ABIM Internal Medicine Boards & ITE Exam –
Practice Questions with Verified Answers &
Rationales
This comprehensive practice guide is designed for physicians preparing for the
American Board of Internal Medicine (ABIM) Certification Exam and the In-Training
Examination (ITE). The questions reflect the ABIM exam blueprint, covering the most
commonly tested topics across all major subspecialties.
EXAM OVERVIEW
Category Details
Format Up to 240 multiple-choice
questions,
single-best-answer format
Duration Approximately 10 hours,
divided into sections
Key Content Areas Cardiovascular (14-15%),
Endocrinology (9-10%),
Gastroenterology (9-10%),
Infectious Disease
(9-10%), Pulmonary
(8-9%), Rheumatology
(9-10%)
,Question Types Clinical vignettes, lab
results, ECGs, imaging,
dermatologic
photographs
SECTION 1: CARDIOVASCULAR MEDICINE
Question 1
A 55-year-old man reports palpitations. ECG shows atrial fibrillation with a ventricular
rate of 140 bpm. He is hemodynamically stable. What is the most appropriate acute
management?
A) Immediate synchronized cardioversion
B) Rate control with metoprolol or diltiazem
C) Aspirin 325 mg
D) Amiodarone 150 mg IV push
Correct Answer: B
Rationale: Atrial fibrillation with rapid ventricular response in a hemodynamically stable
patient is managed with rate control using a beta-blocker (metoprolol) or a
nondihydropyridine calcium channel blocker (diltiazem). Cardioversion is reserved for
unstable patients or those who fail rate control after appropriate anticoagulation.
Aspirin is no longer recommended for stroke prevention in AF; anticoagulation is based
on CHA₂DS₂-VASc score.
Question 2
A 70-year-old woman has a blood pressure of 150/92 mmHg. She has diabetes and
chronic kidney disease (eGFR 40 mL/min). What is the target blood pressure for this
patient per recent guidelines?
A) <120/80 mmHg
B) <130/80 mmHg
, C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: B
Rationale: ACC/AHA guidelines recommend a blood pressure target of <130/80 mmHg
for patients with diabetes, chronic kidney disease, or established cardiovascular
disease. The SPRINT trial supported intensive BP control for high-risk patients, though
caution is needed in those with frailty or orthostatic symptoms.
Question 3
A 72-year-old man with hypertension reports lightheadedness when standing. BP supine
is 140/80, HR 72; standing BP is 100/60, HR 80. Which medication is most likely
contributing?
A) Metoprolol
B) Lisinopril
C) Hydrochlorothiazide
D) Doxazosin
Correct Answer: D
Rationale: Alpha-blockers (doxazosin, terazosin, prazosin) cause significant orthostatic
hypotension due to peripheral vasodilation. Beta-blockers and ACE inhibitors cause less
orthostatic hypotension. Thiazides can cause volume depletion but are less likely to
cause this degree of orthostasis.
Question 4
A 65-year-old woman has a new diastolic murmur best heard at the left sternal border
with an opening snap. What is the most likely diagnosis?
A) Aortic stenosis
B) Mitral stenosis
C) Tricuspid stenosis
D) Pulmonic stenosis
Practice Questions with Verified Answers &
Rationales
This comprehensive practice guide is designed for physicians preparing for the
American Board of Internal Medicine (ABIM) Certification Exam and the In-Training
Examination (ITE). The questions reflect the ABIM exam blueprint, covering the most
commonly tested topics across all major subspecialties.
EXAM OVERVIEW
Category Details
Format Up to 240 multiple-choice
questions,
single-best-answer format
Duration Approximately 10 hours,
divided into sections
Key Content Areas Cardiovascular (14-15%),
Endocrinology (9-10%),
Gastroenterology (9-10%),
Infectious Disease
(9-10%), Pulmonary
(8-9%), Rheumatology
(9-10%)
,Question Types Clinical vignettes, lab
results, ECGs, imaging,
dermatologic
photographs
SECTION 1: CARDIOVASCULAR MEDICINE
Question 1
A 55-year-old man reports palpitations. ECG shows atrial fibrillation with a ventricular
rate of 140 bpm. He is hemodynamically stable. What is the most appropriate acute
management?
A) Immediate synchronized cardioversion
B) Rate control with metoprolol or diltiazem
C) Aspirin 325 mg
D) Amiodarone 150 mg IV push
Correct Answer: B
Rationale: Atrial fibrillation with rapid ventricular response in a hemodynamically stable
patient is managed with rate control using a beta-blocker (metoprolol) or a
nondihydropyridine calcium channel blocker (diltiazem). Cardioversion is reserved for
unstable patients or those who fail rate control after appropriate anticoagulation.
Aspirin is no longer recommended for stroke prevention in AF; anticoagulation is based
on CHA₂DS₂-VASc score.
Question 2
A 70-year-old woman has a blood pressure of 150/92 mmHg. She has diabetes and
chronic kidney disease (eGFR 40 mL/min). What is the target blood pressure for this
patient per recent guidelines?
A) <120/80 mmHg
B) <130/80 mmHg
, C) <140/90 mmHg
D) <150/90 mmHg
Correct Answer: B
Rationale: ACC/AHA guidelines recommend a blood pressure target of <130/80 mmHg
for patients with diabetes, chronic kidney disease, or established cardiovascular
disease. The SPRINT trial supported intensive BP control for high-risk patients, though
caution is needed in those with frailty or orthostatic symptoms.
Question 3
A 72-year-old man with hypertension reports lightheadedness when standing. BP supine
is 140/80, HR 72; standing BP is 100/60, HR 80. Which medication is most likely
contributing?
A) Metoprolol
B) Lisinopril
C) Hydrochlorothiazide
D) Doxazosin
Correct Answer: D
Rationale: Alpha-blockers (doxazosin, terazosin, prazosin) cause significant orthostatic
hypotension due to peripheral vasodilation. Beta-blockers and ACE inhibitors cause less
orthostatic hypotension. Thiazides can cause volume depletion but are less likely to
cause this degree of orthostasis.
Question 4
A 65-year-old woman has a new diastolic murmur best heard at the left sternal border
with an opening snap. What is the most likely diagnosis?
A) Aortic stenosis
B) Mitral stenosis
C) Tricuspid stenosis
D) Pulmonic stenosis
