Rapid Access Internal Medicine 2026:
The Ultimate High-Yield Board
Review –Evidence-Based Q&A with
Detailed Clinical Rationales,
Diagnostic Workups, and Guideline-
Driven Treatment Strategies for ABIM
Success and Ward Readiness
Cardiology
Q1. A 62-year-old man with a history of hypertension presents with
acute onset substernal chest pain. ECG shows ST-segment elevation in
leads V2-V4. What is the most appropriate immediate management?
A) Aspirin and beta-blockers
B) Aspirin, benzodiazepines, and nitrates
C) Aspirin and calcium-channel blockers
D) Benzodiazepines alone
E) Beta-blockers alone
Answer: A) Aspirin and beta-blockers
Rationale: This patient has an acute STEMI. Aspirin reduces mortality by
inhibiting platelet aggregation. Beta-blockers decrease myocardial oxygen
,demand and reduce infarct size. In patients with cocaine use,
benzodiazepines may be preferred, but the standard of care for STEMI
remains aspirin and beta-blockers .
Q2. A 72-year-old man presents with progressive dyspnea, orthopnea,
and lower extremity edema. He has a history of hypertension and
coronary artery disease. Echocardiogram shows an ejection fraction of
30%. Which medication class has been shown to reduce mortality in
this condition?
A) Calcium channel blockers
B) Digoxin
C) Beta-blockers
D) Nitrates
E) Thiazide diuretics
Answer: C) Beta-blockers
Rationale: This patient has heart failure with reduced ejection fraction
(HFrEF). Beta-blockers (carvedilol, bisoprolol, metoprolol succinate)
significantly reduce mortality and hospitalizations in HFrEF. Digoxin
improves symptoms but does not reduce mortality. Calcium channel
blockers are generally avoided in HFrEF.
Q3. A 55-year-old woman with a history of palpitations presents to the
emergency department. ECG shows atrial fibrillation with a ventricular
rate of 140 bpm. She is hemodynamically stable. What is the most
appropriate initial management?
, A) Immediate synchronized cardioversion
B) Rate control with a beta-blocker
C) IV amiodarone
D) Aspirin only
E) Digoxin loading
Answer: B) Rate control with a beta-blocker
Rationale: In hemodynamically stable patients with atrial fibrillation, rate
control (target <110 bpm) is preferred initially. Beta-blockers or calcium
channel blockers are first-line agents. Synchronized cardioversion is
indicated for unstable patients. Anticoagulation should be considered
based on CHA₂DS₂-VASc score.
Q4. A 48-year-old man with hypertension is found to have a blood
pressure of 155/95 mmHg despite treatment with lisinopril 20 mg
daily. He has no end-organ damage. Which of the following is the
most appropriate next step?
A) Add hydrochlorothiazide
B) Increase lisinopril to 40 mg
C) Add amlodipine
D) Switch to an ARB
E) Add a beta-blocker
Answer: A) Add hydrochlorothiazide
Rationale: For patients not at goal blood pressure on a single agent,
adding a second agent (especially a thiazide diuretic with an ACE inhibitor)
is more effective than increasing the dose of a single agent. The
combination provides synergistic effects.
, Q5. A 68-year-old woman presents with chest tightness upon exertion
that resolves with rest. Stress testing reveals reversible ischemia in the
inferolateral distribution. What is the most appropriate medical
therapy to reduce mortality?
A) Aspirin and statin
B) Aspirin and nitroglycerin
C) Calcium channel blockers
D) Ranexa
E) Aspirin, statin, and beta-blocker
Answer: E) Aspirin, statin, and beta-blocker
Rationale: In patients with stable angina and proven CAD, the combination
of aspirin (antiplatelet), statin (lipid-lowering, plaque stabilization), and
beta-blocker (reduces myocardial oxygen demand) has been shown to
reduce mortality and major adverse cardiac events.
Q6. A 52-year-old man with a history of hypertension and diabetes
presents with acute shortness of breath. He has crackles at both lung
bases, jugular venous distension, and an S3 gallop. What is the most
likely diagnosis?
A) COPD exacerbation
B) Acute pulmonary embolism
C) Acute decompensated heart failure
D) Pneumonia
E) Asthma exacerbation
The Ultimate High-Yield Board
Review –Evidence-Based Q&A with
Detailed Clinical Rationales,
Diagnostic Workups, and Guideline-
Driven Treatment Strategies for ABIM
Success and Ward Readiness
Cardiology
Q1. A 62-year-old man with a history of hypertension presents with
acute onset substernal chest pain. ECG shows ST-segment elevation in
leads V2-V4. What is the most appropriate immediate management?
A) Aspirin and beta-blockers
B) Aspirin, benzodiazepines, and nitrates
C) Aspirin and calcium-channel blockers
D) Benzodiazepines alone
E) Beta-blockers alone
Answer: A) Aspirin and beta-blockers
Rationale: This patient has an acute STEMI. Aspirin reduces mortality by
inhibiting platelet aggregation. Beta-blockers decrease myocardial oxygen
,demand and reduce infarct size. In patients with cocaine use,
benzodiazepines may be preferred, but the standard of care for STEMI
remains aspirin and beta-blockers .
Q2. A 72-year-old man presents with progressive dyspnea, orthopnea,
and lower extremity edema. He has a history of hypertension and
coronary artery disease. Echocardiogram shows an ejection fraction of
30%. Which medication class has been shown to reduce mortality in
this condition?
A) Calcium channel blockers
B) Digoxin
C) Beta-blockers
D) Nitrates
E) Thiazide diuretics
Answer: C) Beta-blockers
Rationale: This patient has heart failure with reduced ejection fraction
(HFrEF). Beta-blockers (carvedilol, bisoprolol, metoprolol succinate)
significantly reduce mortality and hospitalizations in HFrEF. Digoxin
improves symptoms but does not reduce mortality. Calcium channel
blockers are generally avoided in HFrEF.
Q3. A 55-year-old woman with a history of palpitations presents to the
emergency department. ECG shows atrial fibrillation with a ventricular
rate of 140 bpm. She is hemodynamically stable. What is the most
appropriate initial management?
, A) Immediate synchronized cardioversion
B) Rate control with a beta-blocker
C) IV amiodarone
D) Aspirin only
E) Digoxin loading
Answer: B) Rate control with a beta-blocker
Rationale: In hemodynamically stable patients with atrial fibrillation, rate
control (target <110 bpm) is preferred initially. Beta-blockers or calcium
channel blockers are first-line agents. Synchronized cardioversion is
indicated for unstable patients. Anticoagulation should be considered
based on CHA₂DS₂-VASc score.
Q4. A 48-year-old man with hypertension is found to have a blood
pressure of 155/95 mmHg despite treatment with lisinopril 20 mg
daily. He has no end-organ damage. Which of the following is the
most appropriate next step?
A) Add hydrochlorothiazide
B) Increase lisinopril to 40 mg
C) Add amlodipine
D) Switch to an ARB
E) Add a beta-blocker
Answer: A) Add hydrochlorothiazide
Rationale: For patients not at goal blood pressure on a single agent,
adding a second agent (especially a thiazide diuretic with an ACE inhibitor)
is more effective than increasing the dose of a single agent. The
combination provides synergistic effects.
, Q5. A 68-year-old woman presents with chest tightness upon exertion
that resolves with rest. Stress testing reveals reversible ischemia in the
inferolateral distribution. What is the most appropriate medical
therapy to reduce mortality?
A) Aspirin and statin
B) Aspirin and nitroglycerin
C) Calcium channel blockers
D) Ranexa
E) Aspirin, statin, and beta-blocker
Answer: E) Aspirin, statin, and beta-blocker
Rationale: In patients with stable angina and proven CAD, the combination
of aspirin (antiplatelet), statin (lipid-lowering, plaque stabilization), and
beta-blocker (reduces myocardial oxygen demand) has been shown to
reduce mortality and major adverse cardiac events.
Q6. A 52-year-old man with a history of hypertension and diabetes
presents with acute shortness of breath. He has crackles at both lung
bases, jugular venous distension, and an S3 gallop. What is the most
likely diagnosis?
A) COPD exacerbation
B) Acute pulmonary embolism
C) Acute decompensated heart failure
D) Pneumonia
E) Asthma exacerbation
