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ABIM IM (Internal Medicine) BOARDS ITE Exam
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
ABIM Internal Medicine Boards & ITE Exam Practice Questions
10 Most Tested Exam Coverage Areas
1. Cardiovascular Disease (14-15%) - HFrEF guideline-directed therapy (ARNI, SGLT2i, CRT criteria),
acute coronary syndromes, atrial fibrillation anticoagulation (CHA₂DS₂-VASc, DOAC selection),
valvular heart disease, cardiac tamponade, aortic dissection
2. Endocrinology, Diabetes & Metabolism (9-10%) - Type 2 diabetes medication updates
(SGLT2i/GLP-1 RA cardiovascular benefits), thyroid disorders (Graves' disease, hypothyroidism),
adrenal insufficiency (Addison disease, Cushing syndrome), hyperparathyroidism
3. Gastroenterology (9-10%) - Cirrhosis complications (hepatic encephalopathy, SBP, ascites, HRS),
hepatitis B/C screening and management, inflammatory bowel disease, pancreatic insufficiency,
Barrett's esophagus
4. Infectious Disease (9-10%) - Sepsis management (Surviving Sepsis Campaign), community-
acquired pneumonia, infective endocarditis, HIV/AIDS (ART, opportunistic infections),
meningitis, C. difficile infection
5. Pulmonary Disease (8-9%) - COPD exacerbations, asthma management, acute respiratory
distress syndrome (lung-protective ventilation, prone positioning), pulmonary embolism (risk
stratification, anticoagulation), lung cancer screening (USPSTF criteria)
6. Rheumatology & Orthopedics (9-10%) - Rheumatoid arthritis (DMARD selection), systemic lupus
erythematosus, gout, polymyalgia rheumatica/giant cell arteritis, spondyloarthropathies,
vasculitides
7. Hematology (4-6%) - Anemia (iron deficiency, anemia of chronic disease, hemolytic), multiple
myeloma, myelodysplastic syndrome, myeloproliferative neoplasms, transfusion medicine
8. Medical Oncology (6%) - Breast cancer screening, colorectal cancer screening, lung cancer
(EGFR mutations, targeted therapy), prostate cancer, tumor lysis syndrome, spinal cord
compression
9. Nephrology & Urology (6%) - Acute kidney injury (prerenal, intrinsic, postrenal), chronic kidney
disease, glomerulonephritis, nephrolithiasis, hypertension management, electrolyte disorders
(hyponatremia, hyperkalemia)
10. Neurology (4%) - Stroke (tPA criteria), transient ischemic attack, headache, Parkinson's disease,
multiple sclerosis, seizure disorders, Alzheimer's disease/dementia
ABIM Board-Style Questions with Answers and Rationales
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Question 1
A 64-year-old man with a history of hypertension and type 2 diabetes presents with progressive dyspnea
on exertion and bilateral lower extremity edema. Echocardiography demonstrates a left ventricular
ejection fraction of 32% with global hypokinesis. Coronary angiography shows nonobstructive coronary
artery disease. He is started on guideline-directed medical therapy but remains symptomatic. Which
additional medication class has been shown to reduce cardiovascular death and heart failure
hospitalizations in patients with heart failure with reduced ejection fraction regardless of diabetes status
according to the "four-pillar" approach?
• A) Metformin
• B) Dapagliflozin
• C) Pioglitazone
• D) Glipizide
Answer: B
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) have demonstrated cardiovascular benefits in
patients with HFrEF, reducing cardiovascular death and heart failure hospitalization regardless of
diabetes status. This is a key component of the "four-pillar" HFrEF therapy along with ARNI, beta-
blockers, and mineralocorticoid receptor antagonists.
Question 2
A 45-year-old woman who is 28 weeks pregnant presents for routine prenatal care. She received a Tdap
vaccination during her previous pregnancy two years ago. According to current recommendations,
which of the following is the most appropriate management regarding Tdap vaccination for this patient?
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• A) Tdap is not indicated this pregnancy since she received it during her previous pregnancy
• B) Administer Tdap between 27 and 36 weeks gestation during this pregnancy
• C) Administer Tdap only if she has not received it within the last 5 years
• D) Administer Tdap in the immediate postpartum period
Answer: B
Rationale: Tdap vaccination is recommended during every pregnancy, ideally between 27 and 36 weeks
gestation, regardless of prior receipt. This optimizes maternal antibody transfer to the fetus.
Question 3
A 69-year-old man with a 45-pack-year smoking history presents for a routine health maintenance visit.
He quit smoking 12 years ago. He has no respiratory symptoms. According to current USPSTF guidelines,
which of the following is the most appropriate lung cancer screening recommendation for this patient?
• A) Annual low-dose CT chest for patients ages 55-80 with ≥30 pack-year history, including those
who quit within 15 years
• B) Annual chest radiograph for all smokers over age 50
• C) Low-dose CT chest only if symptoms develop
• D) No screening is recommended as he quit >10 years ago
Answer: A
Rationale: Annual low-dose CT screening for lung cancer is recommended for adults ages 55-80 with a
30-pack-year smoking history, including those who quit within the past 15 years. This patient meets
criteria.
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Question 4
A 56-year-old man with newly diagnosed type 2 diabetes mellitus and an LDL cholesterol of 110 mg/dL
has a calculated 10-year ASCVD risk of 8.5%. According to current guidelines, which of the following is
the most appropriate statin intensity for this patient?
• A) No statin indicated as LDL is <130 mg/dL
• B) Low-intensity statin
• C) Moderate-intensity statin
• D) High-intensity statin
Answer: D
Rationale: For patients aged 40-75 with diabetes and LDL 70-189 mg/dL with a 10-year ASCVD risk
≥7.5%, high-intensity statin therapy is recommended.
Question 5
A 52-year-old woman with a history of migraines with visual aura is inquiring about hormonal
contraception for perimenopausal symptoms. Which of the following is the most significant concern
regarding combined hormonal contraception in this patient?
• A) Worsening of migraine frequency
• B) Increased risk of venous thromboembolism
• C) Increased risk of ischemic stroke
ABIM IM (Internal Medicine) BOARDS ITE Exam
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
ABIM Internal Medicine Boards & ITE Exam Practice Questions
10 Most Tested Exam Coverage Areas
1. Cardiovascular Disease (14-15%) - HFrEF guideline-directed therapy (ARNI, SGLT2i, CRT criteria),
acute coronary syndromes, atrial fibrillation anticoagulation (CHA₂DS₂-VASc, DOAC selection),
valvular heart disease, cardiac tamponade, aortic dissection
2. Endocrinology, Diabetes & Metabolism (9-10%) - Type 2 diabetes medication updates
(SGLT2i/GLP-1 RA cardiovascular benefits), thyroid disorders (Graves' disease, hypothyroidism),
adrenal insufficiency (Addison disease, Cushing syndrome), hyperparathyroidism
3. Gastroenterology (9-10%) - Cirrhosis complications (hepatic encephalopathy, SBP, ascites, HRS),
hepatitis B/C screening and management, inflammatory bowel disease, pancreatic insufficiency,
Barrett's esophagus
4. Infectious Disease (9-10%) - Sepsis management (Surviving Sepsis Campaign), community-
acquired pneumonia, infective endocarditis, HIV/AIDS (ART, opportunistic infections),
meningitis, C. difficile infection
5. Pulmonary Disease (8-9%) - COPD exacerbations, asthma management, acute respiratory
distress syndrome (lung-protective ventilation, prone positioning), pulmonary embolism (risk
stratification, anticoagulation), lung cancer screening (USPSTF criteria)
6. Rheumatology & Orthopedics (9-10%) - Rheumatoid arthritis (DMARD selection), systemic lupus
erythematosus, gout, polymyalgia rheumatica/giant cell arteritis, spondyloarthropathies,
vasculitides
7. Hematology (4-6%) - Anemia (iron deficiency, anemia of chronic disease, hemolytic), multiple
myeloma, myelodysplastic syndrome, myeloproliferative neoplasms, transfusion medicine
8. Medical Oncology (6%) - Breast cancer screening, colorectal cancer screening, lung cancer
(EGFR mutations, targeted therapy), prostate cancer, tumor lysis syndrome, spinal cord
compression
9. Nephrology & Urology (6%) - Acute kidney injury (prerenal, intrinsic, postrenal), chronic kidney
disease, glomerulonephritis, nephrolithiasis, hypertension management, electrolyte disorders
(hyponatremia, hyperkalemia)
10. Neurology (4%) - Stroke (tPA criteria), transient ischemic attack, headache, Parkinson's disease,
multiple sclerosis, seizure disorders, Alzheimer's disease/dementia
ABIM Board-Style Questions with Answers and Rationales
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Question 1
A 64-year-old man with a history of hypertension and type 2 diabetes presents with progressive dyspnea
on exertion and bilateral lower extremity edema. Echocardiography demonstrates a left ventricular
ejection fraction of 32% with global hypokinesis. Coronary angiography shows nonobstructive coronary
artery disease. He is started on guideline-directed medical therapy but remains symptomatic. Which
additional medication class has been shown to reduce cardiovascular death and heart failure
hospitalizations in patients with heart failure with reduced ejection fraction regardless of diabetes status
according to the "four-pillar" approach?
• A) Metformin
• B) Dapagliflozin
• C) Pioglitazone
• D) Glipizide
Answer: B
Rationale: SGLT2 inhibitors (dapagliflozin, empagliflozin) have demonstrated cardiovascular benefits in
patients with HFrEF, reducing cardiovascular death and heart failure hospitalization regardless of
diabetes status. This is a key component of the "four-pillar" HFrEF therapy along with ARNI, beta-
blockers, and mineralocorticoid receptor antagonists.
Question 2
A 45-year-old woman who is 28 weeks pregnant presents for routine prenatal care. She received a Tdap
vaccination during her previous pregnancy two years ago. According to current recommendations,
which of the following is the most appropriate management regarding Tdap vaccination for this patient?
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• A) Tdap is not indicated this pregnancy since she received it during her previous pregnancy
• B) Administer Tdap between 27 and 36 weeks gestation during this pregnancy
• C) Administer Tdap only if she has not received it within the last 5 years
• D) Administer Tdap in the immediate postpartum period
Answer: B
Rationale: Tdap vaccination is recommended during every pregnancy, ideally between 27 and 36 weeks
gestation, regardless of prior receipt. This optimizes maternal antibody transfer to the fetus.
Question 3
A 69-year-old man with a 45-pack-year smoking history presents for a routine health maintenance visit.
He quit smoking 12 years ago. He has no respiratory symptoms. According to current USPSTF guidelines,
which of the following is the most appropriate lung cancer screening recommendation for this patient?
• A) Annual low-dose CT chest for patients ages 55-80 with ≥30 pack-year history, including those
who quit within 15 years
• B) Annual chest radiograph for all smokers over age 50
• C) Low-dose CT chest only if symptoms develop
• D) No screening is recommended as he quit >10 years ago
Answer: A
Rationale: Annual low-dose CT screening for lung cancer is recommended for adults ages 55-80 with a
30-pack-year smoking history, including those who quit within the past 15 years. This patient meets
criteria.
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Question 4
A 56-year-old man with newly diagnosed type 2 diabetes mellitus and an LDL cholesterol of 110 mg/dL
has a calculated 10-year ASCVD risk of 8.5%. According to current guidelines, which of the following is
the most appropriate statin intensity for this patient?
• A) No statin indicated as LDL is <130 mg/dL
• B) Low-intensity statin
• C) Moderate-intensity statin
• D) High-intensity statin
Answer: D
Rationale: For patients aged 40-75 with diabetes and LDL 70-189 mg/dL with a 10-year ASCVD risk
≥7.5%, high-intensity statin therapy is recommended.
Question 5
A 52-year-old woman with a history of migraines with visual aura is inquiring about hormonal
contraception for perimenopausal symptoms. Which of the following is the most significant concern
regarding combined hormonal contraception in this patient?
• A) Worsening of migraine frequency
• B) Increased risk of venous thromboembolism
• C) Increased risk of ischemic stroke
