FLORIDA BOARD OF MEDICINE INTERNAL
MEDICINE CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 68-year-old man with hypertension, diabetes mellitus, and
hyperlipidemia presents with 45 minutes of substernal chest
pressure radiating to the left arm. ECG shows ST-segment elevation
in leads II, III, and aVF. Blood pressure is 108/68 mm Hg, heart rate
82/min, and oxygen saturation is 97% on room air. Which coronary
artery is most likely responsible?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery exclusively
Answer: C. Right coronary artery
Rationale: An inferior STEMI with ST elevation in leads II, III, and
aVF is most commonly caused by right coronary artery occlusion. The
RCA frequently supplies the inferior wall and may also supply the
right ventricle and AV node. If right ventricular infarction is
suspected, nitrates and other preload-reducing agents should be used
cautiously because these patients may be highly preload dependent.
1
,2. A 72-year-old woman presents with progressive dyspnea,
orthopnea, bilateral ankle edema, and fatigue. Examination reveals
elevated jugular venous pressure, bibasilar crackles, and an S3
gallop. Echocardiography demonstrates a left ventricular ejection
fraction of 30%. Which combination represents guideline-directed
pharmacologic therapy that improves survival in symptomatic heart
failure with reduced ejection fraction?
A. Furosemide and digoxin only
B. ACE inhibitor, beta-blocker, mineralocorticoid receptor antagonist,
and SGLT2 inhibitor
C. Calcium-channel blocker and nitrate
D. Digoxin and hydrochlorothiazide
E. Aspirin and statin alone
Answer: B. ACE inhibitor, beta-blocker, mineralocorticoid receptor
antagonist, and SGLT2 inhibitor
Rationale: Foundational therapy for HFrEF includes neurohormonal
blockade and SGLT2 inhibition. Evidence-based beta-blockers, renin-
angiotensin system inhibition/ARNI therapy, mineralocorticoid
receptor antagonists, and SGLT2 inhibitors reduce morbidity and
mortality. Loop diuretics primarily relieve congestion and symptoms
but do not provide the same mortality benefit.
3. A 59-year-old man with atrial fibrillation presents with
palpitations and mild dyspnea. His ventricular rate is 145/min.
Blood pressure is 126/78 mm Hg, and he has no evidence of shock,
ischemia, or pulmonary edema. Which is the most appropriate
initial approach?
A. Immediate unsynchronized defibrillation
B. Intravenous rate-control therapy
C. Intravenous thrombolysis
2
,D. Permanent pacemaker implantation
E. Carotid sinus massage as definitive therapy
Answer: B. Intravenous rate-control therapy
Rationale: A hemodynamically stable patient with rapid atrial
fibrillation generally requires ventricular rate control using an
appropriate AV-nodal blocking agent. Beta-blockers or
nondihydropyridine calcium-channel blockers are commonly used
when there is no contraindication. Unstable atrial fibrillation requires
synchronized cardioversion rather than routine pharmacologic rate
control.
4. A 64-year-old man with atrial fibrillation has hypertension,
diabetes mellitus, and a prior ischemic stroke. Which factor most
strongly supports long-term anticoagulation?
A. Presence of occasional palpitations
B. Left atrial enlargement alone
C. Elevated thromboembolic risk based on clinical risk factors
D. Ventricular rate greater than 100/min
E. Use of a beta-blocker
Answer: C. Elevated thromboembolic risk based on clinical risk
factors
Rationale: Stroke prevention in atrial fibrillation is based primarily on
thromboembolic risk assessment rather than symptoms or ventricular
rate. Prior stroke or transient ischemic attack is particularly important
because it substantially increases future embolic risk. Oral
anticoagulation is generally favored when the patient's estimated
stroke risk warrants it and there is no major contraindication.
3
, 5. A 43-year-old woman presents with fatigue, constipation, cold
intolerance, weight gain, and dry skin. Laboratory studies show an
elevated TSH and low free T4. Which diagnosis is most likely?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Euthyroid sick syndrome
E. Subclinical hyperthyroidism
Answer: A. Primary hypothyroidism
Rationale: Primary hypothyroidism results from thyroid gland failure,
producing low circulating thyroid hormone and compensatory
elevation of TSH. Typical manifestations include fatigue, weight gain,
constipation, cold intolerance, dry skin, bradycardia, and cognitive
slowing. Secondary hypothyroidism from pituitary disease usually
produces a low or inappropriately normal TSH with low free T4.
6. A 36-year-old woman has tremor, heat intolerance, weight loss
despite increased appetite, anxiety, and palpitations. TSH is
suppressed and free T4 is elevated. Which additional finding would
most strongly support Graves disease?
A. Tender thyroid gland
B. Ophthalmopathy
C. Low radioactive iodine uptake
D. Elevated serum calcitonin
E. Severe hypocalcemia
Answer: B. Ophthalmopathy
Rationale: Graves disease is an autoimmune cause of hyperthyroidism
caused by antibodies stimulating the TSH receptor. Thyroid-associated
ophthalmopathy is particularly characteristic. Toxic multinodular
4
MEDICINE CERTIFICATION EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 68-year-old man with hypertension, diabetes mellitus, and
hyperlipidemia presents with 45 minutes of substernal chest
pressure radiating to the left arm. ECG shows ST-segment elevation
in leads II, III, and aVF. Blood pressure is 108/68 mm Hg, heart rate
82/min, and oxygen saturation is 97% on room air. Which coronary
artery is most likely responsible?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
E. Posterior descending artery exclusively
Answer: C. Right coronary artery
Rationale: An inferior STEMI with ST elevation in leads II, III, and
aVF is most commonly caused by right coronary artery occlusion. The
RCA frequently supplies the inferior wall and may also supply the
right ventricle and AV node. If right ventricular infarction is
suspected, nitrates and other preload-reducing agents should be used
cautiously because these patients may be highly preload dependent.
1
,2. A 72-year-old woman presents with progressive dyspnea,
orthopnea, bilateral ankle edema, and fatigue. Examination reveals
elevated jugular venous pressure, bibasilar crackles, and an S3
gallop. Echocardiography demonstrates a left ventricular ejection
fraction of 30%. Which combination represents guideline-directed
pharmacologic therapy that improves survival in symptomatic heart
failure with reduced ejection fraction?
A. Furosemide and digoxin only
B. ACE inhibitor, beta-blocker, mineralocorticoid receptor antagonist,
and SGLT2 inhibitor
C. Calcium-channel blocker and nitrate
D. Digoxin and hydrochlorothiazide
E. Aspirin and statin alone
Answer: B. ACE inhibitor, beta-blocker, mineralocorticoid receptor
antagonist, and SGLT2 inhibitor
Rationale: Foundational therapy for HFrEF includes neurohormonal
blockade and SGLT2 inhibition. Evidence-based beta-blockers, renin-
angiotensin system inhibition/ARNI therapy, mineralocorticoid
receptor antagonists, and SGLT2 inhibitors reduce morbidity and
mortality. Loop diuretics primarily relieve congestion and symptoms
but do not provide the same mortality benefit.
3. A 59-year-old man with atrial fibrillation presents with
palpitations and mild dyspnea. His ventricular rate is 145/min.
Blood pressure is 126/78 mm Hg, and he has no evidence of shock,
ischemia, or pulmonary edema. Which is the most appropriate
initial approach?
A. Immediate unsynchronized defibrillation
B. Intravenous rate-control therapy
C. Intravenous thrombolysis
2
,D. Permanent pacemaker implantation
E. Carotid sinus massage as definitive therapy
Answer: B. Intravenous rate-control therapy
Rationale: A hemodynamically stable patient with rapid atrial
fibrillation generally requires ventricular rate control using an
appropriate AV-nodal blocking agent. Beta-blockers or
nondihydropyridine calcium-channel blockers are commonly used
when there is no contraindication. Unstable atrial fibrillation requires
synchronized cardioversion rather than routine pharmacologic rate
control.
4. A 64-year-old man with atrial fibrillation has hypertension,
diabetes mellitus, and a prior ischemic stroke. Which factor most
strongly supports long-term anticoagulation?
A. Presence of occasional palpitations
B. Left atrial enlargement alone
C. Elevated thromboembolic risk based on clinical risk factors
D. Ventricular rate greater than 100/min
E. Use of a beta-blocker
Answer: C. Elevated thromboembolic risk based on clinical risk
factors
Rationale: Stroke prevention in atrial fibrillation is based primarily on
thromboembolic risk assessment rather than symptoms or ventricular
rate. Prior stroke or transient ischemic attack is particularly important
because it substantially increases future embolic risk. Oral
anticoagulation is generally favored when the patient's estimated
stroke risk warrants it and there is no major contraindication.
3
, 5. A 43-year-old woman presents with fatigue, constipation, cold
intolerance, weight gain, and dry skin. Laboratory studies show an
elevated TSH and low free T4. Which diagnosis is most likely?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Euthyroid sick syndrome
E. Subclinical hyperthyroidism
Answer: A. Primary hypothyroidism
Rationale: Primary hypothyroidism results from thyroid gland failure,
producing low circulating thyroid hormone and compensatory
elevation of TSH. Typical manifestations include fatigue, weight gain,
constipation, cold intolerance, dry skin, bradycardia, and cognitive
slowing. Secondary hypothyroidism from pituitary disease usually
produces a low or inappropriately normal TSH with low free T4.
6. A 36-year-old woman has tremor, heat intolerance, weight loss
despite increased appetite, anxiety, and palpitations. TSH is
suppressed and free T4 is elevated. Which additional finding would
most strongly support Graves disease?
A. Tender thyroid gland
B. Ophthalmopathy
C. Low radioactive iodine uptake
D. Elevated serum calcitonin
E. Severe hypocalcemia
Answer: B. Ophthalmopathy
Rationale: Graves disease is an autoimmune cause of hyperthyroidism
caused by antibodies stimulating the TSH receptor. Thyroid-associated
ophthalmopathy is particularly characteristic. Toxic multinodular
4
