ABIM INTERNAL MEDICINE BOARDS & ITE EXAM – QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
CORE DOMAINS
• Cardiovascular Medicine
• Pulmonary and Critical Care Medicine
• Gastroenterology and Hepatology
• Nephrology and Electrolyte Disorders
• Infectious Diseases
• Endocrinology and Metabolism
• Hematology and Oncology
• Rheumatology and Musculoskeletal Medicine
• Neurology and General Internal Medicine
• Ethics, Patient Safety, and Preventive Medicine
INTRODUCTION
This ABIM Internal Medicine Boards & ITE Exam Practice Test is designed as an exam-
preparation resource covering major domains encountered in internal medicine training and
certification preparation. The questions assess clinical knowledge, diagnostic reasoning,
interpretation of investigations, treatment selection, preventive care, ethics, and evidence-based
decision-making. Scenario-based questions emphasize application of knowledge to realistic
patient presentations rather than simple recall. The Practice Questions are designed to help
learners identify knowledge gaps, strengthen clinical reasoning, and prepare systematically using
a structured Study Guide approach. This resource is intended for educational Exam Prep,
Practice Test, and Certification Preparation purposes.
SECTION ONE: QUESTIONS 1–50
1. A 67-year-old man with hypertension, type 2 diabetes mellitus, and hyperlipidemia
presents for routine follow-up. He has no history of atherosclerotic cardiovascular
disease. His LDL cholesterol is 148 mg/dL despite dietary counseling. Which
intervention is most appropriate to reduce his cardiovascular risk?
A. Begin low-dose aspirin therapy
B. Start a high-intensity statin
C. Begin niacin therapy
D. Start a fibrate
Correct Answer: B. Start a high-intensity statin
Rationale:
Patients with diabetes who are at increased cardiovascular risk benefit from statin therapy, and
,a high-intensity statin is appropriate when substantial LDL reduction is indicated. Aspirin is not
routinely recommended for primary prevention in all older adults because bleeding risk must be
considered.
2. A 54-year-old woman presents with episodic substernal chest pressure occurring with
exertion and resolving within 5 minutes of rest. Her ECG at rest is normal. Which
description best characterizes her symptoms?
A. Noncardiac chest pain
B. Atypical angina
C. Acute coronary syndrome
D. Typical stable angina
Correct Answer: D. Typical stable angina
Rationale:
Typical angina is characterized by substernal discomfort, provocation by exertion or emotional
stress, and relief with rest or nitroglycerin. This patient's predictable exertional symptoms meet
all three criteria.
3. A 72-year-old woman with atrial fibrillation has hypertension, diabetes, and a prior
ischemic stroke. Which therapy is most appropriate for long-term stroke prevention?
A. Oral anticoagulation
B. Aspirin alone
C. Clopidogrel alone
D. No antithrombotic therapy
Correct Answer: A. Oral anticoagulation
Rationale:
This patient has multiple major stroke-risk factors, including prior stroke, hypertension,
diabetes, age, and female sex. Oral anticoagulation provides substantially better stroke
prevention than antiplatelet therapy in atrial fibrillation.
4. A 63-year-old man presents with sudden-onset dyspnea and pleuritic chest pain 5 days
after knee replacement surgery. His heart rate is 118/min and oxygen saturation is 89%
on room air. Which diagnosis should be strongly suspected?
A. Acute pericarditis
B. Pneumonia
C. Pulmonary embolism
D. Stable angina
Correct Answer: C. Pulmonary embolism
,Rationale:
Recent major orthopedic surgery, tachycardia, hypoxemia, sudden dyspnea, and pleuritic chest
pain strongly suggest acute pulmonary embolism. Recent surgery is a major venous
thromboembolism risk factor.
5. A 45-year-old woman has fatigue, weight gain, constipation, dry skin, and cold
intolerance. Laboratory testing shows an elevated TSH and low free T4. What is the most
likely diagnosis?
A. Secondary hypothyroidism
B. Euthyroid sick syndrome
C. Subclinical hypothyroidism
D. Primary hypothyroidism
Correct Answer: D. Primary hypothyroidism
Rationale:
Primary hypothyroidism results from thyroid gland dysfunction and is characterized by low free
T4 with an elevated TSH because the pituitary increases stimulation of an underactive thyroid
gland.
6. A 70-year-old man with COPD presents with worsening dyspnea, increased sputum
production, and increased sputum purulence. Which treatment is most appropriate in
addition to bronchodilator therapy?
A. Long-term oxygen therapy for all patients
B. Short course of systemic corticosteroids and appropriate antibiotics
C. Immediate lung transplantation
D. Chronic oral corticosteroid therapy
Correct Answer: B. Short course of systemic corticosteroids and appropriate antibiotics
Rationale:
An acute COPD exacerbation with increased dyspnea, sputum volume, and sputum purulence is
commonly treated with systemic corticosteroids and antibiotics when bacterial infection is
suspected. Chronic systemic corticosteroids are generally avoided because of adverse effects.
7. A 59-year-old man with cirrhosis presents with hematemesis and hypotension.
Esophageal variceal bleeding is suspected. Which medication should be initiated
promptly while definitive endoscopic therapy is arranged?
A. Omeprazole alone
B. Propranolol alone
C. Lactulose
D. Octreotide
, Correct Answer: D. Octreotide
Rationale:
Octreotide reduces portal venous pressure and is used immediately in suspected acute variceal
hemorrhage. It should be combined with appropriate resuscitation, antibiotics, and urgent
endoscopic therapy.
8. A 34-year-old woman presents with dysuria and urinary frequency without fever, flank
pain, or vaginal symptoms. Urinalysis is positive for leukocyte esterase and nitrites.
Which diagnosis is most likely?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Nephrolithiasis
D. Interstitial cystitis
Correct Answer: A. Acute uncomplicated cystitis
Rationale:
Dysuria and urinary frequency without systemic symptoms or flank pain are typical of
uncomplicated lower urinary tract infection. Nitrites and leukocyte esterase further support
bacterial cystitis.
9. A 61-year-old man with chronic kidney disease has a serum potassium level of 6.9
mEq/L and peaked T waves on ECG. Which intervention should be performed
immediately?
A. Administer sodium polystyrene sulfonate alone
B. Begin oral potassium restriction
C. Administer intravenous calcium
D. Start a loop diuretic only
Correct Answer: C. Administer intravenous calcium
Rationale:
Severe hyperkalemia with ECG changes is a medical emergency. Intravenous calcium stabilizes
the cardiac membrane and reduces the immediate risk of fatal arrhythmia, although it does not
lower serum potassium.
10. A 29-year-old woman presents with fever, headache, neck stiffness, and photophobia.
Bacterial meningitis is suspected. Which action is most appropriate?
A. Wait for lumbar puncture results before treatment
B. Begin empiric intravenous antibiotics promptly
C. Treat with oral antibiotics
D. Observe without treatment until cultures are available
| VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST
CORE DOMAINS
• Cardiovascular Medicine
• Pulmonary and Critical Care Medicine
• Gastroenterology and Hepatology
• Nephrology and Electrolyte Disorders
• Infectious Diseases
• Endocrinology and Metabolism
• Hematology and Oncology
• Rheumatology and Musculoskeletal Medicine
• Neurology and General Internal Medicine
• Ethics, Patient Safety, and Preventive Medicine
INTRODUCTION
This ABIM Internal Medicine Boards & ITE Exam Practice Test is designed as an exam-
preparation resource covering major domains encountered in internal medicine training and
certification preparation. The questions assess clinical knowledge, diagnostic reasoning,
interpretation of investigations, treatment selection, preventive care, ethics, and evidence-based
decision-making. Scenario-based questions emphasize application of knowledge to realistic
patient presentations rather than simple recall. The Practice Questions are designed to help
learners identify knowledge gaps, strengthen clinical reasoning, and prepare systematically using
a structured Study Guide approach. This resource is intended for educational Exam Prep,
Practice Test, and Certification Preparation purposes.
SECTION ONE: QUESTIONS 1–50
1. A 67-year-old man with hypertension, type 2 diabetes mellitus, and hyperlipidemia
presents for routine follow-up. He has no history of atherosclerotic cardiovascular
disease. His LDL cholesterol is 148 mg/dL despite dietary counseling. Which
intervention is most appropriate to reduce his cardiovascular risk?
A. Begin low-dose aspirin therapy
B. Start a high-intensity statin
C. Begin niacin therapy
D. Start a fibrate
Correct Answer: B. Start a high-intensity statin
Rationale:
Patients with diabetes who are at increased cardiovascular risk benefit from statin therapy, and
,a high-intensity statin is appropriate when substantial LDL reduction is indicated. Aspirin is not
routinely recommended for primary prevention in all older adults because bleeding risk must be
considered.
2. A 54-year-old woman presents with episodic substernal chest pressure occurring with
exertion and resolving within 5 minutes of rest. Her ECG at rest is normal. Which
description best characterizes her symptoms?
A. Noncardiac chest pain
B. Atypical angina
C. Acute coronary syndrome
D. Typical stable angina
Correct Answer: D. Typical stable angina
Rationale:
Typical angina is characterized by substernal discomfort, provocation by exertion or emotional
stress, and relief with rest or nitroglycerin. This patient's predictable exertional symptoms meet
all three criteria.
3. A 72-year-old woman with atrial fibrillation has hypertension, diabetes, and a prior
ischemic stroke. Which therapy is most appropriate for long-term stroke prevention?
A. Oral anticoagulation
B. Aspirin alone
C. Clopidogrel alone
D. No antithrombotic therapy
Correct Answer: A. Oral anticoagulation
Rationale:
This patient has multiple major stroke-risk factors, including prior stroke, hypertension,
diabetes, age, and female sex. Oral anticoagulation provides substantially better stroke
prevention than antiplatelet therapy in atrial fibrillation.
4. A 63-year-old man presents with sudden-onset dyspnea and pleuritic chest pain 5 days
after knee replacement surgery. His heart rate is 118/min and oxygen saturation is 89%
on room air. Which diagnosis should be strongly suspected?
A. Acute pericarditis
B. Pneumonia
C. Pulmonary embolism
D. Stable angina
Correct Answer: C. Pulmonary embolism
,Rationale:
Recent major orthopedic surgery, tachycardia, hypoxemia, sudden dyspnea, and pleuritic chest
pain strongly suggest acute pulmonary embolism. Recent surgery is a major venous
thromboembolism risk factor.
5. A 45-year-old woman has fatigue, weight gain, constipation, dry skin, and cold
intolerance. Laboratory testing shows an elevated TSH and low free T4. What is the most
likely diagnosis?
A. Secondary hypothyroidism
B. Euthyroid sick syndrome
C. Subclinical hypothyroidism
D. Primary hypothyroidism
Correct Answer: D. Primary hypothyroidism
Rationale:
Primary hypothyroidism results from thyroid gland dysfunction and is characterized by low free
T4 with an elevated TSH because the pituitary increases stimulation of an underactive thyroid
gland.
6. A 70-year-old man with COPD presents with worsening dyspnea, increased sputum
production, and increased sputum purulence. Which treatment is most appropriate in
addition to bronchodilator therapy?
A. Long-term oxygen therapy for all patients
B. Short course of systemic corticosteroids and appropriate antibiotics
C. Immediate lung transplantation
D. Chronic oral corticosteroid therapy
Correct Answer: B. Short course of systemic corticosteroids and appropriate antibiotics
Rationale:
An acute COPD exacerbation with increased dyspnea, sputum volume, and sputum purulence is
commonly treated with systemic corticosteroids and antibiotics when bacterial infection is
suspected. Chronic systemic corticosteroids are generally avoided because of adverse effects.
7. A 59-year-old man with cirrhosis presents with hematemesis and hypotension.
Esophageal variceal bleeding is suspected. Which medication should be initiated
promptly while definitive endoscopic therapy is arranged?
A. Omeprazole alone
B. Propranolol alone
C. Lactulose
D. Octreotide
, Correct Answer: D. Octreotide
Rationale:
Octreotide reduces portal venous pressure and is used immediately in suspected acute variceal
hemorrhage. It should be combined with appropriate resuscitation, antibiotics, and urgent
endoscopic therapy.
8. A 34-year-old woman presents with dysuria and urinary frequency without fever, flank
pain, or vaginal symptoms. Urinalysis is positive for leukocyte esterase and nitrites.
Which diagnosis is most likely?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Nephrolithiasis
D. Interstitial cystitis
Correct Answer: A. Acute uncomplicated cystitis
Rationale:
Dysuria and urinary frequency without systemic symptoms or flank pain are typical of
uncomplicated lower urinary tract infection. Nitrites and leukocyte esterase further support
bacterial cystitis.
9. A 61-year-old man with chronic kidney disease has a serum potassium level of 6.9
mEq/L and peaked T waves on ECG. Which intervention should be performed
immediately?
A. Administer sodium polystyrene sulfonate alone
B. Begin oral potassium restriction
C. Administer intravenous calcium
D. Start a loop diuretic only
Correct Answer: C. Administer intravenous calcium
Rationale:
Severe hyperkalemia with ECG changes is a medical emergency. Intravenous calcium stabilizes
the cardiac membrane and reduces the immediate risk of fatal arrhythmia, although it does not
lower serum potassium.
10. A 29-year-old woman presents with fever, headache, neck stiffness, and photophobia.
Bacterial meningitis is suspected. Which action is most appropriate?
A. Wait for lumbar puncture results before treatment
B. Begin empiric intravenous antibiotics promptly
C. Treat with oral antibiotics
D. Observe without treatment until cultures are available
