and established
atherosclerotic cardiovascular disease, GLP-1 receptor agonists and
SGLT2 inhibitors with proven cardiovascular benefit are recommended
independently of baseline hemoglobin A1c.
Question 3
A 64-year-old man with a 45 pack-year smoking history presents with a
3-month history of a persistent cough, hemoptysis, and a 15-lb weight
loss. Chest radiography reveals a hilar mass in the right lung. Laboratory
studies show serum sodium of 124 mEq/L, serum osmolality of 250
mOsm/kg, urine osmolality of 480 mOsm/kg, and urine sodium of 55
mEq/L. He is clinically euvolemic. Which of the following underlying
malignancies is most commonly associated with this presentation?
,A. Small cell lung cancer
B. Squamous cell carcinoma of the lung
C. Adenocarcinoma of the lung
D. Large cell carcinoma of the lung
Correct Answer: A. Small cell lung cancer
Detailed Rationale: Small cell lung cancer is frequently complicated by
the syndrome of inappropriate antidiuretic hormone secretion (SIADH),
leading to euvolemic hypotonic hyponatremia due to ectopic
production of ADH.
Question 4
A 45-year-old man is evaluated for acute kidney injury 3 weeks after
starting a new nonsteroidal anti-inflammatory drug (NSAID) for joint
pain. Serum creatinine is 2.5 mg/dL. Urinalysis shows sterile pyuria,
mild proteinuria, and eosinophiluria. Wright stain of the urine sediment
confirms white blood cell casts containing eosinophils. Which of the
following is the most likely diagnosis?
A. Acute interstitial nephritis
B. Acute tubular necrosis
C. Contrast-induced nephropathy
D. Post-streptococcal glomerulonephritis
Correct Answer: A. Acute interstitial nephritis
Detailed Rationale: Acute interstitial nephritis (AIN) is a hypersensitivity
reaction commonly caused by medications like NSAIDs, antibiotics, or
, proton pump inhibitors, characterized by fever, rash, pyuria,
eosinophiluria, and white blood cell casts.
Question 5
A 60-year-old man with chronic obstructive pulmonary disease presents
with fever, productive cough, and pleuritic chest pain. Vital signs: blood
pressure 125/80 mm Hg, heart rate 95/min, respiratory rate 22/min,
temperature 38.5°C, oxygen saturation 93% on room air. Chest
radiograph demonstrates a right lower lobe consolidation. CURB-65
score is 1. Which of the following is the most appropriate management
setting?
A. Outpatient treatment with oral antibiotics
B. Immediate admission to the intensive care unit
C. Emergency mechanical ventilation
D. Observation without antibiotics
Correct Answer: A. Outpatient treatment with oral antibiotics
Detailed Rationale: Patients with community-acquired pneumonia who
have low risk scores (such as a CURB-65 score of 0 or 1) and stable vital
signs can be managed safely as outpatients with oral antimicrobial
therapy.
Question 6
A 35-year-old woman with a history of Crohn disease presents with a
painful, expanding ulcer on her lower leg with a violaceous,
undermined border and a necrotic base. Biopsy of the lesion shows
neutrophilic dermatosis without evidence of vasculitis or infection.
Which of the following is the most likely diagnosis?
