ABIM INTERNAL MEDICINE BOARDS & ITE
EXAMINATION COMPLETE QUESTIONS AND
DETAILED SOLUTIONS LATEST UPDATE THIS YEAR
JUST RELEASED
1. A 67-year-old man with hypertension and chronic kidney disease presents
with progressive fatigue and exertional dyspnea. Hemoglobin is 8.9 g/dL,
MCV is 88 fL, ferritin is 210 ng/mL, and transferrin saturation is 18%. Which
mechanism most likely explains his anemia?
A. Absolute iron deficiency from occult gastrointestinal bleeding
B. Reduced erythropoietin production by damaged kidneys
C. Autoimmune destruction of circulating erythrocytes
D. Impaired globin-chain synthesis
E. Vitamin B12 malabsorption
Answer: B. Reduced erythropoietin production by damaged kidneys
Rationale: Chronic kidney disease commonly causes normocytic anemia
because damaged kidneys produce inadequate erythropoietin. Ferritin is not
consistent with uncomplicated absolute iron deficiency.
2. A 72-year-old woman develops sudden aphasia and right-sided weakness
90 minutes before arriving at the emergency department. CT head shows no
hemorrhage. She has no recent surgery or bleeding history. Which
treatment should be considered immediately?
A. Aspirin alone
B. Intravenous alteplase
C. Warfarin
,D. Carotid endarterectomy
E. Observation with repeat CT in 24 hours
Answer: B. Intravenous alteplase
Rationale: An eligible patient with acute ischemic stroke presenting within
the thrombolysis window should receive intravenous thrombolytic therapy
after intracranial hemorrhage is excluded.
3. A 58-year-old man presents with crushing substernal chest pain and
diaphoresis. ECG demonstrates ST-segment elevation in leads II, III, and aVF.
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. First diagonal artery
Answer: C. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most commonly
caused by right coronary artery occlusion, although the circumflex can
occasionally be responsible.
4. A 64-year-old woman with atrial fibrillation has a ventricular rate of
150/min, blood pressure 78/46 mm Hg, and severe dyspnea. What is the
most appropriate immediate management?
A. Oral metoprolol
B. Intravenous digoxin
C. Intravenous amiodarone over several hours
,D. Synchronized cardioversion
E. Oral anticoagulation alone
Answer: D. Synchronized cardioversion
Rationale: Atrial fibrillation causing hemodynamic instability requires
immediate synchronized electrical cardioversion rather than delayed
pharmacologic rate control.
5. A 35-year-old woman presents with weight loss, tremor, heat intolerance,
and palpitations. TSH is suppressed, and free T4 is elevated. Which antibody
is most closely associated with the underlying disorder?
A. Anti-double-stranded DNA antibody
B. Antithyroid peroxidase antibody only
C. Thyroid-stimulating immunoglobulin
D. Antimitochondrial antibody
E. Anti-centromere antibody
Answer: C. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from thyroid-stimulating immunoglobulins
that activate the TSH receptor, producing diffuse thyroid hormone
overproduction.
6. A 45-year-old man with cirrhosis presents with hematemesis and
hypotension. After initial stabilization, which medication should be started
promptly to reduce portal hypertensive bleeding?
A. Propranolol orally
B. Octreotide intravenously
C. Aspirin
, D. Heparin
E. Mesalamine
Answer: B. Octreotide intravenously
Rationale: Acute suspected variceal hemorrhage should be treated with
vasoactive therapy such as octreotide, along with urgent endoscopic
evaluation and antibiotic prophylaxis.
7. A 29-year-old woman develops fever, hypotension, diffuse erythematous
rash, and multiorgan dysfunction during menstruation. She recently began
using highly absorbent tampons. Which organism is most likely responsible?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Escherichia coli
D. Neisseria meningitidis
E. Clostridioides difficile
Answer: B. Staphylococcus aureus
Rationale: Menstrual toxic shock syndrome is classically associated with
toxin-producing Staphylococcus aureus and causes fever, hypotension, rash,
and multisystem involvement.
8. A 61-year-old man with COPD has worsening dyspnea, increased sputum
volume, and purulent sputum. Which intervention most directly improves
outcomes during an acute exacerbation?
A. Long-term oxygen regardless of oxygen saturation
B. Short-acting bronchodilators and systemic corticosteroids
C. Inhaled corticosteroid monotherapy
EXAMINATION COMPLETE QUESTIONS AND
DETAILED SOLUTIONS LATEST UPDATE THIS YEAR
JUST RELEASED
1. A 67-year-old man with hypertension and chronic kidney disease presents
with progressive fatigue and exertional dyspnea. Hemoglobin is 8.9 g/dL,
MCV is 88 fL, ferritin is 210 ng/mL, and transferrin saturation is 18%. Which
mechanism most likely explains his anemia?
A. Absolute iron deficiency from occult gastrointestinal bleeding
B. Reduced erythropoietin production by damaged kidneys
C. Autoimmune destruction of circulating erythrocytes
D. Impaired globin-chain synthesis
E. Vitamin B12 malabsorption
Answer: B. Reduced erythropoietin production by damaged kidneys
Rationale: Chronic kidney disease commonly causes normocytic anemia
because damaged kidneys produce inadequate erythropoietin. Ferritin is not
consistent with uncomplicated absolute iron deficiency.
2. A 72-year-old woman develops sudden aphasia and right-sided weakness
90 minutes before arriving at the emergency department. CT head shows no
hemorrhage. She has no recent surgery or bleeding history. Which
treatment should be considered immediately?
A. Aspirin alone
B. Intravenous alteplase
C. Warfarin
,D. Carotid endarterectomy
E. Observation with repeat CT in 24 hours
Answer: B. Intravenous alteplase
Rationale: An eligible patient with acute ischemic stroke presenting within
the thrombolysis window should receive intravenous thrombolytic therapy
after intracranial hemorrhage is excluded.
3. A 58-year-old man presents with crushing substernal chest pain and
diaphoresis. ECG demonstrates ST-segment elevation in leads II, III, and aVF.
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. First diagonal artery
Answer: C. Right coronary artery
Rationale: Inferior STEMI involving leads II, III, and aVF is most commonly
caused by right coronary artery occlusion, although the circumflex can
occasionally be responsible.
4. A 64-year-old woman with atrial fibrillation has a ventricular rate of
150/min, blood pressure 78/46 mm Hg, and severe dyspnea. What is the
most appropriate immediate management?
A. Oral metoprolol
B. Intravenous digoxin
C. Intravenous amiodarone over several hours
,D. Synchronized cardioversion
E. Oral anticoagulation alone
Answer: D. Synchronized cardioversion
Rationale: Atrial fibrillation causing hemodynamic instability requires
immediate synchronized electrical cardioversion rather than delayed
pharmacologic rate control.
5. A 35-year-old woman presents with weight loss, tremor, heat intolerance,
and palpitations. TSH is suppressed, and free T4 is elevated. Which antibody
is most closely associated with the underlying disorder?
A. Anti-double-stranded DNA antibody
B. Antithyroid peroxidase antibody only
C. Thyroid-stimulating immunoglobulin
D. Antimitochondrial antibody
E. Anti-centromere antibody
Answer: C. Thyroid-stimulating immunoglobulin
Rationale: Graves disease results from thyroid-stimulating immunoglobulins
that activate the TSH receptor, producing diffuse thyroid hormone
overproduction.
6. A 45-year-old man with cirrhosis presents with hematemesis and
hypotension. After initial stabilization, which medication should be started
promptly to reduce portal hypertensive bleeding?
A. Propranolol orally
B. Octreotide intravenously
C. Aspirin
, D. Heparin
E. Mesalamine
Answer: B. Octreotide intravenously
Rationale: Acute suspected variceal hemorrhage should be treated with
vasoactive therapy such as octreotide, along with urgent endoscopic
evaluation and antibiotic prophylaxis.
7. A 29-year-old woman develops fever, hypotension, diffuse erythematous
rash, and multiorgan dysfunction during menstruation. She recently began
using highly absorbent tampons. Which organism is most likely responsible?
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Escherichia coli
D. Neisseria meningitidis
E. Clostridioides difficile
Answer: B. Staphylococcus aureus
Rationale: Menstrual toxic shock syndrome is classically associated with
toxin-producing Staphylococcus aureus and causes fever, hypotension, rash,
and multisystem involvement.
8. A 61-year-old man with COPD has worsening dyspnea, increased sputum
volume, and purulent sputum. Which intervention most directly improves
outcomes during an acute exacerbation?
A. Long-term oxygen regardless of oxygen saturation
B. Short-acting bronchodilators and systemic corticosteroids
C. Inhaled corticosteroid monotherapy
