ABIM INTERNAL MEDICINE ITE TEST
BANK – COMPLETE PRACTICE
QUESTIONS WITH VERIFIED ANSWERS &
EXPLANATIONS – UPDATED 2026 Q&A |
INSTANT DOWNLOAD PDF
Core Domains:
Cardiology
Pulmonology
Gastroenterology
Nephrology
Endocrinology
Infectious Diseases
Rheumatology
Hematology/Oncology
Neurology
Geriatrics
This comprehensive examination is designed to assess the clinical knowledge,
diagnostic reasoning, and therapeutic decision-making skills essential for internal
medicine practice. The content evaluates foundational medical sciences, applied
clinical knowledge, and the ability to integrate complex patient data in real-world
scenarios. The exam utilizes a multiple-choice format with clinical vignettes that
emphasize evidence-based medicine, patient safety, ethical considerations, and
regulatory compliance. Each question challenges the examinee to demonstrate
critical thinking, prioritize differential diagnoses, and select appropriate
management strategies in both ambulatory and hospital settings. This assessment
serves as a rigorous tool for evaluating readiness for clinical practice and board
certification.
,SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old male with a history of hypertension and type 2 diabetes presents to
the emergency department with sudden-onset chest pain radiating to the left arm,
associated with diaphoresis and nausea. ECG reveals ST-segment elevation in
leads V1–V4. He is hemodynamically stable. Which of the following is the most
appropriate initial reperfusion strategy?
A. Immediate administration of tenecteplase
B. Urgent referral for percutaneous coronary intervention
C. Sublingual nitroglycerin and observation
D. Intravenous heparin infusion alone
B. Urgent referral for percutaneous coronary intervention
RATIONALE: In patients with acute ST-segment elevation myocardial infarction
(STEMI), percutaneous coronary intervention (PCI) is the preferred reperfusion
strategy when it can be performed within 90–120 minutes of first medical contact.
PCI offers superior outcomes compared to fibrinolysis, including lower rates of
recurrent infarction and hemorrhagic stroke. Fibrinolysis is reserved for cases
where PCI is not available in a timely manner.
Question 2
A 72-year-old female presents with progressive dyspnea on exertion and orthopnea
over the past 3 months. She has a history of hypertension and atrial fibrillation.
Physical examination reveals jugular venous distension, bilateral lower extremity
edema, and an S3 gallop. Echocardiogram shows a left ventricular ejection fraction
of 35%. Which medication class has been shown to reduce mortality in this patient
population?
,A. Calcium channel blockers
B. Beta-blockers
C. Loop diuretics
D. Digoxin
B. Beta-blockers
RATIONALE: Beta-blockers are a cornerstone of guideline-directed medical
therapy for heart failure with reduced ejection fraction (HFrEF). They have been
proven to reduce mortality and hospitalizations in multiple large randomized
controlled trials. Carvedilol, metoprolol succinate, and bisoprolol are the beta-
blockers with established mortality benefit in HFrEF. Loop diuretics improve
symptoms but do not reduce mortality, and digoxin reduces hospitalizations but has
a neutral effect on mortality.
Question 3
A 45-year-old male with alcoholic cirrhosis presents with increasing abdominal
distension and discomfort. Paracentesis reveals ascitic fluid with a
polymorphonuclear cell count of 320 cells/mm³. Serum-ascites albumin gradient is
1.4 g/dL. Which of the following is the most appropriate initial antibiotic regimen?
A. Cefotaxime 2 g IV every 8 hours
B. Piperacillin-tazobactam 4.5 g IV every 6 hours
C. Vancomycin 1 g IV every 12 hours
D. Metronidazole 500 mg IV every 8 hours
A. Cefotaxime 2 g IV every 8 hours
RATIONALE: This patient has spontaneous bacterial peritonitis (SBP), defined
as ascitic fluid PMN count ≥250 cells/mm³. The most common pathogens are
Gram-negative enteric organisms, particularly Escherichia coli and Klebsiella
species. Third-generation cephalosporins, such as cefotaxime, are the first-line
empiric therapy for SBP. Cefotaxime provides adequate coverage for
, Enterobacteriaceae and has been shown to be as effective as piperacillin-
tazobactam with a narrower spectrum and lower risk of resistance.
Question 4
A 28-year-old female presents with fatigue, weight gain, cold intolerance, and dry
skin. Physical examination reveals a diffuse goiter and delayed deep tendon
reflexes. Laboratory results show TSH of 15.8 mIU/L and free T4 of 0.6 ng/dL. Anti-
thyroid peroxidase antibodies are elevated. Which of the following is the most
appropriate initial treatment?
A. Levothyroxine 50 mcg daily
B. Liothyronine 25 mcg daily
C. Radioactive iodine ablation
D. Methimazole 10 mg daily
A. Levothyroxine 50 mcg daily
RATIONALE: This patient has primary hypothyroidism likely due to Hashimoto
thyroiditis, as evidenced by elevated TSH, low free T4, and elevated anti-TPO
antibodies. Levothyroxine monotherapy is the standard of care for hypothyroidism.
Liothyronine is not recommended as monotherapy due to lack of evidence for
superiority and increased cardiovascular risks. Radioactive iodine and methimazole
are treatments for hyperthyroidism and are contraindicated here.
Question 5
A 65-year-old male with a history of COPD presents with worsening dyspnea and
cough productive of purulent sputum for 3 days. He has a low-grade fever of 38.1°C.
Chest X-ray reveals no infiltrates. Which of the following is the most appropriate
management?
A. Outpatient antibiotics and a short course of oral corticosteroids
B. Hospital admission for intravenous antibiotics
BANK – COMPLETE PRACTICE
QUESTIONS WITH VERIFIED ANSWERS &
EXPLANATIONS – UPDATED 2026 Q&A |
INSTANT DOWNLOAD PDF
Core Domains:
Cardiology
Pulmonology
Gastroenterology
Nephrology
Endocrinology
Infectious Diseases
Rheumatology
Hematology/Oncology
Neurology
Geriatrics
This comprehensive examination is designed to assess the clinical knowledge,
diagnostic reasoning, and therapeutic decision-making skills essential for internal
medicine practice. The content evaluates foundational medical sciences, applied
clinical knowledge, and the ability to integrate complex patient data in real-world
scenarios. The exam utilizes a multiple-choice format with clinical vignettes that
emphasize evidence-based medicine, patient safety, ethical considerations, and
regulatory compliance. Each question challenges the examinee to demonstrate
critical thinking, prioritize differential diagnoses, and select appropriate
management strategies in both ambulatory and hospital settings. This assessment
serves as a rigorous tool for evaluating readiness for clinical practice and board
certification.
,SECTION ONE: QUESTIONS 1–100
Question 1
A 58-year-old male with a history of hypertension and type 2 diabetes presents to
the emergency department with sudden-onset chest pain radiating to the left arm,
associated with diaphoresis and nausea. ECG reveals ST-segment elevation in
leads V1–V4. He is hemodynamically stable. Which of the following is the most
appropriate initial reperfusion strategy?
A. Immediate administration of tenecteplase
B. Urgent referral for percutaneous coronary intervention
C. Sublingual nitroglycerin and observation
D. Intravenous heparin infusion alone
B. Urgent referral for percutaneous coronary intervention
RATIONALE: In patients with acute ST-segment elevation myocardial infarction
(STEMI), percutaneous coronary intervention (PCI) is the preferred reperfusion
strategy when it can be performed within 90–120 minutes of first medical contact.
PCI offers superior outcomes compared to fibrinolysis, including lower rates of
recurrent infarction and hemorrhagic stroke. Fibrinolysis is reserved for cases
where PCI is not available in a timely manner.
Question 2
A 72-year-old female presents with progressive dyspnea on exertion and orthopnea
over the past 3 months. She has a history of hypertension and atrial fibrillation.
Physical examination reveals jugular venous distension, bilateral lower extremity
edema, and an S3 gallop. Echocardiogram shows a left ventricular ejection fraction
of 35%. Which medication class has been shown to reduce mortality in this patient
population?
,A. Calcium channel blockers
B. Beta-blockers
C. Loop diuretics
D. Digoxin
B. Beta-blockers
RATIONALE: Beta-blockers are a cornerstone of guideline-directed medical
therapy for heart failure with reduced ejection fraction (HFrEF). They have been
proven to reduce mortality and hospitalizations in multiple large randomized
controlled trials. Carvedilol, metoprolol succinate, and bisoprolol are the beta-
blockers with established mortality benefit in HFrEF. Loop diuretics improve
symptoms but do not reduce mortality, and digoxin reduces hospitalizations but has
a neutral effect on mortality.
Question 3
A 45-year-old male with alcoholic cirrhosis presents with increasing abdominal
distension and discomfort. Paracentesis reveals ascitic fluid with a
polymorphonuclear cell count of 320 cells/mm³. Serum-ascites albumin gradient is
1.4 g/dL. Which of the following is the most appropriate initial antibiotic regimen?
A. Cefotaxime 2 g IV every 8 hours
B. Piperacillin-tazobactam 4.5 g IV every 6 hours
C. Vancomycin 1 g IV every 12 hours
D. Metronidazole 500 mg IV every 8 hours
A. Cefotaxime 2 g IV every 8 hours
RATIONALE: This patient has spontaneous bacterial peritonitis (SBP), defined
as ascitic fluid PMN count ≥250 cells/mm³. The most common pathogens are
Gram-negative enteric organisms, particularly Escherichia coli and Klebsiella
species. Third-generation cephalosporins, such as cefotaxime, are the first-line
empiric therapy for SBP. Cefotaxime provides adequate coverage for
, Enterobacteriaceae and has been shown to be as effective as piperacillin-
tazobactam with a narrower spectrum and lower risk of resistance.
Question 4
A 28-year-old female presents with fatigue, weight gain, cold intolerance, and dry
skin. Physical examination reveals a diffuse goiter and delayed deep tendon
reflexes. Laboratory results show TSH of 15.8 mIU/L and free T4 of 0.6 ng/dL. Anti-
thyroid peroxidase antibodies are elevated. Which of the following is the most
appropriate initial treatment?
A. Levothyroxine 50 mcg daily
B. Liothyronine 25 mcg daily
C. Radioactive iodine ablation
D. Methimazole 10 mg daily
A. Levothyroxine 50 mcg daily
RATIONALE: This patient has primary hypothyroidism likely due to Hashimoto
thyroiditis, as evidenced by elevated TSH, low free T4, and elevated anti-TPO
antibodies. Levothyroxine monotherapy is the standard of care for hypothyroidism.
Liothyronine is not recommended as monotherapy due to lack of evidence for
superiority and increased cardiovascular risks. Radioactive iodine and methimazole
are treatments for hyperthyroidism and are contraindicated here.
Question 5
A 65-year-old male with a history of COPD presents with worsening dyspnea and
cough productive of purulent sputum for 3 days. He has a low-grade fever of 38.1°C.
Chest X-ray reveals no infiltrates. Which of the following is the most appropriate
management?
A. Outpatient antibiotics and a short course of oral corticosteroids
B. Hospital admission for intravenous antibiotics
