INTERNAL MEDICINE BOARD REVIEW | ABIM BOARD REVIEW PRACTICE QUESTIONS & ANSWERS |
COMPREHENSIVE INTERNAL MEDICINE EXAM PREP 2026/2027
Worst risk factor CAD - ANS ✔✔Diabetes Mellitus
Most common risk factor CAD - ANS ✔✔HTN
In patients with CAD, LDL cholesterol should be kept below...... - ANS ✔✔100mg/dL
Metabolic Syndrome X - ANS ✔✔-any combination of hyperlipidemia, HTN, hypertriglyceridemia,
glucose intolerance, diabetes, and hyperuricemia
- underlying mechanism is insulin resistance (d/t obesity)
Syndrome X - ANS ✔✔-Exertional Angina with normal coronary arteriogram
-presents with angina on exertion but have coronary artery stenosis at cardiac catheterization.
-exercise testing and nuclear imagine DOES show myocardial ischemia.
Exercise ischemia results in what EKG finding? - ANS ✔✔ST segment depression due to subendocardial
ischemia
Stress Echocardiography - ANS ✔✔-more sensitive than stress EKG. Can see wall motion abnormalities
such as akinesis or dyskinesis
-any positive stress test, send patient for cardiac catheterization.
Describe the purpose of Thallium 201 in stress tests - ANS ✔✔-IV administration of thallium 201 is used
to physically look for unperfused tissue.
-Viable cardiac muscle cells extract thallium 201 from blood. Any dead or unperfused areas will not show
any uptake.
Reversible ischemia may be rescued with..... - ANS ✔✔-Percutaneous Coronary intervention (PCI) or
coronary artery bypass graft (CABG)
Describe how IV adenosine and dipyridamole work in a pharmacologic stress test - ANS ✔✔-adenosine
and dipyridamole cause generalized coronary vasodilation. Because coronary vessels in underperfused
regions are already maximally dilated, this generalized vasodilation results in an overall decrease in
blood flow to ischemic areas due to the phenomenon of coronary steal.
Describe how Dobutamine works in a stress test. - ANS ✔✔-dobutamine works in a cardiac stress test by
increasing cardiac oxygen demand by increasing HR, BP, and cardiac contractility.
What are 5 indications for cardiac catheterizations. - ANS ✔✔1) after a positive stress test
2) Acute MI with intent of performing angiogram and PCI
3) Noninvasive tests are non-diagnostic, angina that occurs despite medical therapy, angina that occurs
soon after MI, and angina that is a diagnostic dilemma.
4) Severely symptomatic and urgent diagnosis and management are necessary.
, 5) Evaluation of valvular disease and determine need for surgical intervention.
Standard of care for stable angina - ANS ✔✔1) Aspirin (decreases risk of MI)
2) B-Blockers (lowers mortality)
-Atenolol and metoprolol
3) Nitrates for chest pains.
- CCB's second line treatment if B-blockers not fully effective. Cause generalized vasodilation and
decrease after load. May actually increase mortality due to increased HR.
- If CHF also present, ACE-inhibitors and or diuretics indicated
Side effects of nitrates - ANS ✔✔1) TOLERANCE
2) Headaches
3) Syncope
4) Orthostatic Hypotension
How does USA differ from stable angina - ANS ✔✔Stable angina- due to increased oxygen demand for
heart
Unstable angina- Due to decreased perfusion of heart muscle. Due to stenosed artery. Treatment is same
as MI without fibrinolysis
How does USA differ from NSTEMI? - ANS ✔✔NSTEMI will have elevated troponin and CK-MB. EKG
findings are the same.
Management of USA - ANS ✔✔-Aspirin, clopidogrel, oxygen, LMWH (for at least 2 days), nitrates, b-
blockers, electrolyte replacement.
-If symptoms improve after medical management, perform a stress test to evaluate need for
catheterization
-If symptoms persist after medical intervention, send directly for cardiac catheterization.
-continue treatment with Aspirin or other anti-platelet therapy, b-blocker, and nitrates. talk about
lifestyle modification and treat HTN and hyperlipidemia regardless of LDL level.
Which is the most sensitive and specific enzyme to order for acute MI? - ANS ✔✔Troponin I and T
elevated within 3-5 hours, returns to baseline after 5-14 days
Which cardiac enzyme is important for evaluating for recurrent MI - ANS ✔✔CK-MB is better than
troponin I or T due to its quicker return to baseline. Usually within 2-3 days as opposed to 5-14 days with
troponin I or T.
Dressler syndrome - ANS ✔✔Occurs within a few weeks or months after MI. Consists of fever, malaise,
pericarditis, leukocytosis and pleuritis.
Best treatment is aspirin, Ibuprofen is second option.
Tests to order for patient with suspected CHF - ANS ✔✔1) chest x-ray to look for cardiomegaly,
pulmonary edema and rule out COPD
COMPREHENSIVE INTERNAL MEDICINE EXAM PREP 2026/2027
Worst risk factor CAD - ANS ✔✔Diabetes Mellitus
Most common risk factor CAD - ANS ✔✔HTN
In patients with CAD, LDL cholesterol should be kept below...... - ANS ✔✔100mg/dL
Metabolic Syndrome X - ANS ✔✔-any combination of hyperlipidemia, HTN, hypertriglyceridemia,
glucose intolerance, diabetes, and hyperuricemia
- underlying mechanism is insulin resistance (d/t obesity)
Syndrome X - ANS ✔✔-Exertional Angina with normal coronary arteriogram
-presents with angina on exertion but have coronary artery stenosis at cardiac catheterization.
-exercise testing and nuclear imagine DOES show myocardial ischemia.
Exercise ischemia results in what EKG finding? - ANS ✔✔ST segment depression due to subendocardial
ischemia
Stress Echocardiography - ANS ✔✔-more sensitive than stress EKG. Can see wall motion abnormalities
such as akinesis or dyskinesis
-any positive stress test, send patient for cardiac catheterization.
Describe the purpose of Thallium 201 in stress tests - ANS ✔✔-IV administration of thallium 201 is used
to physically look for unperfused tissue.
-Viable cardiac muscle cells extract thallium 201 from blood. Any dead or unperfused areas will not show
any uptake.
Reversible ischemia may be rescued with..... - ANS ✔✔-Percutaneous Coronary intervention (PCI) or
coronary artery bypass graft (CABG)
Describe how IV adenosine and dipyridamole work in a pharmacologic stress test - ANS ✔✔-adenosine
and dipyridamole cause generalized coronary vasodilation. Because coronary vessels in underperfused
regions are already maximally dilated, this generalized vasodilation results in an overall decrease in
blood flow to ischemic areas due to the phenomenon of coronary steal.
Describe how Dobutamine works in a stress test. - ANS ✔✔-dobutamine works in a cardiac stress test by
increasing cardiac oxygen demand by increasing HR, BP, and cardiac contractility.
What are 5 indications for cardiac catheterizations. - ANS ✔✔1) after a positive stress test
2) Acute MI with intent of performing angiogram and PCI
3) Noninvasive tests are non-diagnostic, angina that occurs despite medical therapy, angina that occurs
soon after MI, and angina that is a diagnostic dilemma.
4) Severely symptomatic and urgent diagnosis and management are necessary.
, 5) Evaluation of valvular disease and determine need for surgical intervention.
Standard of care for stable angina - ANS ✔✔1) Aspirin (decreases risk of MI)
2) B-Blockers (lowers mortality)
-Atenolol and metoprolol
3) Nitrates for chest pains.
- CCB's second line treatment if B-blockers not fully effective. Cause generalized vasodilation and
decrease after load. May actually increase mortality due to increased HR.
- If CHF also present, ACE-inhibitors and or diuretics indicated
Side effects of nitrates - ANS ✔✔1) TOLERANCE
2) Headaches
3) Syncope
4) Orthostatic Hypotension
How does USA differ from stable angina - ANS ✔✔Stable angina- due to increased oxygen demand for
heart
Unstable angina- Due to decreased perfusion of heart muscle. Due to stenosed artery. Treatment is same
as MI without fibrinolysis
How does USA differ from NSTEMI? - ANS ✔✔NSTEMI will have elevated troponin and CK-MB. EKG
findings are the same.
Management of USA - ANS ✔✔-Aspirin, clopidogrel, oxygen, LMWH (for at least 2 days), nitrates, b-
blockers, electrolyte replacement.
-If symptoms improve after medical management, perform a stress test to evaluate need for
catheterization
-If symptoms persist after medical intervention, send directly for cardiac catheterization.
-continue treatment with Aspirin or other anti-platelet therapy, b-blocker, and nitrates. talk about
lifestyle modification and treat HTN and hyperlipidemia regardless of LDL level.
Which is the most sensitive and specific enzyme to order for acute MI? - ANS ✔✔Troponin I and T
elevated within 3-5 hours, returns to baseline after 5-14 days
Which cardiac enzyme is important for evaluating for recurrent MI - ANS ✔✔CK-MB is better than
troponin I or T due to its quicker return to baseline. Usually within 2-3 days as opposed to 5-14 days with
troponin I or T.
Dressler syndrome - ANS ✔✔Occurs within a few weeks or months after MI. Consists of fever, malaise,
pericarditis, leukocytosis and pleuritis.
Best treatment is aspirin, Ibuprofen is second option.
Tests to order for patient with suspected CHF - ANS ✔✔1) chest x-ray to look for cardiomegaly,
pulmonary edema and rule out COPD
