ABIM EXAM STUDY GUIDE | INTERNAL
MEDICINE BOARD REVIEW, PRACTICE
QUESTIONS & CERTIFICATION PREP 2026/2027
250 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
ABIM EXAM STUDY GUIDE | INTERNAL MEDICINE BOARD REVIEW, PRACTICE QUESTIONS &
CERTIFICATION PREP 2026/2027. It contains 250 carefully selected questions that reflect the most current
exam content and testing strategies. Each question is accompanied by a correct answer and a detailed rationale
that explains the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 250 Questions
Foundations - Application - ABIM Study Guide Internal Medicine Board Review & Certification PREP
2026/2027 Internal Medicine Graduate
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
ABIM Study Guide Internal 1-42 Appropriate, Kidney, Urine, Develops, History
Medicine Board Review &
Certification PREP 2026/2027
Internal Medicine Graduate
Acute 43-84 Appropriate, Presents, History, Chronic, Kidney
Kidney 85-126 Appropriate, Develops, Disease, Presents, Acute
Presents 127-168 Appropriate, Therapy, Acute, Kidney, Likely
Disease 169-210 Appropriate, Management, Acute, Presents, Calcium
Develops 211-250 Appropriate, Acute, Therapy, NEXT STEP, Kidney
TOTAL 250 All questions include answers and detailed rationales
,Section A - ABIM Study Guide Internal Medicine Board
Review & Certification PREP 2026/2027 Internal Medicine
Graduate
Q1.
A patient with recurrent calcium oxalate kidney stones has a 24-hour urine collection
showing hypercalciuria (350 mg/day) and hyperoxaluria (60 mg/day). Which of the
following is the most appropriate initial pharmacologic intervention?
A. Thiazide diuretic B. Allopurinol
C. Potassium citrate D. Low-dose prednisone
Correct: A - Thiazide diuretic
Rationale:Thiazide diuretics reduce urinary calcium excretion and are first-line for
hypercalciuric calcium stones. Allopurinol is for hyperuricosuria, potassium citrate for
hypocitraturia or uric acid stones, and prednisone is not indicated.
Q2.
Which of the following cardiac biomarkers is most useful for distinguishing acute
decompensated heart failure with preserved ejection fraction (HFpEF) from non-cardiac
causes of dyspnea in a patient with obesity and hypertension?
A. B-type natriuretic peptide (BNP) B. High-sensitivity troponin I
C. Soluble ST2 D. Galectin-3
Correct: A - B-type natriuretic peptide (BNP)
Rationale:BNP is elevated in heart failure, including HFpEF, and is guideline-recommended
for differentiating cardiac from non-cardiac dyspnea. Troponin indicates myocardial injury, not
specific for HF, while ST2 and galectin-3 are prognostic markers, not diagnostic.
Q3.
A patient on long-term omeprazole for GERD is found to have iron deficiency anemia and
a positive fecal occult blood test. Which of the following is the most likely mechanism for
the anemia?
A. Reduced gastric acid leading to B. Chronic blood loss from gastric erosions
decreased iron absorption
C. Vitamin B12 deficiency causing D. Autoimmune gastritis secondary to proton
ineffective erythropoiesis pump inhibitor use
Page 3
, Section A - ABIM Study Guide Internal Medicine Board Review & Certification PREP 2026/2027 Internal Medicine Graduate
Correct: A - Reduced gastric acid leading to decreased iron absorption
Rationale:PPIs reduce gastric acid, impairing the reduction of ferric to ferrous iron and
decreasing absorption. Chronic blood loss would be from an independent lesion, B12
deficiency causes megaloblastic anemia, and autoimmune gastritis is not caused by PPIs.
Q4.
A patient with type 2 diabetes and chronic kidney disease (eGFR 35 mL/min/1.73m²) has
persistent albuminuria (UACR 500 mg/g) despite maximal ACE inhibitor therapy. Which of
the following agents has been shown to reduce the risk of kidney failure and
cardiovascular events when added?
A. Finerenone B. Dapagliflozin
C. Liraglutide D. Empagliflozin
Correct: A - Finerenone
Rationale:Finerenone, a nonsteroidal MRA, reduces kidney and cardiovascular outcomes in
diabetic kidney disease. SGLT2 inhibitors (dapagliflozin/empagliflozin) are also beneficial but
are typically added earlier; liraglutide is a GLP-1 RA with cardiovascular but not
kidney-specific outcome data in this setting.
Q5.
Which of the following is the strongest predictor of progression to AIDS in a patient with
untreated HIV infection?
A. Baseline CD4 count B. Plasma HIV RNA level
C. Presence of HIV-associated nephropathy D. Co-infection with hepatitis C virus
Correct: A - Baseline CD4 count
Rationale:Baseline CD4 count is the strongest predictor of AIDS progression, with lower
counts correlating with higher risk. HIV RNA level is a predictor of progression but less strong
than CD4 count; nephropathy and hepatitis C co-infection are complications but not primary
predictors.
Q6.
A patient with acute myeloid leukemia undergoes induction chemotherapy and develops
febrile neutropenia. Which of the following empirical antibiotic regimens is most
appropriate?
A. Cefepime B. Ceftriaxone plus azithromycin
Page 4
MEDICINE BOARD REVIEW, PRACTICE
QUESTIONS & CERTIFICATION PREP 2026/2027
250 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
ABIM EXAM STUDY GUIDE | INTERNAL MEDICINE BOARD REVIEW, PRACTICE QUESTIONS &
CERTIFICATION PREP 2026/2027. It contains 250 carefully selected questions that reflect the most current
exam content and testing strategies. Each question is accompanied by a correct answer and a detailed rationale
that explains the underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 250 Questions
Foundations - Application - ABIM Study Guide Internal Medicine Board Review & Certification PREP
2026/2027 Internal Medicine Graduate
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
ABIM Study Guide Internal 1-42 Appropriate, Kidney, Urine, Develops, History
Medicine Board Review &
Certification PREP 2026/2027
Internal Medicine Graduate
Acute 43-84 Appropriate, Presents, History, Chronic, Kidney
Kidney 85-126 Appropriate, Develops, Disease, Presents, Acute
Presents 127-168 Appropriate, Therapy, Acute, Kidney, Likely
Disease 169-210 Appropriate, Management, Acute, Presents, Calcium
Develops 211-250 Appropriate, Acute, Therapy, NEXT STEP, Kidney
TOTAL 250 All questions include answers and detailed rationales
,Section A - ABIM Study Guide Internal Medicine Board
Review & Certification PREP 2026/2027 Internal Medicine
Graduate
Q1.
A patient with recurrent calcium oxalate kidney stones has a 24-hour urine collection
showing hypercalciuria (350 mg/day) and hyperoxaluria (60 mg/day). Which of the
following is the most appropriate initial pharmacologic intervention?
A. Thiazide diuretic B. Allopurinol
C. Potassium citrate D. Low-dose prednisone
Correct: A - Thiazide diuretic
Rationale:Thiazide diuretics reduce urinary calcium excretion and are first-line for
hypercalciuric calcium stones. Allopurinol is for hyperuricosuria, potassium citrate for
hypocitraturia or uric acid stones, and prednisone is not indicated.
Q2.
Which of the following cardiac biomarkers is most useful for distinguishing acute
decompensated heart failure with preserved ejection fraction (HFpEF) from non-cardiac
causes of dyspnea in a patient with obesity and hypertension?
A. B-type natriuretic peptide (BNP) B. High-sensitivity troponin I
C. Soluble ST2 D. Galectin-3
Correct: A - B-type natriuretic peptide (BNP)
Rationale:BNP is elevated in heart failure, including HFpEF, and is guideline-recommended
for differentiating cardiac from non-cardiac dyspnea. Troponin indicates myocardial injury, not
specific for HF, while ST2 and galectin-3 are prognostic markers, not diagnostic.
Q3.
A patient on long-term omeprazole for GERD is found to have iron deficiency anemia and
a positive fecal occult blood test. Which of the following is the most likely mechanism for
the anemia?
A. Reduced gastric acid leading to B. Chronic blood loss from gastric erosions
decreased iron absorption
C. Vitamin B12 deficiency causing D. Autoimmune gastritis secondary to proton
ineffective erythropoiesis pump inhibitor use
Page 3
, Section A - ABIM Study Guide Internal Medicine Board Review & Certification PREP 2026/2027 Internal Medicine Graduate
Correct: A - Reduced gastric acid leading to decreased iron absorption
Rationale:PPIs reduce gastric acid, impairing the reduction of ferric to ferrous iron and
decreasing absorption. Chronic blood loss would be from an independent lesion, B12
deficiency causes megaloblastic anemia, and autoimmune gastritis is not caused by PPIs.
Q4.
A patient with type 2 diabetes and chronic kidney disease (eGFR 35 mL/min/1.73m²) has
persistent albuminuria (UACR 500 mg/g) despite maximal ACE inhibitor therapy. Which of
the following agents has been shown to reduce the risk of kidney failure and
cardiovascular events when added?
A. Finerenone B. Dapagliflozin
C. Liraglutide D. Empagliflozin
Correct: A - Finerenone
Rationale:Finerenone, a nonsteroidal MRA, reduces kidney and cardiovascular outcomes in
diabetic kidney disease. SGLT2 inhibitors (dapagliflozin/empagliflozin) are also beneficial but
are typically added earlier; liraglutide is a GLP-1 RA with cardiovascular but not
kidney-specific outcome data in this setting.
Q5.
Which of the following is the strongest predictor of progression to AIDS in a patient with
untreated HIV infection?
A. Baseline CD4 count B. Plasma HIV RNA level
C. Presence of HIV-associated nephropathy D. Co-infection with hepatitis C virus
Correct: A - Baseline CD4 count
Rationale:Baseline CD4 count is the strongest predictor of AIDS progression, with lower
counts correlating with higher risk. HIV RNA level is a predictor of progression but less strong
than CD4 count; nephropathy and hepatitis C co-infection are complications but not primary
predictors.
Q6.
A patient with acute myeloid leukemia undergoes induction chemotherapy and develops
febrile neutropenia. Which of the following empirical antibiotic regimens is most
appropriate?
A. Cefepime B. Ceftriaxone plus azithromycin
Page 4
