ABIM Internal Medicine Boards & ITE Exam
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
SECTION 1: CARDIOVASCULAR DISEASE (14-15% of Exam)
1. A 55-year-old woman with no prior cardiac history presents with palpitations
and lightheadedness. ECG shows an irregularly irregular rhythm with no
discernible P-waves. What is the most appropriate initial management if
hemodynamically stable?
- A) Immediate cardioversion
- B) Rate control with metoprolol
- C) Radiofrequency ablation
- D) Aspirin only
Correct Answer: B) Rate control with metoprolol
Rationale: This ECG is classic for atrial fibrillation. In a hemodynamically stable
patient, the initial priority is rate control to manage symptoms . Anticoagulation
decisions should follow based on CHA2DS2-VASc score.
1
,2. A 65-year-old man with hypertension and diabetes presents with acute onset of
severe, tearing chest pain radiating to his back. Blood pressure is 180/100 mmHg
in the right arm and 110/70 mmHg in the left arm. What is the most likely
diagnosis?
- A) Acute Myocardial Infarction
- B) Pulmonary Embolism
- C) Aortic Dissection
- D) Pericarditis
Correct Answer: C) Aortic Dissection
Rationale: Aortic dissection classically presents with sudden, severe "tearing" chest
pain radiating to the back, often with a pulse deficit or blood pressure differential
between arms .
3. Which of the following is the most appropriate first-line therapy for a patient
with newly diagnosed heart failure with reduced ejection fraction (HFrEF)?
- A) Furosemide
- B) Carvedilol
- C) Lisinopril (ACE inhibitor)
- D) Digoxin
2
,Correct Answer: C) Lisinopril
Rationale: ACE inhibitors are foundational therapy for HFrEF as they have been
proven to reduce mortality and hospitalizations .
4. A 52-year-old male presents with chest pain that occurs at rest and is associated
with transient ST-segment elevation on ECG. Which is most likely?
- A) Stable angina
- B) Unstable angina
- C) Prinzmetal's angina (vasospastic)
- D) NSTEMI
Correct Answer: C) Prinzmetal's angina
Rationale: Prinzmetal's angina is characterized by chest pain at rest with transient
ST-segment elevation due to coronary artery vasospasm. Unlike stable angina, it is
not associated with exertion .
5. Which finding on ECG is most specific for acute pericarditis?
3
, - A) ST-segment elevation in all leads
- B) PR-segment depression
- C) Diffuse ST-segment elevation with PR-segment depression
- D) Q waves
Correct Answer: C) Diffuse ST-segment elevation with PR-segment depression
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation
(concave upward) with PR-segment depression across multiple leads. This
distinguishes it from MI .
6. A 70-year-old man with severe aortic stenosis (valve area 0.8 cm²) is
asymptomatic. What is the most appropriate management?
- A) Observation with yearly echocardiogram
- B) Aortic valve replacement
- C) Antibiotic prophylaxis
- D) Balloon valvuloplasty
Correct Answer: A) Observation with yearly echocardiogram
4
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
SECTION 1: CARDIOVASCULAR DISEASE (14-15% of Exam)
1. A 55-year-old woman with no prior cardiac history presents with palpitations
and lightheadedness. ECG shows an irregularly irregular rhythm with no
discernible P-waves. What is the most appropriate initial management if
hemodynamically stable?
- A) Immediate cardioversion
- B) Rate control with metoprolol
- C) Radiofrequency ablation
- D) Aspirin only
Correct Answer: B) Rate control with metoprolol
Rationale: This ECG is classic for atrial fibrillation. In a hemodynamically stable
patient, the initial priority is rate control to manage symptoms . Anticoagulation
decisions should follow based on CHA2DS2-VASc score.
1
,2. A 65-year-old man with hypertension and diabetes presents with acute onset of
severe, tearing chest pain radiating to his back. Blood pressure is 180/100 mmHg
in the right arm and 110/70 mmHg in the left arm. What is the most likely
diagnosis?
- A) Acute Myocardial Infarction
- B) Pulmonary Embolism
- C) Aortic Dissection
- D) Pericarditis
Correct Answer: C) Aortic Dissection
Rationale: Aortic dissection classically presents with sudden, severe "tearing" chest
pain radiating to the back, often with a pulse deficit or blood pressure differential
between arms .
3. Which of the following is the most appropriate first-line therapy for a patient
with newly diagnosed heart failure with reduced ejection fraction (HFrEF)?
- A) Furosemide
- B) Carvedilol
- C) Lisinopril (ACE inhibitor)
- D) Digoxin
2
,Correct Answer: C) Lisinopril
Rationale: ACE inhibitors are foundational therapy for HFrEF as they have been
proven to reduce mortality and hospitalizations .
4. A 52-year-old male presents with chest pain that occurs at rest and is associated
with transient ST-segment elevation on ECG. Which is most likely?
- A) Stable angina
- B) Unstable angina
- C) Prinzmetal's angina (vasospastic)
- D) NSTEMI
Correct Answer: C) Prinzmetal's angina
Rationale: Prinzmetal's angina is characterized by chest pain at rest with transient
ST-segment elevation due to coronary artery vasospasm. Unlike stable angina, it is
not associated with exertion .
5. Which finding on ECG is most specific for acute pericarditis?
3
, - A) ST-segment elevation in all leads
- B) PR-segment depression
- C) Diffuse ST-segment elevation with PR-segment depression
- D) Q waves
Correct Answer: C) Diffuse ST-segment elevation with PR-segment depression
Rationale: Acute pericarditis is characterized by diffuse ST-segment elevation
(concave upward) with PR-segment depression across multiple leads. This
distinguishes it from MI .
6. A 70-year-old man with severe aortic stenosis (valve area 0.8 cm²) is
asymptomatic. What is the most appropriate management?
- A) Observation with yearly echocardiogram
- B) Aortic valve replacement
- C) Antibiotic prophylaxis
- D) Balloon valvuloplasty
Correct Answer: A) Observation with yearly echocardiogram
4
