ABIM INTERNAL MEDICINE BOARDS & ITE EXAM
– UNIQUE PRACTICE QUESTIONS (SET 7)
ABOUT THIS STUDY SET
This is the seventh set of unique practice questions for the ABIM Internal
Medicine Boards & In-Training Exam (ITE) . These questions
are completely different from all previous sets and are organized by the
ABIM exam blueprint content categories.
Content Area Approximate Weight
Cardiovascular Disease 14%
Pulmonary & Critical Care 9%
Gastroenterology & Hepatology 9%
Infectious Disease 9%
Endocrinology & Metabolism 9%
Hematology & Oncology 9%
Rheumatology & Immunology 8%
Nephrology & Urology 8%
,Content Area Approximate Weight
Neurology 5%
Other (Dermatology, Geriatrics, Ethics, etc.) 20%
SECTION 1: CARDIOVASCULAR DISEASE (Questions 1–
28)
Question 1: A 62-year-old man with a history of hypertension presents
with progressive dyspnea on exertion and orthopnea. Echocardiogram
shows left ventricular hypertrophy with an ejection fraction of 60% and
evidence of diastolic dysfunction. Which of the following is the most
appropriate initial therapy?
A) Digoxin
B) Spironolactone
C) Loop diuretic
D) ACE inhibitor
Correct Answer: C) Loop diuretic
Rationale: This patient has heart failure with preserved ejection fraction
(HFpEF) with signs of volume overload. Loop diuretics are first-line for
symptom management in HFpEF. ACE inhibitors (D) may be used but are not
the initial therapy for acute symptom management. Digoxin (A) is not
indicated in HFpEF. Spironolactone (B) may be considered for long-term
management but is not first-line for acute symptoms.
,Question 2: A 55-year-old woman presents with palpitations and
lightheadedness. ECG shows a regular, narrow-complex tachycardia at 190
bpm. She is hemodynamically stable. Carotid sinus massage fails to
terminate the rhythm. What is the most appropriate next step?
A) Adenosine 6 mg IV push
B) Verapamil 5 mg IV
C) Metoprolol 5 mg IV
D) Amiodarone 150 mg IV
Correct Answer: A) Adenosine 6 mg IV push
Rationale: Adenosine is the first-line agent for stable, regular, narrow-
complex SVT. It is administered as a rapid IV push (6 mg followed by 12 mg if
needed). Verapamil (B) and metoprolol (C) are second-line agents.
Amiodarone (D) is not first-line for SVT.
Question 3: A 68-year-old man with a history of hypertension and diabetes
presents with a BP of 165/95 mmHg. He is on lisinopril 20 mg daily and
hydrochlorothiazide 25 mg daily. Creatinine is 1.3 mg/dL. What is the most
appropriate next step?
A) Increase lisinopril to 40 mg
B) Add amlodipine
C) Add spironolactone
D) Switch to an ARB
Correct Answer: B) Add amlodipine
Rationale: The patient is on two antihypertensives (ACE inhibitor and
thiazide) and is not at goal. The next step is to add a calcium channel blocker
such as amlodipine. Increasing lisinopril (A) beyond 20 mg may be
, considered but adding a third agent is preferred. Spironolactone (C) is not
first-line for hypertension without heart failure. Switching to an ARB (D) is
not likely to provide additional benefit.
Question 4: A 70-year-old man presents with sudden onset of severe chest
pain radiating to the back. His blood pressure is 180/100 mmHg in the right
arm and 130/80 mmHg in the left arm. Which imaging study is most
appropriate for diagnosis?
A) Chest X-ray
B) CT angiography of the chest
C) Echocardiography
D) ECG
Correct Answer: B) CT angiography of the chest
Rationale: CT angiography of the chest is the imaging study of choice for
diagnosing aortic dissection. It can visualize the intimal flap and determine
the extent of the dissection. Chest X-ray (A) may show a widened
mediastinum but is not diagnostic. Echocardiography (C) may be useful but
CT is more definitive. ECG (D) is useful for MI but not for dissection.
Question 5: A 45-year-old woman presents with a new murmur.
Echocardiogram shows a bicuspid aortic valve with severe aortic stenosis
(peak velocity 4.5 m/s, mean gradient 50 mmHg). She is asymptomatic.
What is the most appropriate management?
A) Watchful waiting with annual echocardiograms
B) Aortic valve replacement
C) Medical therapy with beta-blockers
D) Balloon valvuloplasty
– UNIQUE PRACTICE QUESTIONS (SET 7)
ABOUT THIS STUDY SET
This is the seventh set of unique practice questions for the ABIM Internal
Medicine Boards & In-Training Exam (ITE) . These questions
are completely different from all previous sets and are organized by the
ABIM exam blueprint content categories.
Content Area Approximate Weight
Cardiovascular Disease 14%
Pulmonary & Critical Care 9%
Gastroenterology & Hepatology 9%
Infectious Disease 9%
Endocrinology & Metabolism 9%
Hematology & Oncology 9%
Rheumatology & Immunology 8%
Nephrology & Urology 8%
,Content Area Approximate Weight
Neurology 5%
Other (Dermatology, Geriatrics, Ethics, etc.) 20%
SECTION 1: CARDIOVASCULAR DISEASE (Questions 1–
28)
Question 1: A 62-year-old man with a history of hypertension presents
with progressive dyspnea on exertion and orthopnea. Echocardiogram
shows left ventricular hypertrophy with an ejection fraction of 60% and
evidence of diastolic dysfunction. Which of the following is the most
appropriate initial therapy?
A) Digoxin
B) Spironolactone
C) Loop diuretic
D) ACE inhibitor
Correct Answer: C) Loop diuretic
Rationale: This patient has heart failure with preserved ejection fraction
(HFpEF) with signs of volume overload. Loop diuretics are first-line for
symptom management in HFpEF. ACE inhibitors (D) may be used but are not
the initial therapy for acute symptom management. Digoxin (A) is not
indicated in HFpEF. Spironolactone (B) may be considered for long-term
management but is not first-line for acute symptoms.
,Question 2: A 55-year-old woman presents with palpitations and
lightheadedness. ECG shows a regular, narrow-complex tachycardia at 190
bpm. She is hemodynamically stable. Carotid sinus massage fails to
terminate the rhythm. What is the most appropriate next step?
A) Adenosine 6 mg IV push
B) Verapamil 5 mg IV
C) Metoprolol 5 mg IV
D) Amiodarone 150 mg IV
Correct Answer: A) Adenosine 6 mg IV push
Rationale: Adenosine is the first-line agent for stable, regular, narrow-
complex SVT. It is administered as a rapid IV push (6 mg followed by 12 mg if
needed). Verapamil (B) and metoprolol (C) are second-line agents.
Amiodarone (D) is not first-line for SVT.
Question 3: A 68-year-old man with a history of hypertension and diabetes
presents with a BP of 165/95 mmHg. He is on lisinopril 20 mg daily and
hydrochlorothiazide 25 mg daily. Creatinine is 1.3 mg/dL. What is the most
appropriate next step?
A) Increase lisinopril to 40 mg
B) Add amlodipine
C) Add spironolactone
D) Switch to an ARB
Correct Answer: B) Add amlodipine
Rationale: The patient is on two antihypertensives (ACE inhibitor and
thiazide) and is not at goal. The next step is to add a calcium channel blocker
such as amlodipine. Increasing lisinopril (A) beyond 20 mg may be
, considered but adding a third agent is preferred. Spironolactone (C) is not
first-line for hypertension without heart failure. Switching to an ARB (D) is
not likely to provide additional benefit.
Question 4: A 70-year-old man presents with sudden onset of severe chest
pain radiating to the back. His blood pressure is 180/100 mmHg in the right
arm and 130/80 mmHg in the left arm. Which imaging study is most
appropriate for diagnosis?
A) Chest X-ray
B) CT angiography of the chest
C) Echocardiography
D) ECG
Correct Answer: B) CT angiography of the chest
Rationale: CT angiography of the chest is the imaging study of choice for
diagnosing aortic dissection. It can visualize the intimal flap and determine
the extent of the dissection. Chest X-ray (A) may show a widened
mediastinum but is not diagnostic. Echocardiography (C) may be useful but
CT is more definitive. ECG (D) is useful for MI but not for dissection.
Question 5: A 45-year-old woman presents with a new murmur.
Echocardiogram shows a bicuspid aortic valve with severe aortic stenosis
(peak velocity 4.5 m/s, mean gradient 50 mmHg). She is asymptomatic.
What is the most appropriate management?
A) Watchful waiting with annual echocardiograms
B) Aortic valve replacement
C) Medical therapy with beta-blockers
D) Balloon valvuloplasty
