ABIM IM BOARDS ITE EXAM LATEST VERSION 2025-
2026 ACTUAL EXAM 180 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY
GRADED A+
CSF PCR in Herpes simplex encephalitis - CORRECT ANS-Early CSF PCR may be falsely negative in early
stage of disease, and should be repeated in 3-7 days.
HSV -1 encephalitis imaging - CORRECT ANS-necrotizing infection of the temporal lobes, neuroimaging
reveals inflammation of one or both temporal lobes
adjunctive therapy to bacterial meningitis, suspected to be secondary to streptococcus - CORRECT ANS-
Dexamethasone, improves outcome. Give 15 mins prior to initiation of antimicrobials
Severe C.diff definition - CORRECT ANS-WBC
>15,000 Cr >1.5
Treat with oral vancomycin
mycobacterial skin infection from nail salons, whirlpool footbaths - CORRECT ANS-mycobacterium
fortuitum
Anaplasmosis - CORRECT ANS-Fever, leucopenia, thrombocytopenia , elevated
LFTs Best treated with Doxycycline (amoxicillin not effective)
chlamydia, gonorrhea cervicitis/urethritis treatment - CORRECT ANS-Chlamydia- one dose azithromycin
(preferred to 7-day doxycycline)
Gonorrhea - Give Ceftriaxone and Azithromycin, as there is usually concomitant chlamydia infection
Lyme arthritis exclusion - CORRECT ANS-Symptoms present for more than 1
month Western Blot IgG negative
,Management asymptomatic babesiosis - CORRECT ANS-No treatment. Repeat PCR in 3 months to check
for clearance of parasite
Pre-exposure HIV prophylaxis - CORRECT ANS-Emtricitabine-Tenofovir
non-erosive arthritis caused by SLE - CORRECT ANS-Jaccoud's arthropathy
moderate osteoarthritis/gout flare with one symptomatic joint - CORRECT ANS-targeted therapy with
intra- articular steroids as long as infections ruled out
Severe HSP in adults treatment - CORRECT ANS-Prednisone
Biologic DMARDS - CORRECT ANS-Anakinra,Anti-TNF: Etanercept, Infliximab,
Adalimumab Non Anti-TNF: Rituximab, Abatacept
Non-biologic DMARDS - CORRECT ANS-Methotrexate, Leflunomide, Hydroxychloroquine, Sulfasalazine,
Azathioprine
Neonatal risk of mother positive for anti-Ro/SSA or anti-La/SSB - CORRECT ANS-Congenital heart block
Secondary osteoarthritis due to hemochromatosis presentatoin - CORRECT ANS-characteristically
involves the MCP and the wrist joints
Pulmonary complications of polymyositis with positive anti Jo-1 - CORRECT ANS-Interstitial lung disease
is strongly associated, patient may need CXR or high res CT Chest
Pts may also get aspiration pna, PAH
Goal uric acid level in gout - CORRECT ANS-less than 6, increase allopurinol gradually till goal achieved,
even in CKD
treatment giant cel arthritis - CORRECT ANS-Prednisone 60mg/dayor 1mg/kg/day
, For PMR, patient can be on a lower dose 15mg/day (10 - 20mg/d)
malignancy associated with sjogren syndrome - CORRECT ANS-44X increased risk of Lymphoma. B-cell
lymphoma, MALT (obtain lymph node biopsy if new adenopathy)
ANCA associated vasculitides - CORRECT ANS-1. Granulomatosis with polyangiitis (Wegener's)
2. Microscopic polyangiitis
3. Eosinophilic granulomatosis with polyangiitis (churg-strauss)
treatment interstitial lung disease associated with systemic sclerosis - CORRECT ANS-cyclophosphamide
gold standard new pt with gout symptoms - CORRECT ANS-joint aspiration, to establish diagnosis and
rule out infection
Eosinophilic granulomatosis with polyangiitis presentation - CORRECT ANS-Eosinophilia
Migratory pulmonary infiltrates
mononeuritis multiplex
Purpuric skin rash
+in setting of antecedent atopy
DISH (diffuse idiopathic skeletal hyperostosis) or Forestier disease - CORRECT ANS-Flowing osteophytes
seen on radiography
treatment kerratoconjunctivitis sicca not responding to artifical tears of punctal plug - CORRECT ANS-
cyclosporine eye drop
Cryoglobulinemic vasculitis - CORRECT ANS-Ear infarction (very common) as well as skin
infarctions Low C4 with normal C3 in presence of positive RF
about 90% are infected with hepatitis C
palpable purpura
2026 ACTUAL EXAM 180 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|ALREADY
GRADED A+
CSF PCR in Herpes simplex encephalitis - CORRECT ANS-Early CSF PCR may be falsely negative in early
stage of disease, and should be repeated in 3-7 days.
HSV -1 encephalitis imaging - CORRECT ANS-necrotizing infection of the temporal lobes, neuroimaging
reveals inflammation of one or both temporal lobes
adjunctive therapy to bacterial meningitis, suspected to be secondary to streptococcus - CORRECT ANS-
Dexamethasone, improves outcome. Give 15 mins prior to initiation of antimicrobials
Severe C.diff definition - CORRECT ANS-WBC
>15,000 Cr >1.5
Treat with oral vancomycin
mycobacterial skin infection from nail salons, whirlpool footbaths - CORRECT ANS-mycobacterium
fortuitum
Anaplasmosis - CORRECT ANS-Fever, leucopenia, thrombocytopenia , elevated
LFTs Best treated with Doxycycline (amoxicillin not effective)
chlamydia, gonorrhea cervicitis/urethritis treatment - CORRECT ANS-Chlamydia- one dose azithromycin
(preferred to 7-day doxycycline)
Gonorrhea - Give Ceftriaxone and Azithromycin, as there is usually concomitant chlamydia infection
Lyme arthritis exclusion - CORRECT ANS-Symptoms present for more than 1
month Western Blot IgG negative
,Management asymptomatic babesiosis - CORRECT ANS-No treatment. Repeat PCR in 3 months to check
for clearance of parasite
Pre-exposure HIV prophylaxis - CORRECT ANS-Emtricitabine-Tenofovir
non-erosive arthritis caused by SLE - CORRECT ANS-Jaccoud's arthropathy
moderate osteoarthritis/gout flare with one symptomatic joint - CORRECT ANS-targeted therapy with
intra- articular steroids as long as infections ruled out
Severe HSP in adults treatment - CORRECT ANS-Prednisone
Biologic DMARDS - CORRECT ANS-Anakinra,Anti-TNF: Etanercept, Infliximab,
Adalimumab Non Anti-TNF: Rituximab, Abatacept
Non-biologic DMARDS - CORRECT ANS-Methotrexate, Leflunomide, Hydroxychloroquine, Sulfasalazine,
Azathioprine
Neonatal risk of mother positive for anti-Ro/SSA or anti-La/SSB - CORRECT ANS-Congenital heart block
Secondary osteoarthritis due to hemochromatosis presentatoin - CORRECT ANS-characteristically
involves the MCP and the wrist joints
Pulmonary complications of polymyositis with positive anti Jo-1 - CORRECT ANS-Interstitial lung disease
is strongly associated, patient may need CXR or high res CT Chest
Pts may also get aspiration pna, PAH
Goal uric acid level in gout - CORRECT ANS-less than 6, increase allopurinol gradually till goal achieved,
even in CKD
treatment giant cel arthritis - CORRECT ANS-Prednisone 60mg/dayor 1mg/kg/day
, For PMR, patient can be on a lower dose 15mg/day (10 - 20mg/d)
malignancy associated with sjogren syndrome - CORRECT ANS-44X increased risk of Lymphoma. B-cell
lymphoma, MALT (obtain lymph node biopsy if new adenopathy)
ANCA associated vasculitides - CORRECT ANS-1. Granulomatosis with polyangiitis (Wegener's)
2. Microscopic polyangiitis
3. Eosinophilic granulomatosis with polyangiitis (churg-strauss)
treatment interstitial lung disease associated with systemic sclerosis - CORRECT ANS-cyclophosphamide
gold standard new pt with gout symptoms - CORRECT ANS-joint aspiration, to establish diagnosis and
rule out infection
Eosinophilic granulomatosis with polyangiitis presentation - CORRECT ANS-Eosinophilia
Migratory pulmonary infiltrates
mononeuritis multiplex
Purpuric skin rash
+in setting of antecedent atopy
DISH (diffuse idiopathic skeletal hyperostosis) or Forestier disease - CORRECT ANS-Flowing osteophytes
seen on radiography
treatment kerratoconjunctivitis sicca not responding to artifical tears of punctal plug - CORRECT ANS-
cyclosporine eye drop
Cryoglobulinemic vasculitis - CORRECT ANS-Ear infarction (very common) as well as skin
infarctions Low C4 with normal C3 in presence of positive RF
about 90% are infected with hepatitis C
palpable purpura
