Page 1 of 170
ABIM Internal Medicine Boards WITH ITE QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
ABIM Internal Medicine Boards & ITE Exam Practice Questions (No Repeats)
10 Most Tested Exam Coverage Areas
1. Cardiovascular Disease – Acute coronary syndromes, heart failure (HFrEF/HFpEF), arrhythmias,
valvular disease, pericarditis, hypertension, dyslipidemia
2. Gastroenterology – Cirrhosis complications (HE, ascites, SBP, HRS), GI bleeding, IBD,
pancreatitis, hepatitis, hepatocellular carcinoma
3. Pulmonary Disease – COPD, asthma, ILD, PE, pneumonia, lung cancer screening, OSA, pleural
disease
4. Infectious Disease – Sepsis, pneumonia, HIV, endocarditis, osteomyelitis, UTIs, C. difficile,
cellulitis, antimicrobial stewardship
5. Endocrinology – Diabetes management, thyroid disorders, adrenal insufficiency, osteoporosis,
hypercalcemia, pituitary disorders
6. Hematology & Oncology – Anemia, thrombocytopenia, coagulopathies, breast/lung/colorectal
cancer, leukemia, lymphoma, chemotherapy side effects
7. Rheumatology – RA, SLE, vasculitis, gout, spondyloarthropathies, polymyalgia rheumatica, giant
cell arteritis, Sjögren's syndrome
8. Nephrology – AKI, CKD, electrolyte disorders, acid-base disorders, glomerulonephritis,
nephrolithiasis, renal tubular acidosis
9. Neurology & Psychiatry – Stroke, TIA, seizures, dementia, headache, Parkinson's disease,
multiple sclerosis, depression, anxiety, delirium
10. Patient Safety, Ethics, & Epidemiology – Informed consent, diagnostic errors, infection control,
screening guidelines, biostatistics, end-of-life care
Question 1: A 52-year-old woman with breast cancer is undergoing chemotherapy with doxorubicin and
cyclophosphamide. She presents with dyspnea on exertion, orthopnea, and peripheral edema.
Echocardiogram shows a left ventricular ejection fraction of 35%, down from 55% before chemotherapy.
What is the most likely diagnosis?
, Page 2 of 170
A) Pulmonary embolism
B) Radiation pneumonitis
C) Anthracycline-induced cardiomyopathy
D) Pericardial effusion
Answer: C) Anthracycline-induced cardiomyopathy
Rationale: Doxorubicin is an anthracycline that causes dose-dependent cardiotoxicity, leading to dilated
cardiomyopathy and heart failure. The decline in LVEF with symptoms of heart failure in a patient
receiving doxorubicin is classic for anthracycline-induced cardiomyopathy. Radiation pneumonitis (B)
presents with cough and dyspnea but not typically with reduced EF .
Question 2: A 58-year-old patient with cirrhosis and ascites develops acute kidney injury with a serum
creatinine of 2.1 mg/dL (baseline 0.9). Urine sodium is <10 mEq/L and FENa is <1%. Despite volume
resuscitation with albumin, the creatinine continues to rise. What is the most likely diagnosis?
A) Acute tubular necrosis
B) Hepatorenal syndrome
C) Prerenal azotemia
D) Postrenal obstruction
Answer: B) Hepatorenal syndrome
, Page 3 of 170
Rationale: Hepatorenal syndrome (HRS) is a diagnosis of exclusion in cirrhosis with ascites and AKI.
Findings include low urine sodium (<10), FENa <1%, absence of shock, and no improvement after volume
expansion. The lack of response to albumin distinguishes HRS from prerenal azotemia (C). ATN (A)
typically shows FENa >1 .
Question 3: A 72-year-old patient with heart failure with preserved ejection fraction (HFpEF) presents
with worsening dyspnea, peripheral edema, and fatigue. Which medication has been shown to reduce
heart failure hospitalizations in HFpEF?
A) Spironolactone
B) Entresto (sacubitril/valsartan)
C) Empagliflozin
D) Digoxin
Answer: C) Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated benefit in reducing HF
hospitalization in patients with HFpEF. This is a recent practice-changing trial finding. Spironolactone has
mixed results in HFpEF. Entresto is approved for HFrEF. Digoxin is not used for HFpEF .
, Page 4 of 170
Question 4: A 45-year-old patient with systemic lupus erythematosus presents with pleuritic chest pain,
fever, and a pericardial friction rub. Echocardiogram shows a moderate pericardial effusion without
tamponade. What is the most appropriate initial treatment?
A) High-dose corticosteroids
B) NSAIDs and colchicine
C) Pericardiocentesis
D) Immunosuppressive therapy
Answer: B) NSAIDs and colchicine
Rationale: In SLE-related pericarditis without tamponade, NSAIDs and colchicine are first-line therapy.
High-dose corticosteroids may be needed for refractory cases but increase risk of SLE flare.
Pericardiocentesis is reserved for tamponade or diagnostic uncertainty .
Question 5: A 68-year-old patient with nonvalvular atrial fibrillation has a CHA₂DS₂-VASc score of 4
(hypertension, diabetes, prior stroke, age >75). Which anticoagulant is preferred for stroke prevention?
A) Aspirin 81 mg daily
B) Warfarin with target INR 2-3
C) Apixaban
D) Clopidogrel
ABIM Internal Medicine Boards WITH ITE QUESTIONS
AND VERIFIED ANSWERS WITH RATIONALES JUST
RELEASED
ABIM Internal Medicine Boards & ITE Exam Practice Questions (No Repeats)
10 Most Tested Exam Coverage Areas
1. Cardiovascular Disease – Acute coronary syndromes, heart failure (HFrEF/HFpEF), arrhythmias,
valvular disease, pericarditis, hypertension, dyslipidemia
2. Gastroenterology – Cirrhosis complications (HE, ascites, SBP, HRS), GI bleeding, IBD,
pancreatitis, hepatitis, hepatocellular carcinoma
3. Pulmonary Disease – COPD, asthma, ILD, PE, pneumonia, lung cancer screening, OSA, pleural
disease
4. Infectious Disease – Sepsis, pneumonia, HIV, endocarditis, osteomyelitis, UTIs, C. difficile,
cellulitis, antimicrobial stewardship
5. Endocrinology – Diabetes management, thyroid disorders, adrenal insufficiency, osteoporosis,
hypercalcemia, pituitary disorders
6. Hematology & Oncology – Anemia, thrombocytopenia, coagulopathies, breast/lung/colorectal
cancer, leukemia, lymphoma, chemotherapy side effects
7. Rheumatology – RA, SLE, vasculitis, gout, spondyloarthropathies, polymyalgia rheumatica, giant
cell arteritis, Sjögren's syndrome
8. Nephrology – AKI, CKD, electrolyte disorders, acid-base disorders, glomerulonephritis,
nephrolithiasis, renal tubular acidosis
9. Neurology & Psychiatry – Stroke, TIA, seizures, dementia, headache, Parkinson's disease,
multiple sclerosis, depression, anxiety, delirium
10. Patient Safety, Ethics, & Epidemiology – Informed consent, diagnostic errors, infection control,
screening guidelines, biostatistics, end-of-life care
Question 1: A 52-year-old woman with breast cancer is undergoing chemotherapy with doxorubicin and
cyclophosphamide. She presents with dyspnea on exertion, orthopnea, and peripheral edema.
Echocardiogram shows a left ventricular ejection fraction of 35%, down from 55% before chemotherapy.
What is the most likely diagnosis?
, Page 2 of 170
A) Pulmonary embolism
B) Radiation pneumonitis
C) Anthracycline-induced cardiomyopathy
D) Pericardial effusion
Answer: C) Anthracycline-induced cardiomyopathy
Rationale: Doxorubicin is an anthracycline that causes dose-dependent cardiotoxicity, leading to dilated
cardiomyopathy and heart failure. The decline in LVEF with symptoms of heart failure in a patient
receiving doxorubicin is classic for anthracycline-induced cardiomyopathy. Radiation pneumonitis (B)
presents with cough and dyspnea but not typically with reduced EF .
Question 2: A 58-year-old patient with cirrhosis and ascites develops acute kidney injury with a serum
creatinine of 2.1 mg/dL (baseline 0.9). Urine sodium is <10 mEq/L and FENa is <1%. Despite volume
resuscitation with albumin, the creatinine continues to rise. What is the most likely diagnosis?
A) Acute tubular necrosis
B) Hepatorenal syndrome
C) Prerenal azotemia
D) Postrenal obstruction
Answer: B) Hepatorenal syndrome
, Page 3 of 170
Rationale: Hepatorenal syndrome (HRS) is a diagnosis of exclusion in cirrhosis with ascites and AKI.
Findings include low urine sodium (<10), FENa <1%, absence of shock, and no improvement after volume
expansion. The lack of response to albumin distinguishes HRS from prerenal azotemia (C). ATN (A)
typically shows FENa >1 .
Question 3: A 72-year-old patient with heart failure with preserved ejection fraction (HFpEF) presents
with worsening dyspnea, peripheral edema, and fatigue. Which medication has been shown to reduce
heart failure hospitalizations in HFpEF?
A) Spironolactone
B) Entresto (sacubitril/valsartan)
C) Empagliflozin
D) Digoxin
Answer: C) Empagliflozin
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have demonstrated benefit in reducing HF
hospitalization in patients with HFpEF. This is a recent practice-changing trial finding. Spironolactone has
mixed results in HFpEF. Entresto is approved for HFrEF. Digoxin is not used for HFpEF .
, Page 4 of 170
Question 4: A 45-year-old patient with systemic lupus erythematosus presents with pleuritic chest pain,
fever, and a pericardial friction rub. Echocardiogram shows a moderate pericardial effusion without
tamponade. What is the most appropriate initial treatment?
A) High-dose corticosteroids
B) NSAIDs and colchicine
C) Pericardiocentesis
D) Immunosuppressive therapy
Answer: B) NSAIDs and colchicine
Rationale: In SLE-related pericarditis without tamponade, NSAIDs and colchicine are first-line therapy.
High-dose corticosteroids may be needed for refractory cases but increase risk of SLE flare.
Pericardiocentesis is reserved for tamponade or diagnostic uncertainty .
Question 5: A 68-year-old patient with nonvalvular atrial fibrillation has a CHA₂DS₂-VASc score of 4
(hypertension, diabetes, prior stroke, age >75). Which anticoagulant is preferred for stroke prevention?
A) Aspirin 81 mg daily
B) Warfarin with target INR 2-3
C) Apixaban
D) Clopidogrel
