ABIM INTERNAL MEDICINE BOARDS & ITE
EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES JUST
RELEASED
Core Domains:
• Cardiovascular Disease (14% of exam) — Hypertension, Hyperlipidemia,
Acute Coronary Syndrome, Heart Failure, Atrial Fibrillation, Valvular Disease,
Syncope Evaluation
• Pulmonary Medicine — COPD, Asthma, Pneumonia, Pulmonary Embolism,
Interstitial Lung Disease, Lung Cancer Screening
• Endocrine and Metabolic Disorders — Diabetes Mellitus, Thyroid Disorders,
Adrenal Insufficiency, Osteoporosis, Lipid Disorders
• Gastroenterology and Hepatology — Peptic Ulcer Disease, GERD, Hepatitis,
Cirrhosis, Inflammatory Bowel Disease, Pancreatitis
• Infectious Diseases — Community-Acquired Pneumonia, Meningitis,
HIV/AIDS, Tuberculosis, Infective Endocarditis, UTIs
• Rheumatology and Immunology — Rheumatoid Arthritis, Systemic Lupus
Erythematosus, Vasculitis, Gout, Osteoarthritis
• Nephrology and Acid-Base — Acute Kidney Injury, Chronic Kidney Disease,
Glomerulonephritis, Electrolyte Disorders, Acid-Base Interpretation
• Hematology and Oncology — Anemias, Leukemias, Lymphomas, Multiple
Myeloma, Thrombocytopenia, Coagulopathies
• Neurology — Stroke, Seizures, Headache, Dementia, Parkinson's Disease,
Multiple Sclerosis, Neuropathy
, • Preventive Medicine and Screening — Cancer Screening, Immunizations,
Osteoporosis Screening, Smoking Cessation
Introduction:
This comprehensive examination preparation resource is meticulously designed for
physicians and residents preparing for the American Board of Internal Medicine
(ABIM) Internal Medicine Certification Examination and the Internal Medicine In-
Training Examination (ITE). The assessment mirrors the official ABIM exam
blueprint, testing candidates on the broad clinical knowledge, diagnostic
reasoning, evidence-based management, preventive care, and patient-
management skills required for success. Each question is structured as a clinical
vignette followed by multiple-choice answers, reflecting the format of the actual
board examination. Detailed rationales are provided for each answer, explaining
the underlying pathophysiology, evidence-based guidelines, and clinical reasoning
that support the correct choice. The questions cover all major internal medicine
domains, with emphasis on high-yield topics frequently tested on the ABIM
boards. This resource is designed for self-assessment, identification of knowledge
gaps, and reinforcement of core concepts essential for board certification and in-
training examination success.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old man with hypertension and diabetes presents with exertional
dyspnea. Echocardiography reveals concentric left ventricular hypertrophy,
normal ejection fraction, and impaired relaxation. BNP is mildly elevated. Which
finding most strongly supports the diagnosis of heart failure with preserved
ejection fraction (HFpEF)?
A. Reduced left ventricular end-diastolic volume
B. Elevated pulmonary capillary wedge pressure during exercise
C. QRS prolongation on ECG
D. Reduced stroke volume at rest
E. Global hypokinesis on echocardiography
, B
RATIONALE: HFpEF is characterized by normal systolic function (EF ≥ 50%) but
impaired diastolic filling, leading to elevated filling pressures. Hemodynamic
testing often reveals elevated pulmonary capillary wedge pressure during
exertion, even when resting pressures are normal. This distinguishes HFpEF from
other causes of dyspnea and confirms the diagnosis when clinical suspicion is
high. Concentric LV hypertrophy is a common finding in HFpEF but is not
diagnostic alone.
2. A 62-year-old man presents with exertional chest pain relieved by rest. ECG
shows ST depression in leads V4-V6. What is the next best step in management?
A. Coronary angiography
B. Start nitrates, beta-blocker, and aspirin
C. Schedule a stress echocardiogram
D. Immediate thrombolysis
B
RATIONALE: Stable angina is characterized by predictable exertional chest pain
relieved by rest or nitroglycerin. Initial management includes antianginal therapy
(nitrates, beta-blockers), risk factor modification, and aspirin. Coronary
angiography is indicated only if symptoms persist despite medical therapy or if
there is high-risk features on noninvasive testing.
3. A 72-year-old woman presents with syncope. ECG shows sinus rhythm with
intermittent dropped QRS complexes without PR prolongation. Which
conduction abnormality is most likely?
A. First-degree AV block
B. Mobitz I (Wenckebach)
C. Mobitz II AV block
D. Complete heart block
E. Sinus arrest
C
, RATIONALE: Mobitz II AV block (Type II second-degree AV block) is
characterized by intermittent non-conducted P waves without progressive PR
prolongation. Unlike Mobitz I (Wenckebach), where the PR interval progressively
lengthens before a dropped beat, Mobitz II has a fixed PR interval. This pattern
carries a high risk of progression to complete heart block and often causes
syncope, requiring pacemaker placement.
4. A 55-year-old woman with type 2 diabetes presents with painful burning in
her feet. Examination shows decreased vibration sense. What is the most
appropriate first-line treatment?
A. Gabapentin
B. Amitriptyline
C. Duloxetine
D. Capsaicin cream
C
RATIONALE: Diabetic peripheral neuropathy is best managed with duloxetine
or pregabalin as first-line agents. Duloxetine, a serotonin-norepinephrine reuptake
inhibitor (SNRI), provides both analgesic and antidepressant benefits. Tricyclic
antidepressants like amitriptyline are effective but have more side effects,
particularly in older adults. Gabapentin is also effective but is typically considered
after SNRIs or in combination therapy.
5. A 55-year-old man with a history of an anterior wall MI presents with
progressive dyspnea. Echocardiography reveals an ejection fraction of 25% with
anteroapical akinesis. In addition to ACE inhibitor and beta-blocker therapy,
which medication has been shown to reduce mortality in this population?
A. Digoxin
B. Spironolactone
C. Amiodarone
D. Diltiazem
E. Hydralazine
EXAM QUESTIONS AND VERIFIED
ANSWERS WITH RATIONALES JUST
RELEASED
Core Domains:
• Cardiovascular Disease (14% of exam) — Hypertension, Hyperlipidemia,
Acute Coronary Syndrome, Heart Failure, Atrial Fibrillation, Valvular Disease,
Syncope Evaluation
• Pulmonary Medicine — COPD, Asthma, Pneumonia, Pulmonary Embolism,
Interstitial Lung Disease, Lung Cancer Screening
• Endocrine and Metabolic Disorders — Diabetes Mellitus, Thyroid Disorders,
Adrenal Insufficiency, Osteoporosis, Lipid Disorders
• Gastroenterology and Hepatology — Peptic Ulcer Disease, GERD, Hepatitis,
Cirrhosis, Inflammatory Bowel Disease, Pancreatitis
• Infectious Diseases — Community-Acquired Pneumonia, Meningitis,
HIV/AIDS, Tuberculosis, Infective Endocarditis, UTIs
• Rheumatology and Immunology — Rheumatoid Arthritis, Systemic Lupus
Erythematosus, Vasculitis, Gout, Osteoarthritis
• Nephrology and Acid-Base — Acute Kidney Injury, Chronic Kidney Disease,
Glomerulonephritis, Electrolyte Disorders, Acid-Base Interpretation
• Hematology and Oncology — Anemias, Leukemias, Lymphomas, Multiple
Myeloma, Thrombocytopenia, Coagulopathies
• Neurology — Stroke, Seizures, Headache, Dementia, Parkinson's Disease,
Multiple Sclerosis, Neuropathy
, • Preventive Medicine and Screening — Cancer Screening, Immunizations,
Osteoporosis Screening, Smoking Cessation
Introduction:
This comprehensive examination preparation resource is meticulously designed for
physicians and residents preparing for the American Board of Internal Medicine
(ABIM) Internal Medicine Certification Examination and the Internal Medicine In-
Training Examination (ITE). The assessment mirrors the official ABIM exam
blueprint, testing candidates on the broad clinical knowledge, diagnostic
reasoning, evidence-based management, preventive care, and patient-
management skills required for success. Each question is structured as a clinical
vignette followed by multiple-choice answers, reflecting the format of the actual
board examination. Detailed rationales are provided for each answer, explaining
the underlying pathophysiology, evidence-based guidelines, and clinical reasoning
that support the correct choice. The questions cover all major internal medicine
domains, with emphasis on high-yield topics frequently tested on the ABIM
boards. This resource is designed for self-assessment, identification of knowledge
gaps, and reinforcement of core concepts essential for board certification and in-
training examination success.
SECTION ONE: QUESTIONS 1–100
1. A 68-year-old man with hypertension and diabetes presents with exertional
dyspnea. Echocardiography reveals concentric left ventricular hypertrophy,
normal ejection fraction, and impaired relaxation. BNP is mildly elevated. Which
finding most strongly supports the diagnosis of heart failure with preserved
ejection fraction (HFpEF)?
A. Reduced left ventricular end-diastolic volume
B. Elevated pulmonary capillary wedge pressure during exercise
C. QRS prolongation on ECG
D. Reduced stroke volume at rest
E. Global hypokinesis on echocardiography
, B
RATIONALE: HFpEF is characterized by normal systolic function (EF ≥ 50%) but
impaired diastolic filling, leading to elevated filling pressures. Hemodynamic
testing often reveals elevated pulmonary capillary wedge pressure during
exertion, even when resting pressures are normal. This distinguishes HFpEF from
other causes of dyspnea and confirms the diagnosis when clinical suspicion is
high. Concentric LV hypertrophy is a common finding in HFpEF but is not
diagnostic alone.
2. A 62-year-old man presents with exertional chest pain relieved by rest. ECG
shows ST depression in leads V4-V6. What is the next best step in management?
A. Coronary angiography
B. Start nitrates, beta-blocker, and aspirin
C. Schedule a stress echocardiogram
D. Immediate thrombolysis
B
RATIONALE: Stable angina is characterized by predictable exertional chest pain
relieved by rest or nitroglycerin. Initial management includes antianginal therapy
(nitrates, beta-blockers), risk factor modification, and aspirin. Coronary
angiography is indicated only if symptoms persist despite medical therapy or if
there is high-risk features on noninvasive testing.
3. A 72-year-old woman presents with syncope. ECG shows sinus rhythm with
intermittent dropped QRS complexes without PR prolongation. Which
conduction abnormality is most likely?
A. First-degree AV block
B. Mobitz I (Wenckebach)
C. Mobitz II AV block
D. Complete heart block
E. Sinus arrest
C
, RATIONALE: Mobitz II AV block (Type II second-degree AV block) is
characterized by intermittent non-conducted P waves without progressive PR
prolongation. Unlike Mobitz I (Wenckebach), where the PR interval progressively
lengthens before a dropped beat, Mobitz II has a fixed PR interval. This pattern
carries a high risk of progression to complete heart block and often causes
syncope, requiring pacemaker placement.
4. A 55-year-old woman with type 2 diabetes presents with painful burning in
her feet. Examination shows decreased vibration sense. What is the most
appropriate first-line treatment?
A. Gabapentin
B. Amitriptyline
C. Duloxetine
D. Capsaicin cream
C
RATIONALE: Diabetic peripheral neuropathy is best managed with duloxetine
or pregabalin as first-line agents. Duloxetine, a serotonin-norepinephrine reuptake
inhibitor (SNRI), provides both analgesic and antidepressant benefits. Tricyclic
antidepressants like amitriptyline are effective but have more side effects,
particularly in older adults. Gabapentin is also effective but is typically considered
after SNRIs or in combination therapy.
5. A 55-year-old man with a history of an anterior wall MI presents with
progressive dyspnea. Echocardiography reveals an ejection fraction of 25% with
anteroapical akinesis. In addition to ACE inhibitor and beta-blocker therapy,
which medication has been shown to reduce mortality in this population?
A. Digoxin
B. Spironolactone
C. Amiodarone
D. Diltiazem
E. Hydralazine
